A physiotherapy-led transition to home intervention for older adults following Emergency Department discharge: a pilot feasibility randomised controlled trial

• Main Authors: Mairéad Conneely (Author), Aoife Leahy (Author), Margaret O’Connor (Author), Ahmed Gabr (Author), Blessing Okpaje (Author), Anastasia Saleh (Author), Gillian Corey (Author), Louise Barry (Author), Anne Griffin (Author), Íde O’Shaughnessy (Author), Lorna Ryan (Author), Ida O’Carroll (Author), Siobhán Leahy (Author), Dominic Trépel (Author), Damien Ryan (Author), Katie Robinson (Author), Rose Galvin (Author)
• Format: Book
• Published: James Cook University, 2023-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.22605/RRH8154; 1445-6354
• Keywords: Special situations and conditions; RC952-1245; Public aspects of medicine; RA1-1270
• Source: Rural and Remote Health, Vol 23 (2023)

Introduction: Older adults frequently attend the emergency department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED-PLUS).Methods: Older adults presenting to the ED with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED-PLUS (trial registration: NCT04983602). ED-PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a 6-week, multi-component, self-management programme in the patient’s own home. Feasibility (recruitment and retention rates) and acceptability of the programme were assessed quantitatively and qualitatively. Functional decline was examined post-intervention using the Barthel Index. All outcomes were assessed by a research nurse blinded to group allocation.Results: Twenty-nine participants were recruited, indicating 97% of our recruitment target; 90% of participants completed the ED-PLUS intervention. All participants expressed positive feedback about the intervention. The incidence of functional decline at 6 weeks was 10% in the ED-PLUS group versus 70%-89% in the usual care and CGA-only groups.Discussion: High adherence and retention rates were observed among participants and preliminary findings indicate a lower incidence of functional decline in the ED-PLUS group. Recruitment challenges existed in the context of COVID-19. Data collection is ongoing for 6-month outcomes.