Early Telerehabilitation After Hospital Discharge From Acute Care in Geriatric Patients. A Randomized Study With Four, Eight Weeks and Six Months Follow-up
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 试验地点
- 4
- 主要终点
- Change in Instrumental Activities of Daily Living (IADL)
研究概览
简要总结
Background Older patients admitted to an Emergency Department (ED) are dependent on assistive devices and almost 16 % have no gait function. It seems appropriate to identify patients who need physical exercises immediately after discharge to avoid further functional decline. New IT technologies make it possible to both supervise the exercises and communicate with the patients via video conferencing equipment. Until now no studies have examined if the Otago Exercise Program (OEP) supervised by video conferencing may enhance motivation and maintain or improve physical functional capacity in acute elderly patients.
Hypothesis Early telerehabilitation performed in groups based on the OEP is compared with traditional exercise programs offered in the community centers in geriatric patients after hospital discharge from acute care.
The study is a randomized, controlled study conducted at Aarhus University Hospital (AUH). The population is elderly patients ≥65 years, residents in the Municipality of Aarhus and admitted acutely from there own home to the ED.
Telerehabilitation Group (TG) will start telerehabilitation first to second week after discharge. After the initial two training sessions, the patient will be included in a TG. When there is a group of two to three participants the group will stop including more members in that group in order to achieve the expected benefits of group exercising. It will be possible for physiotherapists to follow the team on the screen and to communicate with the participants. In addition, the participants may communicate with each other. The following four weeks the patients will exercise on their own in their training groups on appointed times via videoconferencing equipment.
The Control Group will receive the usual training offered by the municipality. Participants in both groups will be tested with the same instruments at baseline and after four and eight weeks and at six months.
Perspective If the presented project indicates that the older target group may benefit from telerehabilitation immediately after discharge, elderly patients may increase their Quality of Life and the municipalities may experience public savings.
Telerehabilitation may be a good alternative for patients who aren't able to receive training at the community center for physical reasons. Telerehabilitation may be one of the means to meet the challenge of the increasing proportion of elderly people in Denmark.
详细描述
Background The geriatric patient is often presented with a complex pathological picture, where gait- and balance disturbances are independent risk factors for fall accidents, which are common causes for admittance to hospital. One third of the medical patients discharged after an acute hospitalization experience a decrease in functional capacity following one year after. Impaired gait function also greatly influences the older persons' management of their everyday life e.g. transportation, shopping, meals, and domestic tasks. It may induce fear of falling and can lead to isolation and loneliness.
A hip fracture may have fatal consequences. Half of those who are affected of a hip fracture suffer from disabilities, and 15-25% dies within the first year after the trauma.
A program combining exercises of muscle strength, body balance and endurance can break a vicious spiral. Therefore, it seems appropriate to identify those patients who need physical exercises during their hospital stay and immediately after discharge to avoid further functional decline.
Exercise at home and improvement in the ability to undertake daily tasks are highly valued by community-dwelling people 60 years and older. Communication between the older person and the physiotherapist has positive effects on adherence to an exercise program and its outcome.
New Telerehabilitation Technologies make it possible for the physiotherapist to supervise and communicate with exercising participants by video conferencing equipment.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Single (Outcomes Assessor)
盲法说明
Participants in the two groups will be asked not to inform the test investigator to which intervention they have been allocated. Baseline test will be performed before randomization in the hospital ward or in the participants home. Before re-test the participants in the intervention groups will ensure that the computer used for exercise is not visible in the room where the re-test is done.
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •dependent on a walking aid at discharge
- •familiar with the use of computer
- •informed consent
排除标准
- •terminal illness
- •inability to walk independent with a walking aid
- •inability to speak or understand Danish
- •dementia i.e. Short Portable Mental Status Questionnaire (SPMSQ) score above 4
- •acute stroke
- •inability to complete the Otago Exercise Program without having a great risk of falling
结局指标
主要结局
Change in Instrumental Activities of Daily Living (IADL)
时间窗: Measured at baseline and after 4 and 8 weeks and after 6 months
IADL is measured by Functional Recovery Score (FRS). FRS is a questionnaire divided into three subjects such as Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL) and mobility (range 0-100 point).
次要结局
- Degree of loneliness(Measured at baseline and after 4 and 8 weeks and after 6 months)
- Mobility(Mobiliy measured by Active Pal is measured after 4 weeks and 6 month)
- Health-related quality of life and functional ability(Measured at baseline and after 4 and 8 weeks and after 6 months)
- Fear of falling(Measured at baseline and after 4 and 8 weeks and after 6 months)
- Balance and mobility(A functional test, which consists of 15 items and measures mobility among frail elderly who are lying in bed or sitting in a comfort chair and the elderly, who are independent in everyday life.)