A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS)

Clinical Interventions in Aging · 18 authors, 6 centres

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TL;DR

The intervention showed trends toward improved function and quality of life, and fewer emergency department revisits and unscheduled hospitalisations compared to usual care.

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This pilot feasibility randomised controlled trial assessed the ED PLUS intervention, a physiotherapy-led program initiating a Comprehensive Geriatric Assessment in the emergency department followed by a six-week, home-based self-management programme, for older adults discharged within 72 hours. Descriptive analyses showed a trend towards improved function (Barthel Index) and quality of life (EQ-5D-5L), and lower rates of emergency department re-attendance and unplanned hospitalisations in the ED PLUS group at 6 weeks and 6 months. The study was limited by its small sample size, pilot design, and recruitment challenges related to the COVID-19 pandemic.

STUDY TYPE

RCT

SPECIALTY

geriatrics

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10612516

A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS)

Clinical Interventions in Aging

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ABSTRACT

Abstract Background Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS). Patients and Methods Older adults presenting to the ED of a university teaching hospital 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. 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 six-week, multi-component, self-management programme in the patient’s home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive. Results Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group. Conclusion ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group. Trial Registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602. Keywords: emergencies, recruitment, integrated care, care transitions, public and patient involvement

CITATION EXPORT

Mairéad Conneely, Siobhán Leahy, Margaret O’Connor et al.. A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS). Clinical Interventions in Aging. (2023). https://doi.org/10.2147/CIA.S413961

AUTHORS

18 · 6 CENTRES

Mairéad Conneely, Siobhán Leahy, Margaret O’Connor, Gillian Corey, Ahmed Gabr, Anastasia Saleh, Blessing Okpaje, Íde O’ Shaughnessy, Aoife Synnott, Aoife McCarthy, Alison Holmes, Katie Robinson, Lorna Ryan, Anne Griffin, Louise Barry, Dominic Trépel, Damian Ryan, Rose Galvin

1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
2Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
3Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
4School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
5Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
6Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland