Physical activity programs for older people in the community receiving home care services: systematic review and meta-analysis

Figures & data

Table 1 Search strategy

1	Community care
2	Community health care
3	Home care
4	Community nursing
5	Home and community care
6	Home support
7	Community rehabilitations
8	Restorative care
9	Reablement
10	1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9
11	Physical activity
12	Exercis*
13	11 or 12
14	Ageing
15	Aging
16	Aged
17	Older
18	Elderly
19	14 or 15 or 16 or 17 or 18
20	10 and 13 and 19

Table 2 Summary of included randomized controlled trial (RCT) studies

Reference (country) study design	Study purpose	Sample size; % female; age (years)(SD) comparator	Population	Outcomes and measurement; follow-up	Intervention effect
Burton et al,^Citation28 (Australia) Pragmatic randomized controlled trial	Determine whether LiFE would be undertaken more often and result in greater functional gains than the current structured exercise program delivered as part of a restorative home care service	LiFE =40; 75%; 80.2 years (6.4) Structured exercise =40; 90%; 79.6 years (6.2) Yes	Living in Perth suburbs (Western Australia) referred for a restorative home care service	Functional reach, chair sit-to-stand (1 and 5), TUG, Tandem walk, FES, ABC Scale, Vitality Plus Scale, The Late Life Function and Disability instruments 8 weeks	LiFE group significantly improved in 95% (19 of 20) of outcome measures, compared with the structured exercise group, which significantly improved in 70% (14 of 20).
Burton et al,^Citation29 (Australia) Pragmatic randomized controlled trial	Examine over the longer term, the effectiveness and maintenance of a (modified) LiFE compared to the current, structured exercise program used in a restorative home care service	LiFE =40; 75%; 80.2 years (6.4) Structured exercise =40; 90%; 79.6 years (6.2) Yes	Living in Perth suburbs (Western Australia) referred for a restorative home care service	Functional reach, chair sit-to-stand (1 and 5), TUG, Tandem walk, FES, ABC Scale, Vitality Plus Scale, The Late Life Function and Disability instruments, 6 month fall history 8 weeks and 6 months	A significant main effect of time was found for all measures. LiFE showed significantly greater improvement than the structured exercise group for tandem walk, ABC score, and Vitality Plus scale
Danilovich et al,^Citation30 (USA) Randomized controlled trial	To test the effects of SFL exercise program on the physical performance and self-rated health of older adults enrolled in the Community Care Program, a Medicaid waiver program	42; 83%; 74.8 years Intervention =24; 83%; 74.1 years Control =18; 83%; 75.6 years Yes	Community-dwelling older adults receiving HCA services through the Community Care Systems, Inc. in Illinois	Grip and quadriceps strength using a hand-held dynamometer, TUG, 10 ft gait speed, Self-Efficacy for Exercise, pain, and PROMIS-global health 12 weeks	Effect sizes were moderate for grip strength, pain, and PROMIS-global health. SFL participants significantly improved median quadriceps and TUG (median only) scores compared to controls. No adverse health events and high program satisfaction were reported. Frailty prevalence in the control group increased whereas it decreased in the SFL group.
Danilovich et al,^Citation31 (USA) Randomized controlled trial	Determine the feasibility of training HCAs to lead the SFL program with their Community Care Program clients	42; 83%; 74.8 years (8.8) Intervention =24; 83%; 74.1 years (9.9) Control =18; 83%; 75.6 years (8.1) Yes	Community-dwelling older adults receiving HCA services through the Community Care Systems, Inc. in Illinois	Client and HCA program satisfaction rates, HCA SFL training evaluation information and SFL fidelity rates 12 weeks	It is feasible for HCAs to implement SFL safely with clients. Participants viewed SFL as highly satisfactory and HCAs were able to adapt SFL for their clients. HCAs have high job satisfaction, and leading SFL enhances work achievement and pride
King et al,^Citation32 (New Zealand) Cluster randomized controlled trial	Evaluate the impact of a restorative home care service, compared with usual care for community-dwelling older people	186; 74%; 79 years Restorative =93; 69.9%; 78.4 years (6.5) Control =93; 77.4%; 80.5 years (6.3) Yes	Older people receiving assistance from a home care agency in New Zealand	SF-36, Nottingham Extended ADL, TUG, Mastery scale, DSSI 4 and 7 months	Significant benefit in health-related quality of life (SF-36) at 7 months compared to usual care, particularly in the mental health component. A significantly higher number of older people in the intervention group were identified for reduced paid caregiver support or discharge
