Age Ageing. 2026 Feb 1;55(2):afag011. doi: 10.1093/ageing/afag011.
ABSTRACT
OBJECTIVE: To evaluate whether home-based extended rehabilitation for older people with frailty after hospitalisation with an acute illness or injury can improve physical health-related quality of life.
TRIAL DESIGN: Multi-centre, individually randomised controlled parallel group superiority trial.
SETTING: Recruitment from 15 NHS Trusts in England, with home-based intervention delivery.
PARTICIPANTS: Eligible participants were 65 years or older with mild/moderate/severe frailty (5-7 on Clinical Frailty Scale) admitted to hospital with acute illness/injury, then discharged home.
INTERVENTIONS: Participants were randomly assigned (1.28:1) to the Home-based Older People’s Exercise (HOPE) programme-a 24-week home-based manualised, progressive exercise intervention as extended rehabilitation, or usual care (control).
MAIN OUTCOME MEASURES: Primary outcome was physical health-related quality of life, measured using the physical component summary (PCS) of the modified Short Form 36-item health questionnaire (SF36) at 12 months. Secondary outcomes at six and 12 months included functional independence, death, hospitalisations and care home admissions.
RESULTS: We randomised 740 participants (410 HOPE, 330 control). Intention-to-treat analyses showed no evidence that HOPE was superior to control for 12-month PCS score (adjusted mean difference -0.22, 95% CI -1.47 to 1.03; P = .73). There was some evidence of a higher rate of all-cause hospitalisations in the control arm (incidence rate ratio 1.12, 95% CI 1.00 to 1.25; P = .05). The intervention was not cost-effective.
CONCLUSIONS: We do not recommend routine commissioning of extended rehabilitation for older people with frailty after discharge home from hospital or intermediate care, following an acute admission with a medical illness or injury.
TRIAL REGISTRATION: ISRCTN-13927531 (19/04/2017).
PMID:41719425 | DOI:10.1093/ageing/afag011
