Effects of a physiotherapy and occupational therapy intervention on mobility and activity in care home residents: a cluster randomised controlled trial

Sackley, C; van den Berg, M; Lett, K; Patel, S; Hollands, K; Wright, C; Hoppitt, T

Abstract

Abstract: objective To compare the clinical effectiveness of a programme of physiotherapy and occupational therapy
with standard care in care home residents who have
mobility limitations and are dependent in performing
activities of daily living. Design Cluster randomised controlled trial, with random allocation at the level of care home. Setting Care homes within the NHS South Birmingham primary care trust and the NHS Birmingham East and North primary care trust that had more than five beds and provided for people in the care categories “physical
disability” and “older people”. Participants Care home residents with mobility limitations, limitations in activities of daily living (as screened by the Barthel index), and not receiving end of life care were eligible to take part in the study.
Intervention: a targeted three month occupational therapy
and physiotherapy programme.
Main outcome measures: scores on the Barthel index and
the Rivermead mobility index.
Results: 24 of 77 nursing and residential homes that
catered for residents with mobility limitations and
dependency for activities of daily living were selected for
study: 12 were randomly allocated to the intervention arm
(128 residents, mean age 86 years) and 12 to the control
arm (121 residents, mean age 84 years). Participants
were evaluated by independent assessors blind to study
arm allocation before randomisation (0 months), three
months after randomisation (at the end of the treatment
period for patients who received the intervention), and
again at six months after randomisation. After adjusting
for home effect and baseline characteristics, no significant differences were found in mean Barthel index
scores at six months post-randomisation between treatment arms (mean effect 0.08, 95% confidence interval −1.14 to 1.30; P=0.90), across assessments (−0.01, −0.63 to 0.60; P=0.96), or in the interaction between assessment and intervention (0.42, −0.48 to 1.32; P=0.36). Similarly, no significant differences were found in the mean Rivermead mobility index scores between treatment arms (0.62, −0.51 to 1.76; P=0.28), across assessments (−0.15, −0.65 to 0.35; P=0.55), or interaction (0.71, −0.02 to 1.44; P=0.06).
Conclusions: the three month occupational therapy and
physiotherapy programme had no significant effect on
mobility and independence. On the other hand, the variation in residents’ functional ability, the prevalence of cognitive impairment, and the prevalence of depression
were considerably higher in this sample than expected on
the basis of previous work. Further research to clarify the
efficacy of occupational therapy and physiotherapy is
required if access to therapy services is to be
recommended in this population.

Citation

Sackley, C., van den Berg, M., Lett, K., Patel, S., Hollands, K., Wright, C., & Hoppitt, T. (2009). Effects of a physiotherapy and occupational therapy intervention on mobility and activity in care home residents: a cluster randomised controlled trial. BMJ, 339, 670-685. https://doi.org/10.1136/bmj.b3123

• Journal Article Type: Article
• Publication Date: Sep 1, 2009
• Deposit Date: Jun 8, 2011
• Publicly Available Date: Apr 5, 2016
• Journal: British Medical Journal (BMJ)
• Print ISSN: 0959-8138
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 339
• Pages: 670-685
• DOI: https://doi.org/10.1136/bmj.b3123
• Publisher URL: http://dx.doi.org/10.1136/bmj.b3123