Independence in activities of daily living for home-based geriatric rehabilitation after shortened inpatient rehabilitation: the “Better@Home” center prospective cohort study with a matched historical control group

PURPOSE: Population aging is increasing the demand for geriatric rehabilitation (GR). A transition towards home-based GR could potentially reduce the need for inpatient GR and better align rehabilitation with daily functioning at home. The aim of this study is to compare the level of independence in activities of daily living between patients receiving the "Better@Home" program and those undergoing conventional inpatient geriatric rehabilitation. METHODS: The Better@Home study is a multicenter prospective cohort study with a matched historical control group. Eight GR facilities in the Netherlands implemented the Better@Home program, which is a five-component intervention in which home-based GR replaces part of inpatient GR. Data was gathered at GR admission and discharge through semi-structured interviews, registration forms, and electronic patient files. The Better@Home group was compared with a matched historical control group receiving conventional inpatient GR on independence in activities of daily living (ADL), assessed by the Barthel Index (BI). Data was analyzed using a Cox and linear mixed-effects (LMM) regression model. RESULTS: A total of 350 participants were included (Better@Home n = 110; control n = 240). Groups were comparable on all characteristics at baseline. The LMM analysis found no significant difference between the Better@Home and the control group on independence in ADL at discharge (mean BI difference: 0.48 points, 95% CI -0.323-1.282; p = 0.240). CONCLUSION: This study demonstrates that a structured home-based GR program, replacing part of inpatient GR, can achieve comparable levels of independence in activities of daily living to conventional inpatient GR.