Impact of Home Health Treatment Elements on Older Adult Physical Function Recovery: Secondary Analysis of Two Randomized Controlled Trials

Abstract

After hospitalizations, many older adults experience a rapid functional decline and rely on home health (HH) care services to regain physical function. Understanding rehabilitation treatment elements that improve physical function is important for optimizing care. Two randomized controlled trials demonstrated similar physical function improvement in older adults (≥65 years, ≥3 comorbidities) receiving either high intensity (n=133) or standardized usual care (n=140) HH approaches in the 60 days following hospitalization. This secondary analysis examined the relationship between patient characteristics, treatment elements, and physical function improvements measured by the Short Physical Performance Battery (SPPB). In the high intensity group, lower baseline SPPB performance was associated with greater improvements (β=-0.23, p<0.01). Completing an additional exercise component per session further increased SPPB scores by 0.65-points (β = 3.94, p<0.01). For every two visits completed, there was an associated with a 0.58-point increase in SPPB (β=0.29, p<0.01), exceeding the small meaningful changes threshold (0.5 points). In contrast, four visits in usual care were associated with a 0.56-point change in SPPB (β=0.14, p<0.05). Neither approach demonstrated an association between environmental challenge exercises and functional improvement, potentially due to lower session frequency and shorter duration. These findings suggest that consistent attendance and full participation in high intensity HH components are critical for maximizing recovery. HH therapists should educate patients to prioritize attending 12 sessions and completing all prescribed treatment components to optimize physical function recovery in the 60 days after hospitalization.[AQ3]