Value of home-based physiotherapy

Canadian study performed assessing the value of home based physiotherapy for patients:

Over 75% of people requiring home care are seniors who require assistance in managing physical and cognitive limitations.1 Physiotherapy provided in the home lowers mortality rates related to falls and the risk and rate of falls in older adults, reduces number of nursing home admissions and hospitalizations, and decreases hospital length of stay (LOS). 2

Role of Physiotherapy in Home-based Services

Home-based physiotherapy services provide assessment and treatments to Canadians in their homes and communities for many conditions, including, stroke, heart failure, Parkinson’s disease, and recovery from hip-replacement surgery. 2

Home-based physiotherapy improves overall physical wellbeing, enhances social functioning, ensures routine monitoring of isolated clients, and reduces the rate of re-hospitalization and future health care service utilization. Telerehabilitation programs, as an accessible alternative to home-based physiotherapy services in rural and remote communities, also produce positive health outcomes. Telerehabilitation is “the provision of rehabilitation intervention, education, training and support using technology across distances”. 3

Home-based physiotherapy programs help ensure continuity of care and facilitate the transition from hospital to home.

Impact on Patient Experience

Home-based physiotherapy increases independence, teaches self-management and promotes empowerment. 2

• Home-based services with regular visits from health care professionals, consistent monitoring and follow-up ensures continuity of care in the community. 2
• Patient satisfaction is high for both home-based physiotherapy and Telerehabilitation programs. 3,4
• Home-based physiotherapy enables patients to live in the community longer and more safely. 5

Impact on Population Health

Home-based physiotherapy programs for patients with balance and mobility problems, improves functional abilities and quality of life (QOL). 5

• Implementation of a home-based muscle strengthening, and balance retraining program decreases the rate and risk of falls in seniors living in the community. 6
• Physiotherapy interventions focused on functional improvements reduce mortality rates. 7
• Home-based physiotherapy improves physical and social function and QOL. 1-8

Impact on Health Care Costs

Home-based physiotherapy programs are highly cost-effective, reduce hospital LOS and prevent hospitalization.

• Early discharge home with rehabilitation services reduces hospital LOS for stroke patients. 3
• Home-based physiotherapy for rehabilitation from hip replacements surgery, results in a cost-effectiveness gain of 40%. 8
• Home-based physiotherapy services reduce health care costs by keeping people independent in their homes, preventing falls and providing a safe environment within the home. 1

Summary

Home-based physiotherapy programs are cost-effective when considering the long-term impact on future health care service use. For rural communities with limited access to physiotherapy services, Telerehabilitation produces similar outcomes to home interventions with relatively low costs while still maintaining a high rate of patient satisfaction.

Home-based physiotherapy programs are also critical to service integration. Currently, there are large gaps in the continuum of care for patients who require rehabilitation services in the community. The health care system must start providing services that supports and promotes independent living.

Key References:

1. Health Council of Canada. (2012). Seniors in need, caregivers in distress: what are the home care priorities for senior’s in Canada? Toronto. Health Council of Canada.

2. Valuation of Physiotherapy Services in Canada; CPA report using MCDA analysis for determining value of physiotherapy services; Mitton G; Dionne F. 2012.

3. Alberta Centre for Telerehabilitation. Accessed from: http://www.uofaweb.ualberta.ca/telerehab/about.cfm. Accessed on August 9th, 2012.

4. Langhorne P., Widen-Holmqvist L., Taylor G., et al. Early supported discharge after stroke. Journal of Rehabilitation Medicine. 2007. 39 (2) (pp 103-108).

5. Johansson T, Wild C. Telerehabilitation in stroke care- a systematic review. Ludwig Boltzmann Institute for Health Technology Assessment. 2011;17(1):1-6.

6. Helbostad J.L., Sletvold O., Moe-Nilssen R. Effects of home exercise and group training on functional abilities in home dwelling older persons with mobility and balance problems. A randomized study. Aging-Clinical and Experimental Research. 2004;16(2):113-121.

7. Gillepsie LD, Robertson MC, Gillepsie WJ, Land SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2009; Issue 2, Art.No:CD007146.

8. Fontan E. Long-term effectiveness of a home intervention to reduce functional problems: results of a randomized controlled trial. Cahiers de l’Année Gérontologique. 2010;2(3):188-90.

9. Sigurdsson E., Siggeirsdottir K., Jonsson Jr. H., Gudnason V., Matthiasson T., Jonsson B.Y. Early discharge and home intervention reduces unit costs after total hip replacement: Results of a cost analysis in a randomized study. International Journal of Health Care Finance and Economics. 2008; 8 (3) (pp 181-192).

The value of a health care service is more than its proven cost-effectiveness. Quality of life, access, and continuity of care and integration of services are equally important criteria when looking at the broader concept of value.