Functional Activities to Optimize Patient Outcomes in Home Health: A Pilot Randomized Controlled Trial

Reducing task demands early in the rehabilitation process to promote activity participation, followed by increasing those demands as functional exercise, may enhance the outcome of activities of daily living (ADL) for patients receiving home health therapy. This study examined the feasibility and preliminary effects of the Home-based Activity Reactivation Program (HARP), which combines compensatory and restorative approaches to calibrate task demands as an adjuvant to usual home health therapy, on ADL performance and physical functioning.

A single-blind, pilot randomized controlled trial with repeated measures.

Forty-seven patients who receive home health care (mean age = 82.3 ± 7.5 years) were randomized to receive either HARP and usual therapy (treatment group) or usual therapy alone (control group).

HARP was delivered in 6 weekly home visits, separate from usual therapy sessions. The primary outcome was the Motor Skills domain of the Assessment of Motor and Process Skills. Secondary outcomes included the Activity Measure for Post-Acute Care Home Health Short Form, Box and Block Test, Jebsen Hand Function Test, Timed-Up-and-Go Test, and Short Physical Performance Battery.

HARP showed strong feasibility, achieving an 88% completion rate and 95% satisfaction among completers. No program-related severe adverse events were reported. However, the 2 groups did not differ in change scores for Motor Skills at the postintervention (estimate = -0.31 logits, P = .07) or at 1-month follow-up (estimate = 0.20 logits, P = .37). No significant between-group differences were observed over time for secondary outcomes.

Although feasible and safe, adding HARP to usual therapy did not yield superior functional outcomes compared with usual therapy alone. Factors such as insufficient usual therapy visits, delays in HARP initiation, and potential practitioner bias may have influenced these results. These factors highlight inherent challenges of integrating and evaluating adjuvant interventions within real-world home health care.