Efficacy of functional retraining vs geriatric rehabilitation programs for deconditioned elderly patients

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Efficacy of functional retraining vs geriatric rehabilitation programs for deconditioned elderly patients


Author: Wong, Mei-yuk
Title: Efficacy of functional retraining vs geriatric rehabilitation programs for deconditioned elderly patients
Degree: M.Sc.
Year: 1999
Subject: Older people -- Rehabilitation
Occupational retraining
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: xi, 176 leaves : ill. ; 31 cm
Language: English
OneSearch: https://www.lib.polyu.edu.hk/bib/b1477359
URI: http://theses.lib.polyu.edu.hk/handle/200/1951
Abstract: In rehabilitation hospitals, the majority of geriatric patients suffer from acute medical conditions resulting in functional problems as a consequence extended periods of bed rest. This process is often recognized as deconditioning. Rehabilitation aiming to restore the lost function is often provided for these deconditioned geriatric patients in convalescent hospitals once their acute medical condition has been stabilized. The purpose of this study, in a randomized controlled trial design, is to investigate whether intervention aimed only at functional limitation (Functional Retraining; FR) was more or less effective than an intervention that tackled both impairment and functional limitation (Geriatric Rehabilitation Program; GRP) to improve the functional and physical performance of the deconditioned geriatric patients. The content of the two programs shared the same base of functional retraining, except for the addition of progressive resistance training, endurance training and motor-skills training to the GRP. The GRP program acted as the control for the FR program. Some 31 patients were recruited to the study over the period of one year and were randomized into the FR or GRP group. A total of only 25 patients completed either program, 12 in the FR group and 13 in the GRP. The functional ability of the patients was reflected by The Functional Independence Measure (FIM) motor subscale score measured by the occupational therapist. The strength of biceps and quadriceps were measured to reflect the improvement in muscle strength at impairment level outcomes. The six-minute distance-walking test was chosen to reflect the cardiorespiratory function of patients. The measurements of muscle strength and six-minute distance-walking tests were taken by the physiotherapists in the research team. Baseline assessments showed no significant differences between the two intervention groups, and they were comparable at the start of the programs. Results on two-way repeated measure analysis of variance (ANOVA) indicated significant improvements (F =9.05 to 40.78, 0.00<=p<=0.01) in patients performance on all assessments in both intervention groups before and after intervention. Two-way repeated measure ANOVA was also used to analyze the effects of the FR and GRP interventions, assessment occasions and their interaction for all the outcome variables. No significant differences were revealed in all the comparisons (p ranged from 0.15 to 0.84) that would indicate that either FR was not more effective than the GRP, or vice versa. Results of the study failed to demonstrate that the effect of the FR was superior to GRP, or vice versa; both intervention groups showed improvements in functional and physical performance of deconditioned patients over time. Findings of the present study will enable clinicians to better understand the functional profile of deconditioned patients. The present functional retraining care plan is appropriate and adequate to rehabilitate the functional needs of deconditioned elderly patients. This study also demonstrates the use of functional retraining is sufficient to improve the functional status, biceps, quadriceps strength and aerobic capacity of deconditioned elderly patients who are already frail and old. Occupational therapists may have to reconsider the potential use of functional retraining as a means to alleviating both impairments and functional status of deconditioned patients. Furthermore, the Quadriceps muscle strength (63.5% of variance) was the only significant predictors of (p<0.00) patients' FIM motor score, which is potentially useful as the admission criteria of the program.

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