Family-assisted physiotherapy for older people

Is it a way to enhance traditional physiotherapy interventions for older people?

Leaving the hospital to get back home may be a difficult moment for elderly, especially when facing various comorbidities. Programmes have been developed to help these people get back on their feet after hospitalisation and guide them through a short-term intervention involving various professionals (social workers, nurses, occupational therapists, physiotherapists and more).

Physiotherapy, as part of allied health therapies, can improve physical functions and facilitate return to daily activities for older people. However, the amount of physiotherapy interventions is often very low, and this applies just as much to transitional programmes specifically implemented for this population.

Family-assisted therapy has been studied as a way to enhance interventions for older people but no RCT assessing family-assisted therapy to enhance physiotherapy for older adults with multimorbidity has been conducted so far. The purpose of the present study was therefore to investigate the safety and effectiveness of augmenting physiotherapy with family-assisted therapy for older people moving from hospital to their own place of living, with an overall objective to collect and prepare a more developed and strongly built trial.

The authors found that adding physiotherapy via family-assisted therapy seems to be safe, improves clinical outcomes and appears as feasible for older people transitioning from hospital to the community.

No between-group differences were found with regard to falls-related self-efficacy, quality of life or caregiver strain. The experimental group, however, showed a reduced risk of falling, a reduced falls rate, a significant reduction in activity limitation and a better physical activity (higher daily steps taken) without caregiver strain compared to the control group.

The authors concluded that family-assisted therapy to augment physiotherapy for older people transitioning from hospital to the community may be safe to improve several clinical outcomes. It appears as a feasible intervention and a stronger, more elaborate, RCT is recommended.

> From: Lawler et al., Clin Rehabil 13 (2019) 1625-1635 . All rights reserved to The Author(s). Click here for the online summary.

Expert opinion

The beneficial effects highlighted by the authors in the present study seem in favour of adding family-assisted physiotherapy to usual physiotherapy provided to older patients leaving hospital to go home. The authors do remind us that these are only temporary findings which are indeed encouraging, but which need to be confirmed through a larger and fully powered study. This should especially investigate the long-term benefits of family-assisted therapy as well as larger backgrounds and sample, so that the results may be more generalisable.

Nevertheless, an interesting point is that participants and their families showed a good adherence to the experimental protocol. Family-assessed interventions led to fifteen additional therapy sessions (equivalent to around 226 minutes) compared to usual physiotherapy, which is a much higher amount of therapy.

Moreover, and although some concerns were present at first with regard to caregiver strains and possible risks to have (non-supervised) physiotherapy provided by family members, no adverse effects were found and family members did not express additional burdens in assisting their fellow. This supports the idea that this intervention may be safe and easy to implement, which is consistent with earlier findings about family-assisted therapy after stroke.

Finally, the increase in physical activity highlighted by the higher number of steps taken could be a good way to struggle against sedentary lifestyle which is likely to increase falls and which represent higher risks than those associated with family-assisted therapy.

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