Parsons et al,^Citation33 (New Zealand) Cluster randomized controlled trial	To determine the impact of a restorative model of home care on social support and physical function among community-dwelling older people	Intervention =108; 71.3%; 79.1 years (6.9) Usual care =97; 60.8%; 76.9 years (7.6) Yes	Community-dwelling people older than 65 years (55 years if Maori or Pacific Islander) were eligible if they were new referrals to the care coordination agency for home care in New Zealand	SPPB, DSSI 6 months	Intervention group had a greater mean increase in physical function over time than the usual care group as determined by overall SPPB
Renehan et al,^Citation36 (Australia) Randomized controlled trial	Determine feasibility and acceptability of a community-delivered post-hospital falls prevention program, incorporating exercise, medication review, and education	13; 53.8%; 82.2 years (9.7) Intervention =7; 57.1%; 84.0 years (6.4) Control =6; 50% 75.8 years (11.6) Yes	Recently discharged from a hospital within metropolitan Melbourne, Australia after being admitted for a fall and a new or existing client of the community home care organization	Quality of life (AQoL-8D), falls, fall risk (FROP-Com), FES-I, Fried Frailty Criteria, Katz ADL, qualitative falls interview. Intervention only: five times sit-to-stand, 4 test balance scale (feet together, semi-tandem, tandem and one leg stand), TUG 6 months	The exercise component of the multifactorial intervention was highly valued by intervention participants. Five falls during intervention period: intervention group: 3; control group: 2. No significant changes in physical outcome measures.
Saeterbakken et al,^Citation37 (Norway) Randomized controlled trial	Determine the effects of a 10-week home-based strength training program on physical function tests, level of physical activity, muscle strength, and RFD among frail old adults receiving home care services	23; 73.9% Intervention =11; 86.5 years (6.4) Control =12; 83.5 years (5.7) Yes	Older adults living at home and in need of home care due to functional disabilities and/or medication	Leg extension and elbow flexion maximal strength and RFD, preferred/max walking speed, stair climb, 5x chair rise and physical activity (accelerometer) 10 weeks	Intervention group significantly improved peak RFD in leg extension
Stevens-Lapsley et al,^Citation34 (USA) Randomized controlled trial	To determine whether a progressive multicomponent physical therapy intervention in the home setting can improve functional mobility for deconditioned older adults following acute hospitalization compared to usual care rehabilitation	22; 63.6%; 85.4 years (7.8) Intervention =12; 70%; 83 years (6.8) Usual care =9; 58.3%; 87 years (8.8) Yes	Older adults with multiple chronic conditions, who were discharged from the Acute Care for the Elderly unit of the University of Colorado Hospital, with physician referrals for home health physical therapy	4 m walking speed, modified Physical Performance Test, SPPB, six minute walk test 30 and 60 days	Intervention group had significantly greater improvements in walking speed, modified physical performance test, and SPPB scores compared with the usual care group at 60 days
Tuntland et al,^Citation35 (Norway) Randomized controlled trial	Investigate the effectiveness of reablement (multicomponent home-based rehabilitation) in older adults compared with usual care in relation to daily activities, physical functioning, and health-related quality of life	Intervention =31; 71%; 79.9 years (10.4) Control =30; 63.3%; 78.1 years (9.8) Yes	People applying for, or referred to, home-based services due to functional decline in one or more ADL in a rural municipality in Norway	COPM was used to measure self-perceived activity performance and satisfaction with performance. Health-related quality of life (COOP/Wonka), TUG, grip strength 3 and 9 months	Significant improvements in mean scores favoring reablement in COPM performance at 3 and 9 months and overall treatment, and for COPM satisfaction at 9 months and overall treatment

Abbreviations: LiFE, Lifestyle-integrated Functional Exercise program; TUG, Timed Up and Go; FES, Falls self-Efficacy Scale; ABC, Activities specific-Balance Confidence Scale; SFL, Strong For Life; HCA, home care aide; ADL, activities of daily living; DSSI, Duke Social Support Index; SPPB, Short Performance Physical Battery; FROP-Com, Falls Risk for Older People – Community Setting; FES-I, Falls self-Efficacy Scale – International; RFD, Rate of Force Development; COPM, Canadian Occupational Performance Measure.

