Institut Régional de Formation aux Métiers de Rééducation et de Réadaptation des Pays de la Loire.
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Auteur Jason R. Falvey
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Impaired Physical Performance Predicts Hospitalization Risk for Participants in the Program of All-Inclusive Care for the Elderly / Jason R. Falvey in Physical Therapy, Vol. 99 n° 1 (January 2019)
[article] Impaired Physical Performance Predicts Hospitalization Risk for Participants in the Program of All-Inclusive Care for the Elderly [texte imprimé] / Jason R. Falvey, Auteur ; Robert E. Burke, Auteur ; Cari R. Levy, Auteur . - 2019 . - p. 28-36.
Langues : Français (fre)
in Physical Therapy > Vol. 99 n° 1 (January 2019) . - p. 28-36
Catégories : DÉMOGRAPHIE
Résumé : Background: Medicaid spending on the Program of All-Inclusive Care for the Elderly (PACE) has grown rapidly over the last 5 years. Reducing hospitalization rates is a major goal for PACE. However, there is a paucity of research evaluating the relationship between impaired physical performance and hospitalizations in PACE.
Objective: This study tested whether physical therapistassessed physical performance, measured by the Short Physical Performance Battery (SPPB), can be used to identify participants in PACE at risk for all-cause hospitalizations or potentially avoidable hospitalizations (PAH).
Design: This was a retrospective cohort study of 1093 participants in PACE facilities in the Denver, Colorado, area.
Methods: Data were acquired from linked electronic medical record data and hospitalization claims. Unadjusted and adjusted Cox proportional hazards regression models were used to evaluate the relationship between SPPB scores and the probabilities of both all-cause hospitalizations and PAH.
Results: The unadjusted likelihood of hospitalization increased with greater physical performance impairment (for SPPB scores ≥8/12: 12.2%; for SPPB scores of 4/12 to 7/12: 15.7%; for SPPB scores Limitations: The use of data from a single network of PACE facilities might limit generalizability to states with different Medicaid guidelines.
Conclusions: The findings suggest that impaired physical performance is an independent risk factor for hospitalization among participants in PACE. These findings could help guide the development of PACE program modifications for measuring and intervening on impairments in physical function.
En ligne : https://academic.oup.com/ptj Permalink : [article]Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Acute Hospitalization: Randomized Clinical Trial Protocol / Jason R. Falvey in Physical Therapy, Vol. 99 n° 9 (September 2019)
[article] Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Acute Hospitalization: Randomized Clinical Trial Protocol [texte imprimé] / Jason R. Falvey, Auteur ; Kathleen C. Mangione, Auteur ; Amy Nordon-Craft, Auteur . - 2019 . - p. 1141-1149.
Langues : Français (fre)
in Physical Therapy > Vol. 99 n° 9 (September 2019) . - p. 1141-1149
Catégories : DÉMOGRAPHIE
RandomisationUtilisation du hasard dans la constitution d'un échantillon pour une étude ou une enquête.
Résumé : Background: Hospitalization is a profound contributor to functional loss for older adults. Many modifiable risk factors (ie, weakness) may persist after hospitalization, representing portents of poor health, re-hospitalization, or death. Older adults frequently receive home health (HH) care after hospitalization to manage functional deficits that have worsened during hospital stays. However, how best to manage these deficits in HH settings has yet to be determined.
Objective: The objective is to determine if a higher intensity, progressive, multi-component (PMC) intervention, initiated upon admission to HH after an acute hospitalization, improves objectively measured and self-reported physical function more than usual care (UC) physical therapy.
Design: This will be a 2-arm randomized controlled clinical trial.
Setting: The setting will be participant homes.
Participants: A total of 200 older adults with deconditioning following acute hospitalization and referred for HH physical therapy will participate.
Intervention: Participants will be randomized to either a PMC treatment group or a UC group and receive 12 therapy visits over a 60-day period. PMC participants will perform lower extremity resistance training at 80% of a 1-repetition maximum, task-specific activities of daily living training, along with advanced gait and balance training. PMC groups will also receive nutritional supplementation and nursing support during transition from hospital to home. The UC group will receive standard of care HH interventions.
Measurements: Physical performance, self-reported function, fatigue, and health care utilization outcomes will be measured at baseline, 30 days, 60 days, 90 days, and 180 days. All measures will be assessed by blinded study personnel.
Limitations: The limitation is an inability to blind treating therapists to study allocation.
Conclusions: The authors hope to determine whether higher intensity, multi-component exercise interventions improve outcomes more than UC physical therapy for older adults recovering from acute hospitalization in HH settings.
En ligne : https://academic.oup.com/ptj Permalink : [article]