Independence in activities of daily living for home-based geriatric rehabilitation after shortened inpatient rehabilitation: The “Better@Home” multicentre prospective cohort study with a matched historical control group.

Independence in activities of daily living for home-based geriatric rehabilitation after shortened inpatient rehabilitation: The “Better@Home” multicentre prospective cohort study with a matched historical control group. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Independence in activities of daily living for home-based geriatric rehabilitation after shortened inpatient rehabilitation: The “Better@Home” multicentre prospective cohort study with a matched historical control group. C.J. Gamble, M. Vaz, M.W.M. de Waal, W.G. Groen, M.C. Pol, E.F van Dam van Isselt, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9213809/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose Population ageing is increasing the demand for geriatric rehabilitation (GR). A transition towards home-based GR could potentially reduce the need for inpatient GR and better align rehabilitation with daily functioning at home. The aim of this study is to compare the level of independence in activities of daily living between patients receiving the “Better@Home” program and those undergoing conventional inpatient geriatric rehabilitation. Methods The Better@Home study is a multicentre prospective cohort study with a matched historical control group. Eight GR facilities in the Netherlands implemented the Better@Home program, which is a five-component intervention in which home-based GR replaces part of inpatient GR. Data was gathered at GR-admission- and discharge through semi-structured interviews, registration forms, and electronic patient files. The Better@Home group was compared with a matched historical control group receiving conventional inpatient GR on independence in activities of daily living (ADL), assessed by the Barthel Index (BI). Data was analyzed using a Cox- and linear mixed-effects (LMM) regression model. Results A total of 350 participants were included (Better@Home n = 110; control n = 240). Groups were comparable on all characteristics at baseline. The LMM-analysis found no significant difference between the Better@Home and the control group on independence in ADL at discharge (mean BI difference: 0.48 points, 95% CI: − 0.323–1.282; p =.240). Conclusion This study demonstrates that a structured home-based GR program, replacing part of inpatient GR, can achieve levels of independence in activities of daily living comparable to conventional inpatient GR. Geriatric Rehabilitation Home-Based Activities of Daily Living Barthel Index Rehabilitation Outcomes Figures Figure 1 Figure 2 Key summary points Aim: To compare the level of independence in activities of daily living between patients receiving the “Better@Home” program and those undergoing conventional inpatient geriatric rehabilitation. Findings: A total of 350 participants were included (Better@Home n = 110; control n = 240). No significant differences were found between the Better@Home and the control group on independence in activities of daily living at discharge (mean Barthel Index score difference: 0.48 points, 95% CI: –0.323 - 1.282; p =.240). Message: The Better@Home program may be a valid alternative to conventional inpatient geriatric rehabilitation, achieving equivalent outcomes of independence in activities of daily living. Introduction Older adults who are faced with (sub)acute medical conditions and functional declines, admission to a geriatric rehabilitation (GR) facility may be required [ 1 ]. GR is defined as “ a multidimensional approach of diagnostic and therapeutic interventions, the purpose of which is to optimize functional capacity, promote activity and preserve functional reserve and social participation in older people with disabling impairments” [ 2 ]. Thus, GR facilities provide multidisciplinary care aimed at restoring functional independence and facilitating a safe transition back to the home environment. However, in current inpatient GR programs, the transition towards the home environment can be very challenging and may lack sufficient preparation for independent functioning after discharge [ 3 ]. In addition to the rising demand for GR due to population aging, shortages of trained personnel and increasing budgetary pressures are straining the system’s quality, accessibility, and affordability [ 4 , 5 ]. To reduce the need for prolonged inpatient GR and better align rehabilitation with the functional demands of daily life at home, a shift towards home-based GR is being proposed [ 1 , 5 ]. Adapting GR to the changing landscape of older adult care is essential for its long-term sustainability. The "Aging in Place" policy, which recognises the value of delivering rehabilitation services within familiar environments [ 6 ], highlights the potential of delivering rehabilitation in home-based settings [ 7 ]. Current evidence suggests that home-based GR shows comparable outcomes on readmission- and mortality rates, functional performance and quality of life as conventional inpatient GR [ 8 , 9 ]. Furthermore, home-based GR is associated with reduced inpatient length-of stay, reduced sedentary behaviour and