Application of High-Intensity Functional Resistance Training in a Skilled Nursing Facility: An Implementation Study

Area of Science:

• Gerontology
• Rehabilitation Medicine
• Implementation Science

Background:

• Skilled nursing facilities (SNFs) face pressure to enhance care quality and outcomes efficiently.
• High-intensity resistance training (HIRT) has shown benefits in other populations but not yet in SNFs.
• This study addresses the gap by exploring HIRT in the SNF setting.

Purpose of the Study:

• To assess the safety and feasibility of implementing HIRT in SNFs.
• To gather preliminary data on the effectiveness of HIRT for functional improvement in SNF residents.
• To evaluate patient satisfaction and participation in HIRT within SNFs.

Main Methods:

• A pragmatic study design comparing HIRT (i-STRONGER program) with usual care in two independent groups within a single SNF.
• Physical therapists administered the Short Physical Performance Battery (SPPB) and gait speed assessments.
• Implementation outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, with fidelity assessed via checklists and audits.

Main Results:

• No treatment-related adverse events were reported, indicating safety.
• High treatment fidelity (>99%) was observed, though documentation varied (21-50%).
• Patients in the i-STRONGER group showed greater improvements in gait speed (0.13 m/s) and SPPB scores (0.64 points), with higher satisfaction and fewer refusals; SNF length of stay was reduced by 3.5 days.

Conclusions:

• HIRT is safe and feasible for implementation in SNFs.
• Preliminary evidence suggests HIRT can improve function and patient satisfaction in SNF residents.
• Larger studies are warranted to confirm effectiveness due to population heterogeneity.