Domiciliary vs Centre-Based Rehabilitation of Older Community Dwellers: Randomised Trial with Economic Evaluation

Abstract

Background: Community rehabilitation services for older adults aim to address factors that lead to physical decline and falls and return people to their normal activities in the community. While community rehabilitation has been proven effective in reducing falls in the elderly, previous studies have not specified whether delivering services at home or in a centre-based format is the more appropriate method of service delivery. Aim: This study aims to compare a centre-based group program with a home-based program. The purpose of this study is to identify the most clinically effective way of delivering community rehabilitation services to older fallers and determine which service delivery setting is more economically efficient. Methods/Design: This paper describes the study design and methods of a randomised clinical trial. One group of participants will receive a centre-based community rehabilitation service, the other group a domiciliary (home-based) community rehabilitation service of near identical content. Participants in this study are those clients over 60 years of age referred to a community rehabilitation service. Patients referred to this service typically have had recent falls, poor or declining mobility, functional dependency, cognitive decline, and / or physical deconditioning. Clinical effectiveness will be primarily determined by comparison of health-related quality of life and rates of accidental falls. Secondary outcomes include the levels of participation in functional activities, and physical capacity between the two groups. Economic efficiency will be determined through conduct of a cost-benefit analysis. Discussion: Results from this study will guide clinicians and policy makers to identify the more effective and efficient falls prevention community rehabilitation program service delivery model for older adults living in the community. Trial Registration: Australian New Zealand Clinical Trials Register: ACTRN12605000056695.