Discovering the Effects of Frontloading Homecare Visits for Patients with Heart Failure - Results of a Multicenter Randomized Controlled Trial

This study investigated the impact of frontloading home physiotherapy visits on function in persons with HF. 

A prospective multi-center randomized controlled trial with blinded raters explored differences in function in 82 ambulatory patients with a primary diagnosis of HF, discharged from the hospital to their home. Subjects were randomly allocated into an experimental frontloaded (FLG) or control group (CG) for four weeks. FLG visit frequencies were 5 sessions/week for 2 weeks, and 3 sessions/week for 2 weeks; CG patients received 2 sessions/week for 4 weeks. Functional measures including 2minute step test (2MST), 2minute walk test (2MWT), gait speed (GS), Timed Up and Go (TUG), and 30second chair rise test (30-CRT) were collected at the onset of care, at the end of 2-weeks and 4-weeks.

43 and 39 subjects were assigned to the FLG and CG respectively. Both groups were statistically similar at baseline for all outcome measures. All subjects significantly improved scores in all functional measures over time, within subject main effect (p 0.01). Significant between-subject effects were noted for 30-CRT (p=0.04). Interaction effects were noted for GS (p=0.03) and TUG test (p=0.02). Mean change scores from baseline to the 30-day termination period for outcome measures in the experimental (FLG) and control (CG) groups were as follows: GS 0.22m/sec in FLG and 0.18M/sec in CG; TUG 10 sec in FLG and 8.45 sec in CG; 30-CRT 2.28 rises in FLG and 2.64 rises in CG, 2MST 18.57 steps in FLG and 11.13 steps in CG; 2MWT 65.24 meters in FLG and 43.34 meters in CG.

This is the first trial to report meaningful improvements in function in individuals with HF receiving 30 days of home PT immediately after a hospital admission. Significant treatment effect differences between groups were found for GS, TUG, and 30-CRT. Future research should provide patients with a frontloaded methodology along with an equivalent number of total visits between groups. 

Globally, physiotherapists can benefit from these research findings in validating the value of increased home visits in improving function in patients with HF. With the ubiquity of functional tests used in the geriatric population, it is valuable for professionals to gain knowledge on objective changes in these tests that can be achieved with 30 days of home rehabilitation.