Implementation of a rehabilitation model in a Program of All-Inclusive Care for the Elderly (PACE): Preliminary data

Background: Nursing home eligible participants in the Program of All-inclusive Care for the Elderly (PACE) are at high risk for falls. Physical function is a modifiable predictor of falls and an important target for prevention. We engaged a PACE site to explore feasibility of implementing progressive intensive rehabilitation to improve physical function and preliminary patient-level improvements.

Methods: The research involved a mixed-methods, pre-post implementation study with longitudinal patient follow-up at one Denver PACE site. Older adults at risk for institutionalization (N = 28) took part in Screening and high-intensity interventions to Improve Falls risk and Transform expectations in age and aging (SHIFT) rehabilitation program over six weeks. Outcomes included the short physical performance battery (SPPB); 4-meter gait speed at baseline, discharge, and 6 and 12 months postdischarge from SHIFT. A focus group with staff explored facilitators and barriers to program implementation in the PACE setting and with complex patients and perceived effectiveness.

Results: The rehabilitation team demonstrated high treatment fidelity to SHIFT (>80%). No treatment-specific adverse events were reported. SPPB scores and gait speeds improved significantly over time (p < 0.005). The average SPPB score at evaluation was 4.6 ± 0.24 compared to 7.7 ± 0.38 points at discharge. The average gait speed at evaluation was 0.58 ± 0.03 meters/second (m/s) compared to 0.79 ± 0.04 m/s at discharge. Common barriers to program completion included changes in health status and environmental factors (e.g., transportation).

Conclusions: Rehabilitation therapists incorporated a high-intensity resistance training program into routine care of complex older adults in PACE and improved pre-post physical function to levels above independence thresholds (SPPB ≥6; gait speed ≥0.65 m/s). Our pilot implementation study informed refinement of eligibility criteria, number of visits, and strategies to address long-term adherence to enhance scalability and optimize impact.