Functional incidental training: a randomized, controlled, crossover trial in Veterans Affairs nursing homes.
OBJECTIVE
To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes.


METHODS
Randomized, controlled, crossover trial.


METHODS
Four VA nursing homes.


METHODS
All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55).


METHODS
Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial.


METHODS
Timed measures of walking or wheeling a wheelchair (mobility), sit-to-stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one-repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios.


RESULTS
There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8-week crossover period. Within-person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were "responders" based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period.


CONCLUSIONS
FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care.
Ouslander
Joseph G
JG
Division of Geriatric Medicine and Gerontology, Department of Medicine, and the Center for Health in Aging, Emory University School of Medicine, Atlanta, Georgia 30329, USA. jouslan@emory.edu
Griffiths
Patricia C
PC
McConnell
Eleanor
E
Riolo
Lisa
L
Kutner
Michael
M
Schnelle
John
J
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010807:Physical Endurance; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000534:rehabilitation*; D016138:Walking