higher levels of physical activity when compared to conventional inpatient GR [ 8 , 10 ]. The main difference between home-based GR and conventional inpatient GR is the rehabilitation environment. Home-based GR typically involves treatment either through clinical outpatient visits or by in-home sessions; however, in both cases, patients reside and sleep at home throughout the rehabilitation period. Home-based GR thus offers opportunities to stimulate and practice activities of daily living (ADL) in a familiar environment, which may ease the transition from a care facility to daily functioning at home [ 3 , 11 ]. By stimulating active behaviour and engagement in meaningful activities in the home environment, home-based GR may assist in reaching participation-oriented goals [ 11 , 12 ]. Internationally, home-based GR is organised in various ways, with no universal agreement on the primary principles [ 1 , 13 ]. In a recent European DELPHI study on the organization of GR, consensus was reached that GR should preferably include a home-based component [ 1 ]. Despite the potential benefits of home-based GR and the broad consensus to increase its utilization, home-based GR is applied on a small-scale in The Netherlands. Barriers to implementation include regulatory and reimbursement issues as well as workforce skill gaps, which may hinder implementation in daily practice [ 14 ]. Moreover, knowledge is lacking of how home-based GR following shortened inpatient GR can be provided in a feasible and (cost-)effective way [ 15 ]. To address these challenges, we developed and implemented a structured GR program in which the duration of the inpatient GR phase is reduced and replaced by home-based GR [ 16 ]. This program, called Better@Home, is developed in co-creation with GR-professionals, based on current best practices in GR facilities in the Netherlands and evidence from previous research [ 1 , 2 , 8 , 12 , 17 – 21 ]. The program strives to achieve outcomes in daily activities and participation that are equivalent or superior to those of conventional inpatient GR. Therefore, the aim of the present study is to compare the level of independence in activities of daily living between patients receiving the “Better@Home” program and those undergoing conventional inpatient GR. Methods Study design The Better@Home study is a prospective cohort study and includes an outcome- and economic evaluation. Additionally, the study incorporates a mixed methods feasibility study. Details on the study protocol are described elsewhere [ 16 ]. In this paper, we present the results of the comparative outcome evaluation, to assess the effect of the Better@Home program on the level of independence in activities of daily living (ADL) from GR-admission to discharge in the prospective Better@Home cohort, compared to a historical control group receiving conventional inpatient GR. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines were followed for this study, reported in appendix A. The Better@Home study was assessed by the Medical Ethics Committee of University Hospital Maastricht/Maastricht University (reference number 2023–3744). The Medical Research Involving Human Subjects ACT (WMO) does not apply to this study and an official approval of this study by the Medical Ethics Committee is not required. All procedures in this study involving human participants are in accordance with the recent version of the Declaration of Helsinki [ 22 ]. Written informed consent of all participants was obtained during inpatient rehabilitation before study inclusion and baseline assessment in the Better@Home cohort. Setting and population The Better@Home study was performed in eight GR facilities in the Netherlands, embedded in three university networks for the care for older people. GR facilities were invited to participate if they were willing to co-create and implement the Better@Home program in their GR facility. Prior experience with home-based GR was not a prerequisite to join. Table 1 presents the inclusion criteria for participation in the prospective Better@Home cohort, displayed as criteria for the Better@Home program and criteria for the Better@Home study. The historical control group represents patients who received conventional inpatient GR. Control group patients were admitted to the participating GR facilities between January 2022 and June 2023, at least six months prior to implementing the Better@Home program, thereby minimizing the risk of contamination bias while ensuring a similar context of care. As several facilities had already introduced home-based GR on a limited scale during this period, patients who received home-based GR were excluded from the historical control group to ensure the validity of the comparison. Participants of the historical control group were matched, based on the scores of independence in ADL, as measured by the Barthel Index (BI) at admission. BI strata (0–4; 5–9; 10–14; 15–19; 20) were constructed per diagnosis group in each facility. Subsequently, frequency matching was conducted, whereby patients for the historical control group were matched and randomly selected per facility from each BI stratum within a diagnosis group. Data on diagnosis and BI at admission for the historical control group were