An adaptation of the WHO 4-step Integrated Care for Older People locomotion pathway with blended eHealth resistance training associated with enhanced locomotor capacity in community-dwelling older adults: a retrospective, quasi-experimental study

Abstract Background The World Health Organization Integrated Care for Older People (ICOPE) pathway has yielded inconsistent effects on locomotor capacity, partly because transitions from assessment to intervention are fragmented in community settings. We merged ICOPE steps 1 and 2 for the locomotion domain into a single encounter (4-m walk test [4MWT] and five-times sit-to-stand test [FTSST]), followed by a four-movement progressive resistance-training program and week-8 reassessment, delivered through a blended eHealth and community model embedded in Taiwan’s Long-Term Care 2.0 tier-C network. Methods In this retrospective, quasi-experimental study, 858 community-dwelling adults aged ≥ 60 years were assessed at baseline; after seven exclusions, 851 were analyzed (811 intervention; 40 self-selected, assessment-only comparators, 15 with baseline impairment). Participants were stratified by baseline locomotor status (impaired: 4MWT speed < 1.0 m/s and/or FTSST > 10.8 s). Sensitivity analyses included three-level mixed-effects models with random intercepts for participant and district estimated group-by-time effects; inverse probability of treatment weighting (IPTW), cluster-robust standard errors, wild-cluster bootstrap, and leave-one-district-out analyses. Results Group-by-time interactions favored the intervention: 0.13-m/s greater gain in gait speed (95% CI 0.04 to 0.22, P = 0.005, d = 0.36), exceeding the minimum clinically important difference of 0.10 m/s (robust under CR2, the wild-cluster bootstrap and 37 of 37 leave-one-district-out refits), and a 1.13-s greater reduction in FTSST time (95% CI − 2.00 to − 0.26, P = 0.011, d = 0.27), which was directionally consistent but less robust (significant in 35 of 37 leave-one-district-out refits; continuous baseline moderation significant under model-based inference but not under the wild-cluster bootstrap, P = 0.223) and lacks a population-appropriate minimum clinically important difference. Estimates persisted after modelling district clustering (intraclass correlation coefficients 0.41 and 0.19). The impaired comparator stratum showed essentially no change, whereas the impaired intervention stratum ( n = 365) improved (− 2.17 s, + 0.21 m/s; both P < 0.001), arguing against regression to the mean. IPTW results were concordant. Conclusions This ICOPE-informed locomotion pathway was associated with enhanced locomotor capacity, most robustly for gait speed, with supportive but less consistent sit-to-stand findings, particularly with baseline impairment. As allocation was by preference and comparators few, findings are associational and address one ICOPE domain rather than complete ICOPE implementation.