Table 3 Summary of intervention implementation for randomized controlled trial (RCT) studies

Reference	Implementation strategy	Intervention
Burton et al,^Citation28^,^Citation29	LiFE and structured exercise program were delivered by care managers as part of a restorative home care service. Clients were visited every 10–14 days by their care manager (average 3 visits) to offer support, encouragement and to progress exercises. Exercise was just one aspect of their service that was discussed during these visits	LiFE intervention =7 balance and 6 lower limb strength exercises incorporated into everyday activities. Exercises were explained by care manager and a descriptive manual was given to clients. Control group: structured exercises =3x per day 5 repetitions of 6 strength and 2 balance exercises (15–20 minutes). Exercises were provided on a sheet illustrating exercises.
Danilovich et al,^Citation30,Citation31	HCAs attended a half-day SFL training session. HCAs completed SFL with their clients 2x per week for the first 2 weeks of the program with clients completing a third session independently. After the initial 2-week period, HCAs provided their clients motivation at each usual care visit (2–3x per week) to perform SFL 3 times a week for an additional 10 weeks.	12 weeks SFL; 35-minute DVD that includes a warm up, 11 upper and lower extremity exercises using therabands for resistance, and a cool down.
King et al,^Citation32	Paid caregivers undertook 2 training programs based on a restorative care philosophy designed to optimize independence in older people, taking approximately 5 and 18 weeks. Coordinator (experienced registered nurse) undertook an initial in-depth assessment with the participant using TARGET, leading to a support plan for paid caregivers to implement at visits with participants, ranging from daily to fortnightly. Coordinators provided enhanced supervision for paid caregivers by undertaking compulsory 2-hour fortnightly meetings and also provided follow-up consultations with participant (phone call or visit) every 3 months, and a full re-assessment at 12 months	Repetitive ADL exercises designed to optimize independence and to further support participant in reaching their goals
Parsons et al,^Citation33	Intervention group completed a goal facilitation tool (TARGET) with a needs assessor to determine their needs and to establish the aims for the episode of care. Services were structured according to the principles of restorative home care (independence focused with individually tailored activity programs). HCAs then completed tasks outlined in the support plan for each individual.	Home care services included domestic tasks, personal care, shopping, and individualized activities (walking or exercise programs/other activities aimed at improving functional ability). In the intervention group 61.7% (n=66) of the support plans described such individualized activities as opposed to 15% (n=14) in the usual care group.
Renehan et al,^Citation36	Participants were approached 1–2 weeks after discharge, intervention included a medication review, falls prevention education, and home-based exercise individually prescribed and modified according to pre-existing frailty by exercise physiologist (visits at weeks 1, 2, 4, and 8 for exercise progression), participants were provided diagrams of exercises and instruction on exercise safety. Participant’s primary nurse who regularly visited for other matters provided encouragement.	Three to five times per week 20–30 minutes graduated lower limb strengthening and balance exercises (Otago Exercise Programme)
Saeterbakken et al,^Citation37	A professional training instructor was present at every training session to make sure of the correct technique, intensity, and numbers of sets.	Supervised progressive strength training programme 60 minutes 2x week for 10 weeks, 10–12 repetitions 2–3 sets squats, box lifts, seated row, chest press, and biceps curl.
Stevens-Lapsley et al,^Citation34	Patients placed in the progressive multicomponent intervention group were referred to home health agency and were seen by a single physical therapist who was trained to provide the progressive intervention. Two to three physical therapy visits per week for 30 days.	Progressive multicomponent physical therapy intervention consisted of ADL training (bathroom transfers, bed mobility, and car transfers), evidence-based mobility training (indoor walking, gait training on flat ground and stairs, and outdoor walking transitioning to an independent daily walking program) and progressive strength training (3 sets 8 repetitions max supine leg press, standing hip extension, body-weight resisted plantar flexion, seated press and seated row using the Shuttle Mini Press). Participants were given a home exercise program to continue basic exercises after discharge.
Tuntland et al,^Citation35	Occupational and physical therapists used COPM to identify activity limitations perceived as important by the participant and developed a rehabilitation plan with a maximum rehabilitation period of 3 months. Therapists supervised HCA whose focus was on stimulating the participants to perform the daily activities themselves, rather than letting others do it for them, physiotherapist and/or occupational therapist visited participants for a minimum of 1 hour each week. All HCAs attained training before the intervention was implemented. Therapists had weekly informal lunch meetings with HCAs in order to ensure good communication and follow-up of individual participants	Individualized reablement program including training in daily activities (dressing, food preparation, vacuuming, bus transport), adaptations to the environment or the activity to simplify activity performance, and exercise programs such as indoor or outdoor walking with or without walking aids, climbing stairs, transferring, and performing exercises to improve strength, balance or fine motor skills. The exercises were incorporated into daily routines and participants were given a manual explaining each of the exercises and encouraged to train on their own

