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

Abstract: objective To compare the clinical effectiveness of a programme of physiotherapy and occupational therapywith standard care in care home residents who havemobility limitations and are dependent in performingactivities 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 “physicaldisability” 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 therapyand physiotherapy programme.Main outcome measures: scores on the Barthel index andthe Rivermead mobility index.Results: 24 of 77 nursing and residential homes thatcatered for residents with mobility limitations anddependency for activities of daily living were selected forstudy: 12 were randomly allocated to the intervention arm(128 residents, mean age 86 years) and 12 to the controlarm (121 residents, mean age 84 years). Participantswere evaluated by independent assessors blind to studyarm allocation before randomisation (0 months), threemonths after randomisation (at the end of the treatmentperiod for patients who received the intervention), andagain at six months after randomisation. After adjustingfor home effect and baseline characteristics, no significant differences were found in mean Barthel indexscores 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 andphysiotherapy programme had no significant effect onmobility and independence. On the other hand, the variation in residents’ functional ability, the prevalence of cognitive impairment, and the prevalence of depressionwere considerably higher in this sample than expected onthe basis of previous work. Further research to clarify theefficacy of occupational therapy and physiotherapy isrequired if access to therapy services is to berecommended in this population