HERO - Home-based Extended Rehabilitation for Older People
Research type
Research Study
Full title
Individually randomised controlled multi-centre trial to determine the clinical and cost effectiveness of a home-based exercise intervention for older people with frailty as extended rehabilitation following acute illness or injury, including embedded process evaluation.
IRAS ID
221010
Contact name
Andrew Clegg
Contact email
Sponsor organisation
Bradford Teaching Hospitals NHS Foundation Trust
ISRCTN Number
ISRCTN13927531
Duration of Study in the UK
4 years, 2 months, 31 days
Research summary
Research Summary:
Frailty is a condition that is common in older age. It develops because as we get older our bodies change, and can lose their inbuilt reserves. These changes mean that older people with frailty can become less mobile and unable to carry out day-to-day tasks when they have a minor illness, such as an infection, or an injury, such as a fracture. Older people with frailty are therefore likely to need a period of rehabilitation to improve overall muscle strength and function before returning home from hospital. Current NHS practice is for a relatively short rehabilitation period and research suggests any initial improvement during this period of rehabilitation may not be sustained. Therefore, we have developed the Home-based Older People's Exercise (HOPE) programme, a 24-week programme of exercises delivered via a manual under the guidance of a trained therapist.
This study is a randomised controlled trial which will help find out if the HOPE programme can improve quality of life for older people with frailty who have been discharged home from hospital or from intermediate care (community-based rehabilitation services) after illness or injury. We will also assess whether the HOPE programme provides value for money for the NHS.
We aim to recruit 718 participants from 10 UK hospitals and linked intermediate care across Yorkshire and the South West. Following admission to hospital, participants will be informed about the trial and if they are willing to participate their consent will be sought and baseline assessments completed. At discharge, eligible participants will be randomly allocated to receive either the HOPE intervention and usual care services or usual care only. Usual care services are those provided in the community such as GP care, district nurse input, home care packages and voluntary sector services. Follow-up assessments will be undertaken at 6 and 12 months.
Summary of Results:
Why did we do this research?
When older people with frailty are admitted to hospital, they often lose independence. Short-term NHS rehabilitation can improve independence during hospital stays or following return home, however, independence often deteriorates again once this rehabilitation ends. For these older people who already require some support at home, this further loss of independence can be devastating. This often leads to the person being readmitted to hospital, becoming dependent on homecare services and possibly needing to move to a care home. We wanted to see if a home exercise programme supported by physiotherapists, providing extended rehabilitation after hospital admission, could help these older people after discharge home.What did we do?
Between December 2017 and August 2021, 740 older adults (aged 65 and over) with frailty agreed to take part in our research. We approached people after leaving hospital or short-term NHS rehabilitation services after an illness or injury. 410 participants received our exercise programme. The other 330 participants received their usual care only. We collected information from participants on their health, wellbeing and circumstances for 12 months. We compared the two groups to see if the group who received the exercise programme benefited from it. We observed physiotherapists providing the programme to see how it was delivered, looked at the cost effectiveness of the programme, and asked participants about their experiences.What did we find?
We found that although the exercise programme was delivered largely as planned, and was acceptable to most participants, it did not improve health or wellbeing and was not cost-effective.What does this mean?
We do not recommend that the HOPE Programme should be provided as extended rehabilitation for older people with frailty after discharge home from hospital or short-term rehabilitation services.REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
17/YH/0097
Date of REC Opinion
22 Jun 2017
REC opinion
Further Information Favourable Opinion