| Participants |
Inclusion criteria: aged ≥ 65 years, admitted with a medical diagnosis, with ≥ 1 risk factor for readmission (i.e. aged ≥ 75, multiple hospital admissions in previous 6 months, multiple comorbidities, living alone, lack of social support, poor self‐rating of health, functional impairment, history of depression, or a combination of these)
Exclusion criteria: requiring home oxygen; dependent on a wheelchair or unable to walk independently for 3 m, living in a nursing home; cognitive deficit; progressive neurological disease
Exercise arm
Control arm
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| Interventions |
Exercise arm
TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): older hospitalised patients' discharge planning and in‐home follow‐up. TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): multifaceted transitional care intervention including hospital and home‐based exercise strategies for at‐risk older adults was hypothesised to reduce readmissions and improve functional outcomes of hospitalisation. TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): care plan as described in item 4. Written guidelines were provided on postdischarge management, including diagrams and specific instructions for their exercise programme. TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): within 72 hours of admission, a nurse and physiotherapist undertook a comprehensive participant assessment and developed a goal‐directed, individualised care plan in consultation with the participant, healthcare professionals, family and carers. The care plan included, an exercise intervention, a nursing intervention and an intervention after discharge. The exercise intervention included stretching, balance training, walking, strengthening (elbow flexors/extensors, hip flexors/extensors/abductors, knee extensors). The nursing intervention involved a nurse visiting the participant daily whilst in hospital to address concerns, facilitate the exercise programme and oversee discharge planning. While the participant remained in hospital, the nurse developed a transitional care plan covering the areas of functional ability and need for assistance with ADL, postdischarge treatments and follow‐up care, social support, chronic disease management plans and information, medication information, community services, and assistance with the exercise programme. The intervention after discharge consisted of a home visit by the nurse within 48 hours of discharge, to assess availability of support, address transitional concerns, provide advice and support and ensure that the exercise programme could be safely undertaken at home. Extra home visits were provided if required. Weekly follow‐up telephone calls were provided for 4 weeks, followed by monthly calls for a further 5 months. TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): no specific training for the nurse specified, other than the nurse and physiotherapist combined their visits when planning, explaining and demonstrating the exercise programme to ensure continuity when the nurse continued to facilitate the exercise programme during extended hospital stays and at home. TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): the physiotherapist and nurse explained and demonstrated the exercise programme face‐to‐face. The daily visits whist in hospital by the nurse included 'facilitating the exercise programme'. Written guidance was provided for postdischarge management, and as described in item 4, postdischarge the participants received home visit(s) and regular telephone calls. TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): in‐hospital interventions were carried out on the medical wards. Postdischarge the intervention was carried out in the participants home. TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): intervention commenced within the first 72 hours of admission, and continued daily during the participant's admission. Follow‐up ended with a telephone call at 5 months postdischarge. The daily exercise programme included walking at a slow pace for 3–5 minutes, increasing to a moderate level for 5–10 minutes, followed by a slower pace, initially 2–3 times per week, increasing to 3–4 times per week. The strengthening component of the exercise programme was 2–3 times per week, increasing to 3–4 times per week, progressing from the lowest resistance to higher resistance depending on ability. Contractions were held for 3–5 seconds, repeated 5 times, and building to 2–3 sets of 10 repetitions. TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as in item 4 and 8. Care plan, exercise plan and postdischarge management tailored to individual. TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified. TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): during the telephone follow‐ups feedback was sought on the levels of adherence to the exercise programme and progress with the exercise plan and goals. TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): 31 (53%) participants reported following their programme all the time or nearly every day, another 11 (19%) doing their exercises 3–4 days per week and 16 (28%) doing their exercises ≤ 2 days per week or none of the time.
Control arm
TIDieR item 1: usual care. TIDieR item 2: not specified. TIDieR item 3: not specified. TIDieR item 4: routine care as would normally be provided. TIDieR item 5: not specified. TIDieR item 6: face‐to‐face. TIDieR item 7: medical ward. TIDieR item 8: not specified. TIDieR item 9: not specified. TIDieR item 10: not specified. TIDieR item 11: not specified. TIDieR item 12: not specified.
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