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  • Study: Home Health Physical Therapy Improves Abilities of Individuals With Dementia

    In this review: The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia
    (Health Policy and Economics, January 2020)
    Abstract

    The Message
    Physical therapy delivered at home has a role to play in improving the lives of individuals with dementia, according to authors of a study that found any physical therapy increased the probability of improvement in activities of daily living — ADLs — by 15.2%. Although those probabilities improved in relation to the number of visits received, the greatest rate of increase in ADL function seemed to occur in patients who received between six and 13 visits.

    The Study
    Researchers analyzed CMS data drawn from the 2012 Outcome and Assessment Information Set and the Home Health Research Identifiable File, focusing on patients 66 and older who had a primary diagnosis of dementia and received in-home care. A total of 1,477 patients were included in the analysis.

    The study focused on whether patients with dementia improved ADL performance during the course of their care, and whether physical therapy visits could be correlated to increased chances of improvement. ADL items assessed included grooming, upper body dressing, lower body dressing, bathing, toilet transferring, toileting hygiene, transferring to bed or chair, ambulation, feeding and eating, the ability to prepare light meals, and the ability to use a phone.

    APTA members Cherie LeDoux, PT, DPT; Jason Falvey, PT, DPT, PhD; and Jennifer Stevens-Lapsley, PT, MPT, PhD, were among the authors of the study.

    Findings

    • Patients who received no physical therapy had a 60% probability of ADL improvement; that probability jumped to 75% for patients receiving any physical therapy.
    • The probability of ADL improvement increased with the number of physical therapy visits received, with improvement probability rising to 80.3% for patients receiving six to 13 visits, and to 88.9% for patients who received 14 or more visits.
    • Among all 1,477 patients, 62% received at least one physical therapy visit, with an overall median of four physical therapy visits received.
    • Among the patients who received physical therapy, 52% received between six and 13 visits, 41.3% received one to five visits, and 6.7% received 14 or more visits.
    • Authors believe the most significant improvement rates were associated with the six to 13-visit range, writing that the improvement rates associated with 14 visits and more as statistically insignificant.

    Why It Matters
    The authors write that their study comes when changes to home health payment "may produce downward pressure on home health rehabilitation services … generally discouraging therapy use and potentially increasing avoidable functional decline for [persons with dementia]." Their findings, they assert, help to establish the role of physical therapy in a provider environment that "incentivizes functional improvement."

    "In this study, skilled PT utilization is significantly associated with greater mobility and ADL function in individuals with a primary diagnosis of dementia," the authors write, adding that "our results suggest patients [with dementia] should receive a PT evaluation at minimum as a standard of care."

    Keep in Mind …
    Authors cite limitations in their study, including an inability to correct for possible variation in treatment allocation such as patient participation levels and clinician bias. The study also has a relatively small sample size and did not account for variations in dementia types among patient data analyzed.

    [Editor's note: author Jason Falvey was awarded a 2019 Foundation for Physical Therapy Health Services Research Pipeline Grant. Author Stevens-Lapsley has also received Foundation funding, and author LeDoux is the recipient of a 2019 Foundation Promotion of Doctoral Studies grant.]