Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial

doi:10.1136/bmj.a1445

Published 9 October 2008, doi:10.1136/bmj.a1445
Cite this as: BMJ 2008;337:a1445

Research

Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial

Ngaire Kerse, associate professor¹, Kathy Peri, research fellow², Elizabeth Robinson, biostatistician³, Tim Wilkinson, professor of geriatric medicine⁴, Martin von Randow, statistician⁵, Liz Kiata, research fellow¹, John Parsons, research fellow², Nancy Latham, senior research fellow⁶, Matthew Parsons, senior lecturer², Jane Willingale, research fellow⁷, Paul Brown, associate professor⁷, Bruce Arroll, professor of general practice and primary health care¹

¹ Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1001, New Zealand, ² School of Nursing, University of Auckland, ³ Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, ⁴ Health Care of the Elderly, University of Otago, Christchurch, New Zealand, ⁵ Department of Sociology, University of Auckland, ⁶ Health and Disability Research Unit, Boston University School of Public Health, Boston, MA, USA, ⁷ Health Systems, School of Population Health, University of Auckland

Correspondence to: N Kerse n.kerse{at}auckland.ac.nz

Objective To assess the effectiveness of an activity programmein improving function, quality of life, and falls in older peoplein residential care.

Design Cluster randomised controlled trial with one year follow-up.

Setting 41 low level dependency residential care homes in NewZealand.

Participants 682 people aged 65 years or over.

Interventions 330 residents were offered a goal setting andindividualised activities of daily living activity programmeby a gerontology nurse, reinforced by usual healthcare assistants;352 residents received social visits.

Main outcome measures Function (late life function and disabilityinstruments, elderly mobility scale, FICSIT-4 balance test,timed up and go test), quality of life (life satisfaction index,EuroQol), and falls (time to fall over 12 months). Secondaryoutcomes were depressive symptoms and hospital admissions.

Results 473 (70%) participants completed the trial. The programmehad no impact overall. However, in contrast to residents withimpaired cognition (no differences between intervention andcontrol group), those with normal cognition in the interventiongroup may have maintained overall function (late life functionand disability instrument total function, P=0.024) and lowerlimb function (late life function and disability instrumentbasic lower extremity, P=0.015). In residents with cognitiveimpairment, the likelihood of depression increased in the interventiongroup. No other outcomes differed between groups.

Conclusion A programme of functional rehabilitation had minimalimpact for elderly people in residential care with normal cognitionbut was not beneficial for those with poor cognition.

Trial registration Australian Clinical Trials Register ACTRN12605000667617.

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