Pragmatic Trial Implementing High-Intensity Rehabilitation in Skilled Nursing Facilities

KATIE SEIDLER PT, DPT
Post-doctoral Fellow, University of Colorado Anschutz Medical Campus, Department of Physical Medicine & Rehabilitation, Physical Therapy Program

Functional recovery during a skilled nursing facility (SNF) stay is poor1,2, likely related to inconsistent rehabilitation practices3-5. This pragmatic study evaluated the feasibility and effectiveness of a high-intensity rehabilitation protocol in improving function during a SNF stay.

Older adults (Veterans) admitted to SNF following a hospitalization.

Data were collected on 103 consecutive Veterans admitted to one SNF (age 77.7 ±10 years; 89% male). The i-STRONGER Program (IntenSive Therapeutic Rehabilitation for Older Skilled NursinG HomE Residents) integrates principles of physiologic tissue overload and strength training into rehabilitation6. A comparison of usual care with i-STRONGER occurred using a staged, 2-independent group design with the SNF serving as its own control. Therapists assessed function at evaluation and discharge via the Short Physical Performance Battery (SPPB) and gait speed 7,8. Treatment fidelity of i-STRONGER was assessed with an observational checklist. Regression analyses evaluated the response of SPPB or gait speed change to treatment group.

i-STRONGER participants exhibited a 0.13 meters/second greater change in gait speed than Usual Care (p=0.05). i-STRONGER demonstrated a 0.64-point greater change in SPPB than Usual Care (p=0.27). The average SNF length of stay was 3.5 days shorter during i- STRONGER (p=0.26), which equated to savings of ~$1537.38 per patient9. Adherence to i- Stronger was 99% over 11 sessions. No treatment-specific adverse events were reported.

High-intensity rehabilitation for patients admitted to a SNF following hospitalization effectively and safely improves function with reduced length of stay. Implications for practice: A high-intensity rehabilitation approach in SNFs appeared to improve functional outcomes in less time.