Abbreviations: LiFE, Lifestyle-integrated Functional Exercise program; SFL, Strong For Life; HCA, home care aide; TARGET, Towards Achieving Realistic Goals in Elders Tool; ADL, activities of daily living; COPM, Canadian Occupational Performance Measure.

Figure 1 Flow chart of study selection.

Table 4 Summary of included non-randomized controlled trial (RCT) studies

Reference (country) Study design	Study purpose	Sample size; % female; age (years)(SD) comparator	Population	Outcomes and measurement follow-up	Intervention effect
Bamgbade and Dearmon,^Citation38 (USA) Quasi-experimental single group study pre and post-test	Evaluate the impact of a fall assessment tools and patient-specific fall prevention programs in reducing the incidence of falls and fall-related injuries among older patients receiving home HHS	30; sex unknown; aged 65 and over No	Receiving nursing care services on a long-term basis. Suffer varying degrees of physical, mobility, or cognitive impairments, such as diabetes, stroke, and urinary incontinence	Number of falls and falls with injuries 6 months	Reduction of falls and major injuries.
Burton et al,^Citation39 (Australia) Quasi-experimental single group study pre- and post-test (pilot)	Determine whether a  LiFE was suitable for delivery in a restorative home care service	8; 75%; 80.8 years (5.9) No	Current restorative home care clients, living in Perth (Western Australia)	Functional reach, chair sit-to-stand (1 and 5), TUG, Tandem walk, FES, ABC Scale, Vitality Plus Scale, The Late Life Function and Disability instruments, PASE, Accelerometer, LiFE Assessment tool, 8 weeks	Difficulties using the accelerometer and LiFE Assessment tool. Significant improvement in FES, tandem walk, Late Life Function total score, and PASE
Burton et al,^Citation44 (Australia) Feasibility study	To investigate the feasibility of community care workers delivering a falls prevention exercise program to older clients, at low or medium risk of falling, as part of an existing service provision	29; 65.5%; 82.7 (8.7) years No	Older adults receiving at least one community care service from a participating community care organization or an RAS assessment, living in Perth, Western Australia	FROP-Com, Physical Activity Readiness Questionnaire (PARQ) and LiFE assessment tool measured at baseline. Client and staff program satisfaction measured post-test. 8 weeks	LiFE exercise program was safely delivered by RAS assessors and support workers, with no adverse events reported. The majority of clients (82%) reported enjoying the exercises, 59% felt it made a positive change to their health. Exercise adherence: 4.8 (SD: 2.2) days per week.
Gallagher et al,^Citation45 (USA) Retrospective	Determine concurrent based validity of the MAHC-10 with the Performance Oriented Mobility Scale (Tinetti), and determine the benefit of the Balanced Approach rehabilitation program.	228; sex unknown; aged 65 and over No	Patients referred for home care services to Catholic Home Care	MAHC-10 and Tinetti scores 6 months	There was weak but significant negative relationship between the MAHC-10 and pre-Tinetti scores. Significant differences in Tinetti scores between pre- and post-intervention
Henwood et al,^Citation43 (Australia) Single group study pre- and post-test	Develop an HCA-led exercise program for older adults with aged care needs and evaluate the benefits from both the perspective of the HCA and the person receiving the program	50; 74%; 82.1 years (6.1) No	Older adults receiving government-funded domestic assistance or personal care in Brisbane, Australia	SPPB, falls, hours of sleep, visits to a general or clinical practice health professional, emergency department/hospital, exercise compliance, SF-36 18 weeks	Significantly improved SPPB score, 19% reduction in participants classified as frail and a reduction in health care service access of 47% across the intervention
Kwok et al,^Citation40 (Hong Kong) Quasi-experimental pre- and post-test	Compare the effects of an exercise program supervised by a physiotherapist at a day training center with an exercise program delivered by a care worker at home on physical function, quality of life, and fall incidence in community-dwelling older adults	Center-based =24; 70.8%; 84.4 years (6.9) Home-based =26; 73.1%; 83.2 years (7.0) 5 center-based and 4 home-based participants had MMSE <12 Yes	Clients admitted to the Enhanced Home and Community Care Service team, residing in the Wong Tai Sin District (Hong Kong). Suffering from chronic diseases with moderate or severe level of impairment	Elderly Mobility Scale, BBS, Numeric Pain Rating Scale, SF-12, and fall incidence 6 months	Center-based participants had significant improvement in all outcomes and less falls compared to home-based participants
Muramatsu et al,^Citation41 (USA) Single group study pre- and post-test	Test and enhance the feasibility of HM program delivered by HCAs for community-dwelling older adults in a Medicaid-funded home care setting	54; 78%; 77 (63–101) years; almost 1/3 had mild cognitive impairment No	Receiving in-home support services through the Illinois Department on Aging Community Care Program, Chicago	Daily activity difficulties and dependency (HM6, BADL, IADL), performance of 3 HM movements, SSPB, self-rated general health and pain, FES-I, falls, and exercise related social support 4 months	Clients‘ daily activity function and health outcomes improved significantly. The program was well-received by clients, high retention rates among clients (93%)
Park and Chodzko-Zajko,^Citation42 (USA) Single group study pre- and post-test	Assess the feasibility of implementing simple, safe, non-equipment evidence-based movements (HM program) using an affordable and sustainable HCA based delivery model that reaches the maximum possible number of frail older adults living at home but who are at risk of nursing home admission	13; 84.6%; 76.8 years (11.4) No	Older adults receiving home care services provided by Help at Home and Family Service; home visit programs funded by Older American’s Act in the State of Illinois	Evaluation surveys and interviews with clients, HCAs, and site directors. Functional ability of clients: 30-seconds chair stand, 30-seconds arm curl (5 pounds for females, 8 pounds for males) and chair sit and reach 4 months	Clients significantly improved number of arm curls in 30 seconds. No significant improvement in chair stand or chair sit and reach. Most participants had a positive perception and high satisfaction with the program. HM could be safely and successfully disseminated to frail older adults

