Dose-dependent effect of rehabilitation in functional recovery of older patients in the post-acute care unit

Post-acute care (PAC) is of great importance to promote functional recovery of older patients, which should be provided by the interdisciplinary team. In PAC services, rehabilitative therapy plays a key role, but the optimal intensity for rehabilitative therapy remained unclear. Between July 2007 and December 2010, all patients with functional decline after acute illness hospitalization admitted to the PAC unit of a community hospital in Taiwan were enrolled. Usual rehabilitation program, 40-min per day and five days a week, was provided to all patients before April 2009. After April 2009, the rehabilitative therapy was increased to 80. min per day. Functional improvement was measured by comprehensive geriatric assessment (CGA) at admission and 4 weeks after admissions to the PAC unit. Overall, 458 patients (mean age: 83.4 ± 5.5 years, all males) completed PAC services. Compared of all dimensions in CGA, increased dosage of rehabilitative therapy showed significantly better improvement in daily living activities (Barthel index (BI): 28.8 ± 18.4 vs. 20.0 ± 14.6, p< 0.001), depressive mood (geriatric depression score short form (GDS): -0.5 ± 1.0 vs. -0.1 ± 0.5, p< 0.001), and pain reduction (numerical rating scale (NRS): -2.0 ± 2.2 vs. -0.9 ± 2.1, p= 0.01); but not in cognitive function (mini-mental status examination (MMSE): 2.9 ± 3.3 vs. 3.3 ± 5.2, p= 0.305), and nutritional status (body mass index (BMI): 0.3 ± 0.9 vs. 0.3 ± 2.5, p= 0.9). In conclusion, intensive rehabilitative therapy significantly promote physical and psychological function with pain reduction, which deserves further investigations to evaluate whether there is a ceiling effect of rehabilitative therapy in PAC services.