Home-based extended rehabilitation for older people with frailty (HERO): a randomised controlled trial

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).