Abbreviations: MAHC-10, Missouri Alliance for Home Care tool; LiFE, Lifestyle-integrated Functional Exercise program; FES, Falls self-Efficacy Scale; ABC, Activities specific-Balance Confidence Scale; TUG, Timed Up and GoPASE, Physical Activity Scale for the Elderly; RAS, Regional Assessment Service; HCA, home care aide; SPPB, Short Performance Physical Battery; FROP-Com, Falls Risk for Older People – Community Setting; MMSE, Mini Mental State Examination; BBS, Berg Balance Scale; BADL, Basic Activities of Daily Living; IADL, Instrumental Activities of Daily Living; HM, Healthy Moves; FES-I, Falls self-Efficacy Scale – International.

Table 5 Intervention implementation of included non-randomized controlled trial (RCT) studies

Reference	Implementation strategy	Intervention
Bamgbade and Dearmon,^Citation38	Staff providing nursing care to patients of the privately owned home health care agency were educated on the fall prevention program	MAHC-10 fall risk assessment tool, medication review process and management plan, home safety assessment, patient- and family-specific education, individualized home-based exercise regimen
Burton et al,^Citation39	LiFE program was delivered by care managers as part of a restorative home care service. Care managers explained to the client the different exercises and how these exercises could be incorporated into their daily routines, manual also provided. Clients were visited every 10–14 days by their care manager (average 3 visits) to monitor how well the client was performing the first exercises agreed to and to encourage the client to start doing others. Exercise was just one aspect of their service that was discussed during these visits	7 balance and 6 lower limb strength exercises incorporated into everyday activities
Burton et al,^Citation44	Staff completed a 4-hour training session on delivering the LiFE exercise program. Each staff member received 3 client folders, a staff folder and a LiFE trainer’s manual. Community care workers followed-up with their clients either during their usual services or on a fortnightly basis	7 balance and 6 strength exercises to complete whilst undertaking usual daily activities
Gallagher et al,^Citation45	Staff was trained in assessing risk factors and in fall prevention measures. The training sessions took place over a 6-hour period and were followed-up by performance-based competencies and case studies. Patients were evaluated with MAHC-10, scores ≥4 of 10 (indication of high risk for falls) started on the Balanced Approach rehabilitation program. The CHC falls screening and Balanced Approach rehabilitation program was designed to reduce the risk of falls in a home care population using an interdisciplinary approach	Treatment from physical and occupational therapists aims to improve gait, balance, balance confidence and reduce fall risk through individualized home exercise program designed to address impairments and home safety/mobility adaptations. The home program is in place for as long as the patient demonstrates a benefit or until safety/independence is achieved (average 8 visits, 45–60 minutes each)
