Effect of functional training on the ability to live independently and participation of frail elderly of 75 years and older

The functional training programme, in contrast to traditional exercise
programmes, focuses on training of those daily activities which are problematic
for the elderly. We expect that particularly in frail older people with
multiple problems in daily functioning, functional training can improve their
ability to live independently, especially when it will be delivered
individually and in the older persons* homes.

The aim of this study is to measure the (cost)effectiveness of a functional
training programme delivered in the older persons* homes as compared to
traditional physical therapy with regard to the ability to live independently
and participation of frail elderly of 75 years and older with problems in
physical functioning.

The study consists of two parts: a screening study and an intervention study.
By means of a short screening questionnaire (via general practitioner) frail
elderly will be traced. A research staff member of the LUMC will visit the
frail elderly at home to check whether the older person meet the inclusion
criteria of the intervention study *Physiotherapy 75+*. Their general
practitioner will check whether physiotherapy is safe and give them a referral
for physiotherapy. This is the start of the intervention study. A research
staff member of TNO will visit these elderly at home for a baseline measurement
(questionnaires and physical tests) and will ask informed consent to
participate in the study. Subsequently, the elderly will be randomized to the
functional training programme (n=75) or regular physical therapy (n=75).
Follow-up measurements will take place 3, 6 and 12 months later.
First, a pilot study will be conducted to the feasibility of the training and
the measurements.

The elderly in the functional training programme will be referred to a
physiotherapist who has been specially educated to deliver the functional
training programme in the older person*s home. In the functional training
programme (maximum of 18 sessions) the daily activities experienced as
troublesome by the participant are trained in a stepwise manner in the home
situation. In addition, caretakers or home care workers can be called in for
guidance in the home situation to stimulate the elderly to perform daily
activities themselves and to stay active. To achieve a long-term effect, the
physiotherapist will guide the older person during the training programme in
regular and safe physical activity and thus stimulate him or her to more
physical activity at home and in the neighbourhood. The elderly in the control
group will receive regular physical therapy (usually consisting of muscle
exercises, balance exercises and walking exercises) (maximum of 18 sessions)
from a physiotherapists who has not been educated in the functional training
programme.

Burden
It will take the participants a maximum of 15 minutes to fill in the screening
questionnaire. The visit of the research staff member of the LUMC will take
approximately 1 hour. The research staff member of TNO will visit the
participant 4 times to fill in a questionnaire and to perform some physical
tests (approximately 1.5 hour per visit). The physical therapy intervention
consists of a maximum of 18 sessions of a half hour.

Risks
Physiotherapists are used to treat (frail) elderly in a safe manner. The
training programme will be tuned to the capacities of the individual. As a
result the risk of participation to the study is not larger than the risk of
physical tiredness. Literature shows that high age and frailty are no
contraindications for participation in a training programme. In the former
study on the effectiveness of the functional training programme in fairly
healthy elderly living at home no serious side effects or injuries were
reported. Before inclusion in the study, the general practitioner will check
whether the older person has a contraindication for physical therapy.