Nursing rehabilitation and exercise strategies in the nursing home

Background. The purpose of this study was to evaluate how weight training o r nursing-based rehabilitative care programs in nursing homes impact on res ident performance of Activities of Daily Living (ADL) and objectives tests of physical performance. Methods. This study involved a quasi-experimental control, longitudinal com parison of functional status over a 10-month period, where baseline status was adjusted through a weighting procedure based on functional status, cogn itive status, and age. All residents from six residential care nursing home facilities were eligible except those with a terminal prognosis, a project ed stay of less than 90 days, or with health complications that prohibited contact. Homes were placed into matched triplets based on patient character istics: two members of each triplet were randomly designated to be experime ntal sites, the third became the control site. Baseline data were available for 468 subjects, follow-up for 392. ADL self-performance measures derived from the Minimum Data Set, including indicators of early loss ADL, locomot ion, and late loss ADL; a number of objective functional tests (including m easures of balance, power, and endurance); and mood state as measured by th e Geriatric Depression Scale, Results. Mean ADL values in the two experimental groups declined at a signi ficantly lower rate than did rates for the controls. Functional decline was also lower in more specific measures: locomotion, early loss ADL, and late loss ADL. Conclusions. With both interventions, facilities were able to implement a b road-based intervention that resulted in a significant reduction in ADL dec line rates. A facility-wide nursing rehabilitation program can play a usefu l role in reversing functional decline, helping residents to maintain their involvement in a broad spectrum of ADL activities.