Henwood et al,^Citation43	HCAs attended a 1-day workshop and received a printed manual containing detailed instructions for each exercise, information on healthy lifestyle behaviors, and an overview of common barriers and enablers to exercise participation. HCAs visited clients weekly or fortnightly for 60–90 minutes with at least 10 minutes assisting and monitoring client participation in the exercise program	5 strength exercises (chair stand, seated leg extension, standing calf raise, wall push-ups, theraband seated rows, progressing to 3 sets of 12 repetitions), 3 balance exercises (single leg stand for up to 20 seconds on each side, tight rope walk of 10 steps forward and back, 10 repetitions side to side step). Clients were encouraged to exercise on most, preferably all days
Kwok et al,^Citation40	Participants chose to receive exercise training at either a day training center under supervision of a physiotherapist (groups of 6–10 participants) or individually at home assisted by a care worker. Physiotherapists provided training to all care workers and monitored their performance every 2–3 months through on-site supervision to ensure quality of the training program at home	6 month flexibility, strength, balance, and aerobic exercise program with pain management, 1–2 sessions per week lasting approximately 60 minutes
Muramatsu et al,^Citation41	HCAs received 4 hours of training on how to deliver the HM program. At the initial visit (average 27 minutes, range 10–45 minutes) HCAs assessed readiness for PA, had their clients set personally meaningful goals, and taught the 3 chair-bound movements. HCAs reminded their clients of their personal PA goal/routines as part of their regular home care and logged their HM activities. Frequency of HCA home visits depended on the client’s care needs assessed by the Illinois Determination of Needs instrument (typically 3x per week or 12 hours per week)	Each day clients completed 15 arm curls 2 times (holding a 1-pound weight supplied by the project, or a soup can or water bottle), ankle point and flex up to 30 seconds on each foot 3 times and seated step-in-place up to 1 minute
Park and Chodzko-Zajko,^Citation42	HCAs attended a training session to deliver HM, this included how to teach the clients the 3 chair bound movements whilst utilizing Brief Negotiation techniques as a motivational tool. HCAs visited the client in the home and were asked to deliver the HM program on a regular basis for a 4-month time period	Each day clients completed 15–20 arm curls 2 times (holding a 1-pound weight, either soup can or water bottle), ankle point and flex working up to 30 seconds on each foot 3 times and seated step-in-place working up to 1 minute

Abbreviations: MAHC-10, Missouri Alliance for Home Care tool; LiFE, Lifestyle-integrated Functional Exercise program; CHC, Catholic Home Care; HCA, home care aide; PA, physical activity; HM, Healthy Moves.

Table 6 Randomized controlled trial (RCT) – assessment of risk of bias of RCTs

Study	Sequence generation	Allocation concealment	Blinding	Incomplete outcome data	Selective outcome reporting	Free of other bias
Burton et al,^Citation28	+	+	-	+	+	?
Burton et al,^Citation29	+	+	-	+	+	?
Danilovich et al,^Citation30	+	?	+	+	?	-
Danilovich et al,^Citation31	+	?	+	+	?	-
King et al,^Citation32	+	?	+	+	+	?
Parsons et al,^Citation33	?	?	+	+	+	-
Stevens-Lapsley et al,^Citation34	+	?	+	+	+	-
Tuntland et al,^Citation35	+	+	?	+	+	-
Saeterbakken et al,^Citation37	+	+	-	-	?	-
Renehan et al,^Citation36	+	+	+	+	-	-