obtained from electronic patient files. Randomization of the matched participants of the historical control group was conducted using an online randomization tool with two arms, a permuted block algorithm, and a fixed block size of 1. All patients' data in the historical control group were received anonymised from the GR facilities. Further details of the study procedures can be found in the study protocol [ 16 ]. Table 1 Inclusion criteria of the Better@Home program & study Inclusion criteria of the Better@Home program Primary criteria • Admission to one of the eight participating GR facilities to implement the Better@Home program; • Considered eligible for the Better@Home program judged by the facility’s multidisciplinary team; based on physical, cognitive, and psychological functioning; • Living in the community prior to admission. Secondary criteria (based on organizational differences in local GR facility protocols) • Primary medical diagnosis designated by the local GR facility as eligible for the Better@Home program (ranging from a single diagnosis, e.g. trauma, to several diagnosis groups or all GR admissions); • Practical criteria, e.g. maximum travel distance between GR facility and patients’ home; • Patient-related criteria, e.g. availability of professional home care. Inclusion criteria of the Better@Home study • Able to participate in an interview; • Able to speak and understand Dutch; • Able to provide informed consent. The Better@Home program The Better@Home program was co-created by the eight participating GR facilities, based on previous research and current best practices in GR facilities, in close collaboration with a learning network [ 8 ]. The following five core components are present in the Better@Home program 1) Replacing part of inpatient GR by home-based GR [ 1 , 2 ]; 2) Focusing on participation goals during GR [ 8 , 12 ]; 3) Using eHealth to support rehabilitation [ 17 – 19 ]; 4) Promoting patients’ self-management skills by applying Reablement strategies [ 20 , 21 ]; and 5) Close collaboration between all relevant care partners involved in the GR trajectory. Further details of the Better@Home program can be found in Appendix B and the study protocol [ 16 ]. The Better@Home program was gradually implemented between December 2023 and February 2024, and continued until November 2024. Data collection Table 2 presents the baseline characteristics and outcome measured at GR-admission and discharge, as well as the data collection method. The outcome measure of interest was independence in ADL, assessed with the BI [ 23 ]. The BI was measured within two weeks after admission and discharge from the GR facility. The BI, initially described by Mahoney and Barthel, is a 10-item measure of activities of daily living used in clinical practice to assess baseline abilities, quantify functional change after rehabilitation, and inform discharge planning [ 23 ]. The scoring on the modified version of the BI used in the present study ranges from 0 to 20. Higher scores indicate greater independence [ 23 ]. The BI's structural validity, reliability, and interpretability are sufficient for measuring and interpreting changes in physical functioning of GR patients [ 23 – 25 ]. In two of the participating facilities, the Utrecht Scale for Evaluation of Rehabilitation (USER) was used as an alternative for the BI [ 26 , 27 ], which is common practise in GR-facilities in The Netherlands. In these organizations, scores were converted from USER to BI [ 28 ]. This conversion is performed on a per-item level, as documented by Utrecht Rehabilitation Medicine Knowledge Center (Kenniscentrum Revalidatiegeneeskunde Utrecht), using a template file [ 29 ]. For each BI-item, relevant scores on USER-items are matched, with the derived BI-item scores summed to the BI-total score. Table 2 Outcome and baseline characteristics measured per time point Measurement time points GR admission GR discharge BH CG BH CG Outcome measure Independence in activities of daily living (BI) EPF EPF FI EPF B aseline characteristics Age FI EPF Sex FI EPF Educational level FI Living arrangement FI EPF Medical diagnosis (cause of admission) RF EPF BH=Better@Home group; CG=Control group; EPF=Electronic Patient File; FI=Face-to-face interview patient; RF=registration form care professionals; BI = Barthel-index; Data analysis Statistical analyses were performed using the statistical software package IBM SPSS Statistics version 29.0.2.0, R version 4.5.2 and RStudio version 2026.01.0-392. Descriptive statistics were used to describe the baseline characteristics and scores on the BI at admission to the GR facility. Unadjusted differences in BI-scores between the Better@Home and historical control group were initially examined using independent-samples t-tests. Additionally, two complementary models were used for the main analyses; 1) a Cox regression model to establish factors associated with GR-duration, beyond GR-group assignment. For the historical control group, GR-duration reflected the inpatient length-of-stay; for the Better@Home group, GR-duration reflected the combined duration of inpatient GR and home-based GR. Due to the addition of the home-based phase, GR-duration was expected to be prolonged for the Better@Home group; and 2) a