Rehabilitation for the seriously ill elderly: models of care and quality indicators
The results of this project not only provide clinicians and policy-makers with knowledge on how to evaluate the impact and quality of rehabilitation services in long-term care (LTC), but also identifies the gaps in knowledge and identify areas for future research for rehabilitation for the seriously-ill elderly.
Findings: 331 articles were included in the scoping review. The majority of articles were from the United States (42.5%), with most not reporting the length of stay of included residents (66.8%). Very few articles included residents who were non-ambulatory, bedridden, or with evidence of cognitive impairment. The majority of interventions were delivered and evaluated at the person-level. Performance-based measures (i.e. timed-up and go), activities of daily living (ADLs) and mood were the most frequently reported outcomes. No validated models or tools for determining eligibility for PR services in LTC were included. There was limited evidence in the literature around which QIs could be used to evaluate PR in LTC, though activities of daily living were most frequently suggested. 14 stakeholders participated in the consensus meeting. ADLs and falls were identified as the most important QIs for evaluating PR in LTC, however the importance of measuring QIs in relation to each other (i.e. changes in ADLs relative to falls) and focusing on resident-centered outcomes such as quality of life and mood was emphasized.
Impact of findings: These results suggest that future research consider including all professions involved in delivering PR, length of stay or residents, appropriate inclusion and exclusion criteria to capture a realistic population. A future KT opportunity that may be pursued as a result of this study is working with industry partners (i.e. Osteoporosis Canada and Extendicare Canada) to develop and evaluate PR modules specific to the LTC setting focusing on rehab delivery for short- and long stay residents and those with significant functional and cognitive impairments that are targeted at educating the entire team about PR including all professionals – physical therapy, nursing, recreation, occupational therapy, etc.
Publications, presentations and webinars
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Policy Families Researchers
About the Project
Physiotherapy (PT) can maintain or restore function in LTC residents, yet a cost-effective model of delivery remains elusive. In 2013, there were funding cuts to rehabilitation in LTC in Ontario. Our recent environmental scan of LTC stakeholders revealed that access to individualized exercise and rehabilitation has been severely limited since the funding changes and replaced with generic group exercise programs that are not accessible for the seriously ill, frail elderly adults with complex needs. There were calls for guidance on evolving models of care in the face of budget shortages, and quality indicators (QIs) to help advocate for resources for the seriously ill elderly in LTC.
We proposed a scoping review to describe the types of rehabilitation interventions evaluated in LTC (e.g. therapeutic goals, frequency of services and mode of delivery), the outcomes (at the person-, facility- and system-level) used to evaluate the interventions and tools or models used to guide allocation of services. We then mapped the available evidence onto existing QIs and identify which new or existing QIs could be used to evaluate the impact of rehabilitation at the person, facility or system level.
For more details on the project rationale, objectives and research plan, click here.
Lora Giangregorio, PhD -- University of Waterloo
Katherine Berg, PhD, PT -- University of Toronto
John Hirdes, BSc, MA, PhD -- University of Waterloo
James Milligan, MD -- University of Waterloo Centre for Family Medicine
Alexandra Papaioannou, MD, MSc, FRCPC, PACP -- McMaster University
Knowledge Users and Partners:
Ravi Jain, MHSc, MA, BComm(Hons.) -- Osteoporosis Canada
Jaimie Killingbeck, BSc, RKin -- Schlegel Villages
Carol Miller, DipPT, BA, BAA -- Canadian Physiotherapy Association
Paula Neves, Vice President (Quality and Healthcare Innovation) -- Extendicare
Michael Sharratt, PhD -- Schlegel Research Institute for Aging, University of Waterloo
Project Contact: Lora Giangregorio -- firstname.lastname@example.org
Key words: physical rehabilitation; elderly; quality indicators; long-term care