6533b827fe1ef96bd1285bbd

RESEARCH PRODUCT

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial.

Sarianna SipiläMarkku HupliSara SuikkanenHannu KautiainenKatriina Kukkonen-harjulaEeva M. AartolahtiSanna KääriäKaisu H. PitkäläPaula Soukkio

subject

medicine.medical_specialtyutilization of social and healthcare servicesterveyspalvelutCost effectivenesssosiaalipalvelutCost-Benefit AnalysisFrail ElderlykotihoitovanhuksetPhysical exercisefrailtyliikuntaRate ratiolaitoshoitolaw.invention03 medical and health sciences0302 clinical medicineRandomized controlled triallawHealth caremedicineHumans030212 general & internal medicineExerciseGeneral NursingFinlandAgedAged 80 and overInpatient careexercise cost-effectivenessFrailtybusiness.industryHealth PolicyMedical recordkustannustehokkuusGeneral MedicineConfidence interval3. Good health3121 General medicine internal medicine and other clinical medicinePhysical therapyQuality of LifeFemaleGeriatrics and Gerontologybusiness030217 neurology & neurosurgeryikääntyneetfyysinen aktiivisuus

description

Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored. Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: >65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score >17. Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records. Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group Conclusions and Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months. (c) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine. Peer reviewed

yearjournalcountryeditionlanguage
2021-04-01Journal of the American Medical Directors Association
10.1016/j.jamda.2020.06.005https://pubmed.ncbi.nlm.nih.gov/32694001