linear mixed-effects model (LMM) to evaluate the treatment effect on the BI. The LMM allowed adjustment for relevant confounders and inclusion of participants with missing BI-scores at follow-up. All factors that were statistically significant in the Cox regression model were included as covariates in the LMM. With the continuous nature of GR-duration already modelled in the Cox regression, time was treated as a dichotomous variable (admission versus discharge), which improved interpretability of the treatment effect and avoided inappropriate causal assumptions. The Cox regression model was specified as follows: 1) The dependant variable was GR-duration (time in days); 2) The independent variables were: GR group, age (entered as linear and quadratic terms), BI at admission (entered as linear and quadratic terms), diagnosis, living situation, sex, facility; and all possible two-way interactions between GR-group and each independent variable (including quadratic terms for age and BI at admission), as well as the interactions GR-group x time, facility x time, and BI at admission x time; 3) Participants were censored if they did not complete GR within the follow-up period (24% of the sample). The LMM was specified as follows: 1) The dependent variable was independence in activities of daily living (BI); 2) The independent variables were: GR-group, time (dichotomous: admission versus discharge of GR), age (linear and quadratic), sex, living situation, diagnosis category, facility; the three-way interaction GR-group x time x facility and its associated two-way interactions; and all possible two-way interactions between time and each independent variable; 3) a marginal model with unstructured covariance matrix for the repeated BI measurements. The LMM retains dropouts through a likelihood-based approach to missing outcome data, which is valid under the missing at random (MAR) assumption. Factors associated with dropout were examined through a logistic regression with missing BI at GR-discharge as the outcome, and the following predictors: GR-group, BI at admission, GR-duration, age, sex, living situation, diagnosis category, and facility. Dropout was significantly associated with baseline BI-scores (OR = 0.806) and sex (OR = 0.485, with male sex as reference). To strengthen the plausibility of the MAR assumption, the LMM adjusted for these factors. Lastly, a sample size justification for this study was provided in the study protocol paper by Pol et al. [ 16 ]. Additional information for both the LMM and Cox regression analyses are displayed in Appendix C. Results Figure 1 displays the flowchart for the Better@Home study. A total of 1139 patients admitted to the eight participating GR facilities were assessed, of which 712 patients were excluded due to not meeting the eligibility criteria for the Better@Home program. Furthermore, 317 patients were excluded due to not meeting the eligibility criteria for participating in the study. Finally, 110 participants were included in the Better@Home group, for which 240 matched participants were recruited in the historical control group (350 total participants, Better@Home n = 110; control n = 240). Of the 110 participants in the Better@Home group, 15 participants did not start the home-based phase and 12 participants discontinued the home-based phase. Table 3 presents the baseline characteristics of the study participants. The Better@Home and historical control group were comparable on all characteristics. Furthermore, the mean inpatient GR-duration was 38 days for the control group and 33 days for the Better@Home group, after which only the Better@Home group received home-based GR (mean of 36 days). During the home-based phase, an average of 10 sessions per participant were provided. Almost all patients (97%) received treatment sessions at home, 76% of patients received remote sessions and 14% received outpatient sessions. Three of the eight participating facilities had little to no prior experience with home-based GR, defined as the routine provision of home-based GR trajectories prior to the implementation of the Better@Home program. At GR-discharge, 35% of participants had a BI-score of 19 ( n = 19 Better@Home, n = 25 control) or 20 ( n = 21 Better@Home, n = 53 control), indicating a potential ceiling effect. Table 3 Baseline characteristics of participants in the Better@Home and control group Characteristics Better@Home (n = 110) Control (n = 240) p-value Age, mean (SD) 78.4 (8.9) 78.8 (9.2) 0.718 Female, no (%) 64 (58.2%) 135 (56.3%) 0.735 Living alone, no (%) 62 (56.4%) 135 (57.7%) 0.816 Primary medical diagnosis for admittance 0.952 CVA, no (%) 30 (27.3%) 72 (30%) - Trauma, no (%) 36 (32.7%) 78 (32.5%) - Elective surgery, no (%) 7 (6.4%) 9 (3.8%) - Respiratory, no (%) 17 (15.5%) 36 (15%) - Other a , no (%) 20 (18.1%) 45 (18.8%) - Primary outcome (at baseline) Independence in activities of daily living (BI), mean (SD) 11.3 (4 .9 ) 11.5 ( 4.7 ) 0.740 BI-category 0–4, no (%) 14 (13%) 26 (11%) BI-category 5–9, no (%) 23 (21%) 47 (20%) BI-category 10–14, no (%) 45 (41%) 93 (39%) BI-category 15–19, no (%) 26 (24%) 66 (28%) BI-category 20, no (%) 2 (2%) 8 (3%) BI = Barthel-index; SD=Standard Deviation, CVA=Cerebral vascular accident. a = For example