Randomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation.
Postacute care unit of a skilled nursing facility in St Louis, MO.
Twenty-six older adults admitted from a hospital for postacute rehabilitation.
Based on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists that increase patient engagement and intensity, with the goal of improving functional outcome, through (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress.
Therapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and 6-minute walk.
Participants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 in standard of care, P?= .003) and 6-minute walk (from 73 to 266 feet versus 40 to 94 feet in standard of care, P?= .026), with a trend for better improvement of Barthel Index (+43 points versus 26 points in standard of care, P?= .087), compared with participants randomized to standard-of-care rehabilitation.
Higher intensity and patient engagement in the postacute rehabilitation setting is achievable, with resultant better functional outcomes for older adults. Findings should be confirmed in a larger randomized controlled trial.