Association Between Weekly Amount of Home-Visit Rehabilitation and Changes in Activities of Daily Living: A Retrospective Cohort Study Using Home-Visiting Nursing Station Records.

Abstract

Objective To examine the association between average weekly minutes of home-visit rehabilitation (HR) and 6-month changes in activities of daily living (ADL) for older adults. Design Retrospective cohort study using anonymized electronic health record data. Setting A total of 1525 home-visit nursing stations across Japan. Participants Adults aged ≥65 years who initiated HR after April 2021 and continued for ≥6 months. Interventions HR categorized by average weekly duration: ≤40 min/wk, >40 to ≤60 min/wk, >60 to ≤80 min/wk, and >80 to ≤120 min/wk. Main outcome measure Change in Barthel index (BI) score from baseline to 6 months. Results The analysis included 25,409 participants; the mean (SD) age was 82.9 (7.7) years, and 41.5% were male. The mean (SD) baseline BI was 68.7 (27.1). The proportion of HR duration was as follows: ≤40 min/wk (40.2%), >40-60 min/wk (25.6%), >60-80 min/wk (19.0%), and >80-120 min/wk (15.1%). Multivariable linear regression showed significant BI improvements in the >40-60 min/wk (0.30; 95% confidence interval [CI]: 0.05-0.54), >60-80 min/wk (1.05; 95% CI, 0.78-1.32), and >80-120 min/wk (1.06; 95% CI, 0.77-1.35) groups compared with the ≤40 min/wk group. Among participants with care-need level 1, no significant differences were observed across groups. Conclusions Increased average minutes per week of HR at 6 months is associated with an improvement in BI. This result suggests that an HR of 40 min/wk may be insufficient to improve ADL.