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June 8, 1994

Rehabilitation for Frail Nursing Home Residents-Reply

Author Affiliations

University of Texas Health Science Center San Antonio

JAMA. 1994;271(22):1740-1741. doi:10.1001/jama.1994.03510460032016

In Reply.  —Conservative interpretation of our results is warranted. This is the first randomized trial of PT in nursing home residents and was limited to residents without severe cognitive impairment. Gains in mobility were modest and were not accompanied by significant improvements in other areas of physical function. Significant cost benefits associated with the mobility gains were not discerned, as neither nursing home costs nor total health care costs were lower in the PT group compared with the control group.Physical function (the primary outcome) was evaluated in a comprehensive and reliable manner using a battery of instruments that included performance-based, observer-rated, and self-perceived measures. Specifically, the PDI is a performance-based measure that incorporates areas that are routinely used in practice and research. Range of motion items are performed with standard goniometric techniques. Strength measures use the Nicholas Manual Muscle Tester, which has been shown to be reliable with trained

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