Table 7 Randomized controlled trial (RCT) – assessment of quality of non-RCT papers

Study	1.1	1.2	1.3	2.1	2.2	2.3	2.4	2.5	2.6	2.7	2.8	2.9	2.10	3.1	3.2	3.3	3.4	3.5	3.6	4.1	4.2	4.3	4.4	4.5	4.6	5.1	5.2
Bamgbade and Dearmon,^Citation38	+	NR	NR	NA	+	NA	NA	NA	NA	NA	++	++	++	+	++	+	++	NA	+	NA	NA	NR	NR	+	NR	-	+
Burton et al,^Citation44	++	+	+	NA	++	NA	NA	NA	NA	NA	++	++	++	++	+	++	++	NA	++	NA	NA	NR	NR	++	++	+	++
Henwood et al,^Citation43	++	+	+	NA	++	NA	NA	NA	NA	NA	+	++	+	+	+	++	++	NA	+	NA	NA	NR	NR	++	+	-	+
Kwok and Tong,^Citation40	++	++	++	+	+	-	+	+	++	+	++	+	++	+	++	+	++	++	+	++	++	+	++	++	+	++	+
Muramatsu et al,^Citation41	+	+	++	NA	++	NA	NA	NA	NA	NA	++	++	++	+	++	+	++	NA	+	NA	NA	NR	NR	++	+	+	+
Park and Chodzko-Zajko,^Citation42	++	+	+	NA	+	NA	NA	NA	NA	NA	++	++	++	+	++	+	+	NA	++	NA	NA	NR	NR	++	+	+	+
Burton et al,^Citation44	++	+	+	NA	++	NA	NA	NA	NA	NA	++	++	++	+	++	++	++	NA	++	NA	NA	NR	NR	++	NR	+	++
Gallagher et al,^Citation45	+	+	+	NA	+	NA	NA	NA	NA	NA	NA	++	++	++	++	+	++	NA	+	NA	NA	++	++	++	++	+	+

Notes: 1.1: Is the source population or source area well described?; 1.2 :Is the eligible population or area representative of the source population or area?; 1.3: Do the selected participants or areas represent the eligible population or area?; 2.1: Allocation to intervention (or comparison). How was selection bias minimized?; 2.2: Were interventions (and comparisons) well described and appropriate?; 2.3: Was the allocation concealed?; 2.4: Were participants or investigators blind to exposure and comparison?; 2.5: Was the exposure to the intervention and comparison adequate?; 2.6: Was contamination acceptably low?; 2.7: Were other interventions similar in both groups?; 2.8: Were all participants accounted for at study conclusion?; 2.9: Did the setting reflect usual UK practice?; 2.10: Did the intervention or control comparison reflect usual UK practice?; 3.1: Were outcome measures reliable?; 3.2: Were all outcome measurements complete?; 3.3: Were all important outcomes assessed?; 3.4: Were outcomes relevant?; 3.5: Were there similar follow-up times in exposure and comparison groups?; 3.6: Was follow-up time meaningful?; 4.1: Were exposure and comparison groups similar at baseline? If not, were these adjusted?; 4.2: Was intention to treat analysis conducted?; 4.3: Was the study sufficiently powered to detect an intervention effect (if one exists); 4.4: Were the estimates of effect size given or calculable?; 4.5: Were the analytical methods appropriate?; 4.6: Was the precision of intervention effects given or calculable? Were they meaningful?; 5.1: Are the study results internally valid (ie, unbiased)?; 5.2: Are the findings generalizable to the source population (ie, externally valid)?

Figure 2 Timed Up and Go.

Figure 3 Sit-to-stand five times.

Figure 4 Grip strength.

Figure 5 Walking speed.

