Effect of Biophysical Agents on Outcomes for Older Adults With Chronic Conditions

PURPOSE: This study explored the use of biophysical agents (BPAs) as an adjunct to traditional occupational therapy interventions to further enhance functional outcomes of older adults with chronic conditions. Federal and state reform initiatives such as the National Quality Strategy aim to improve health care quality and stem rising costs by rewarding efficiency and efficacy of outcomes. These initiatives, coupled with stricter care requirements, have led to renewed interest in BPAs as interventions to assist in managing difficult-to-treat conditions.

METHOD: In this retrospective cohort study, we analyzed the electronic medical records (EMR) of clients with multiple chronic conditions treated with BPAs in postacute care (PAC) settings. Deidentified data were collected electronically from the EMR system of participating PAC sites via a research data warehouse containing EMR and cost-related data for more than 1,200,000 clients with more than 60 million encounters. The study was approved by Aegis Therapies institutional review.

Data from clients receiving traditional occupational therapy plus BPAs within PAC locations between January 2010 and July 2015 were extracted and accessed. Data for a control group of age-matched clients managed by occupational therapy without BPAs were also obtained. A case report form was developed before the start of the study to capture variables necessary to meet study objectives. Information extracted included general data, setting, baseline client characteristics, and functional outcomes. The baseline period included data from the initial plan of care before BPA treatment initiation. The date of the first treatment was deemed the index date. The follow-up period was the therapy discharge report.

The main outcome measure was functional performance using the Occupational Therapy Rehabilitation Outcome Measure. In determining health care resource utilization, length of therapy stay (LOS) was controlled. Based on data type, Pearson or Spearman rank correlations were used to measure relationships. Unpaired t test, chi-square, and analysis of variance was used to measure difference in demographics and outcomes. Common criteria for evaluating correlation coefficients were used to assess the strength of the relationship between the target and reference tests (.00–.25 = little or none, .25–.50 = fair, .50–.75 = moderate to good, .75–1.00 = good to excellent).

RESULTS: Compared with the control group, there was a significant within-group difference in pretest and posttest functional performance scores (p < .001). This result indicates that for adults with chronic conditions causing functional disability across the postacute care continuum, traditional occupational therapy with adjunctive BPAs improved functional performance.

CONCLUSION: Occupational therapy can maximize wellness of older adults by using evidence-based interventions such as BPAs. This study revealed that the use of BPAs as an adjunct to traditional occupational therapy interventions can significantly improve performance in occupation for people with a variety of chronic conditions. In the domain of occupational therapy, BPAs promote a physiological response to the body functions aspect of client factors influencing performance in occupation. This study demonstrated that the use of BPAs can improve performance in occupations including activities of daily living, rest and sleep, leisure, and social participation among older adults with chronic conditions when LOS is controlled.

IMPACT STATEMENT: Occupation-based interventions plus BPAs can enhance functional outcomes while containing costs. BPAs can significantly improve client factors and performance skills necessary for obtaining wellness in human occupation of older adults with chronic conditions.

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