Physical Rehabilitation in Long-Term Care

Aim: To determine what types of physical rehabilitation have been evaluated in long-term care, which outcomes or quality indicators have been used for evaluation, and what tools or models exist for decision-making in the allocation of rehabilitation resources.

Overview: A comprehensive literature and grey literature search were conducted and data was abstracted. A half day stakeholer meeting was held to determine which existing or new quality indicators could be used to evaluate physical rehabilitation in long-term care.

Results: The majority of PR interventions were delivered by a physical therapist or other rehabilitation professionals such as occupational therapist. Interventions were most often multicomponent exercise programs, delivered on average for 45 minutes, 3 times a week for a duration of 4 months. The most commonly used outcomes to evaluate physical rehabilitation in long-term care were activities of daily living, falls and cognition. The majority of the outcomes were measured at the resident-level, with very few outcomes measured at the facility- or system-level. No tools were identified to assist in deciding who should receive PR in LTC. The stakeholders agreed that activities of daily living and falls quality indicators could be used to evaluate PR in LTC, but felt that additional quality indicators should be used, including quality of life, pain, incontinence, pressure ulcers, restraints and disruptive behaviours. 

Components of Success: 

  • Knowledge to action and research gaps were identified: there is currently not the capacity to deliver the PR interventions evaluated in the literature; little work has been done to date investigating the effect of rehab at the facility or system level, or with short stay residents in LTC; residents often included in research are higher functioning with little cognitive impairment; there were no tools identified to help decide who should receive rehab in long-term care
  • The quality indicators identified by the stakeholder meeting will be used to evaluate the impact of funding and policy changes for physical rehabilitation in long-term care that occurred in Ontario in 2013.