Burton E, Lewin G, Clemson L, Boldy D. Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial. Clin Interv Aging. 2013;8:1591–1601. doi:10.2147/CIA.S4461424324331

 PubMed Web of Science ®Google Scholar

Burton E, Lewin G, Clemson L, Boldy D. Long term benefits of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial. Healthy Aging Clin Care Elderly. 2014;6:1–9. doi:10.4137/HACCE.S13445

 Google Scholar

Danilovich M, Eisenstein A, Marquez D, Corcos D, Hughes S. The impact of strong for life on the physical functioning and health of older adults receiving home and community-based services. Aging Soc. 2017;7(2):1–10. doi:10.18848/2160-1909/CGP/v07i02/1-1027695646

 PubMedGoogle Scholar

Danilovich M, Hughes S, Corcos D, Marquez D, Eisenstein A. Translating strong for life into the community care program: lessons learned. J Appl Gerontol. 2017;36(5):553–569. doi:10.1177/073346481562583326912729

 PubMed Web of Science ®Google Scholar

King A, Parsons M, Robinson E, Jorgensen D. Assessing the impact of a restorative home care service in New Zealand: a cluster randomised controlled trial. Health Social Care Community. 2012;20(4):36–374. doi:10.1111/j.1365-2524.2011.01039.x

 Web of Science ®Google Scholar

Parsons J, Sheridan N, Rouse P, Robinson E, Connolly M. Randomized controlled trial to determine the effect of a model of restorative home care on physical function and social support among older people. Archives Phys Med Rehabiliation. 2013;94:1015–1022. doi:10.1016/j.apmr.2013.02.003

 PubMed Web of Science ®Google Scholar

Renehan E, Meyer C, Elliott R, et al. Post-hospital falls prevention intervention: a mixed-methods study. J Aging Phys Act. 2019;27(2):155–165. doi:10.1123/japa.2017-0406

 Web of Science ®Google Scholar

Saeterbakken A, Bardstu H, Brudeseth A, Andersen V. Effects of strength training on muscle properties, physical function, and physical activity among frail older people: a pilot study. J Aging Res. 2018;2018:8916274. doi:10.1155/2018/891627429988285

 PubMedGoogle Scholar

Stevens-Lapsley J, Loyd B, Falvey J, et al. Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: a pilot randomized controlled trial. Clin Rehabil. 2016;30(8):776–785. doi:10.1177/026921551560321926337626

 PubMed Web of Science ®Google Scholar

Tuntland H, Aaslund M, Espehaug B, Førland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015;15:145. doi:10.1186/s12877-015-0142-926537789

 PubMed Web of Science ®Google Scholar

Bamgbade S, Dearmon V. Fall prevention for older adults receiving home healthcare. Home Healthcare Now. 2016;34(2):68–75. doi:10.1097/NHH.000000000000033326835805

 PubMedGoogle Scholar

Burton E, Lewin G, Clemson L, Boldy D. Determining the feasibility of a lifestyle activity program for inclusion in a restorative home care service: a pilot study. Act Adapt Aging. 2014;38(2):79–93.

 Google Scholar

Burton E, Lewin G, O’Connell H, Petrich M, Boyle E, Hill K. Can community care workers deliver a falls prevention exercise program? A feasibility study. Clin Interv Aging. 2018;13:485–495. doi:10.2147/CIA.S16272829618925

 PubMed Web of Science ®Google Scholar

Gallagher R, Stith N, Southard V. Evaluation of the missouri alliance for home care fall risk assessment tool and home-based “Balanced approach” fall reduction initiative. Home Health Care Manag Pract. 2013;25(5):224–228. doi:10.1177/1084822313487203

 Google Scholar

Henwood T, Hetherington S, Purss M, Rouse K, Morrow J, Smith M. Active@Home: investigating the value of a home care worker-led exercise program for older adults with complex care needs. J Aging Phys Act. 2019;27(2):284–289. doi:10.1123/japa.2017-0443

 Web of Science ®Google Scholar

Kwok T, Tong C. Effects on centre-based training and home-based training on physical function, quality of life and fall incidence in community dwelling older adults. Physiother Theory Pract. 2014;30(4):243–248. doi:10.3109/09593985.2013.86738724328932

 PubMed Web of Science ®Google Scholar

Muramatsu N, Yin L, Berbaum M, et al. Promoting seniors’ health with home care aides: a pilot The Gerontologist 2018;58(4): 779–788. doi:10.1093/geront/gnx101

 Google Scholar

Park C-H, Chodzko-Zajko W. Feasibility of integrating the “Healthy moves for aging well” program into home care aide services for frail older adults. J Exercise Rehabil. 2014;10(3):191–197. doi:10.12965/jer.140116

 Google Scholar