Long-stay home care clients who receive rehabilitation have improved
outcomes and lower utilization of costly health services, say authors of an article published
online in Archives of Physical Medicine
and Rehabilitation. The findings suggest that investment in physical
therapy and occupational therapy services for relatively short periods may
provide savings to the health care system over the longer term, they add.
This observational study conducted
in home care programs in Ontario, Canada, included 99,764 home care clients
with musculoskeletal disorders who received a baseline screening using the
Resident Assessment Instrument for Home Care, 1 follow-up
assessment, and had discharge or death records between 2003 and 2008.
The effects of physical therapy and
occupational therapy services on transitions in function state, discharge from
home care with service plans complete, institutionalization, and death were
assessed using multistate Markov models.
Home care clients with deficiencies
in instrumental activities of daily living (IADL) and/or activities of daily
living at baseline and who received home-based rehabilitation had significantly
increased odds of showing functional improvements by their next assessment (for
a state 3 → 2 transition OR = 1.17; for a state 2 → 1 transition OR = 1.36).
Receipt of physical therapy or occupational therapy also significantly reduced
the odds of mortality and institutionalization in this group.
With increasing numbers of older
adults with chronic conditions and limited funding for health care services, it
is essential to provide the right services at the right time in a
cost-effective manner, the authors add.