amputation, oncological and/or cardiovascular conditions. The results of the final Cox regression model with details on the hazard ratio (HR) are displayed in appendix D. This model shows that the control group had a significantly shorter GR-duration when compared to the Better@Home group, although this difference diminished over time (appendix C). In addition to GR-group, GR-duration was significantly influenced by age (including a quadratic effect), BI at admission, facility, living situation, and diagnosis. Several interactions were significant; GR-group × time; GR-group × facility; facility x time, and baseline BI × time, which are shown in more detail in appendix C. Sensitivity analyses indicated that the results were affected by how censored observations were handled; therefore, the findings should be interpreted with caution. The results of the final LMM with details on the mean difference in BI-scores between the Better@Home and the historical control group is shown in Table 4 . The adjusted mean difference in BI-scores between the Better@Home and the control group at GR discharge was ∆=0.48 points (95% CI: − 0.32 to 1.28), which was not statistically significant (p = 0.24). The unadjusted mean differences in BI-scores are shown in Fig. 2. Table 4 Linear Mixed Model with independence in activities of daily living as the dependant variable Factor Estimate Std. Error Significance 95% CI Lower Upper Age a − .048 .022 .028 − .091 − .005 Group b .480 .408 .240 − .323 1.282 Time c -4.731 .432 < .001 -5.580 -3.882 Sex d .383 .375 .308 − .354 1.120 Living situation e − .657 .385 .089 -1.415 .101 Intercept 16.600 .679 < .001 15.265 17.936 Facility f • A • B • C • D • E • F • G 2.546 2.755 .546 1.585 1.524 3.411 .023 1.098 .753 .572 .720 .701 1.064 1.479 .021 < .001 .341 .028 .031 .001 .988 .385 1.274 − .579 .168 .144 1.317 -2.887 4.707 4.236 1.671 3.002 2.904 5.505 2.932 Diagnosis g • CVA • Trauma • Respiratory − .492 − .496 − .970 .542 .572 .811 .364 .386 .233 -1.558 -1.622 -2.567 .574 .629 .626 Interactions Group b * time .563 .456 .218 -1.460 .335 Facility f * time • A • B • C • D • E • F • G 1.204 1.433 -2.025 -1.474 − .132 2.394 2.804 1.195 .781 .601 .671 .757 .921 1.455 .341 .067 < .001 .029 .862 .010 .055 -1.147 − .103 -3.208 -2.793 -1.620 .582 − .060 3.554 2.970 − .843 − .154 1.357 4.207 5.668 a = Age centered at 79 years; b= Control group used as reference. At GR-discharge, the BI in the Better&Home group is, on average, 0.48 points higher than in the control group; c= T1 (GR-discharge) used as reference. The mean BI at T0 is, on average, 4.731 points lower than at T1; d= Female used as reference; e= Living alone is used as reference; f=Facility H used as reference; g= ’Other diagnoses’ is the reference category. Discussion This multicentre cohort study evaluated the Better@Home program, in which part of conventional inpatient rehabilitation is replaced by structured home-based GR. No statistically significant difference in independence in ADL at GR-discharge was observed between groups (Δ = 0.48, p =.24). These findings suggest that home-based GR may be as effective as conventional inpatient GR in achieving independence in ADL. The absence of between-group differences in independence in ADL in the present study aligns with evidence from systematic reviews of home-based GR, demonstrating functional outcomes comparable to conventional inpatient rehabilitation [ 8 , 9 ]. Considering a broader post-acute care perspective, meta-analyses of early supported discharge models across different diagnostic populations similarly indicate matching functional outcomes, when comparing early discharge to the home environment with conventional inpatient care [ 30 , 31 ]. Additionally, a recent observational cohort study by Freitas et al. [ 32 ] comparing the efficacy of rehabilitation programs in older patients across different therapeutic settings, also found no significant differences on Barthel Index (BI) scores between inpatient and home-based settings. Together, these studies support the view that similar gains in independence in ADL can be achieved when a substantial portion of GR is delivered in the home environment rather than in an institutional setting. The observed comparability of independence in ADL (BI) between home-based and conventional inpatient interventions may partly be explained by a ceiling effect of the BI [ 25 ]. In the present study, 35% of the participants scored 19 or 20 on the BI at discharge. While the BI is useful for screening and rapid assessment of dependency levels, it may be less sensitive to subtle functional changes in (relatively) high-functioning patients or home-based settings [ 33 ]. Improvements in more complex domains, which are particularly relevant in home-based GR, are better assessed by instrumental activities of daily living (IADL) or participation [ 34 ]. However, in the review of Preitschopf et al.[ 8 ], which assesses the effectiveness of outpatient GR after inpatient rehabilitation, participation outcome measures were only used in seven of the 24 included studies. Their data synthesis revealed that three of these seven studies demonstrated a favourable effect of home-based rehabilitation on participation, and four studies observed a neutral effect. The authors highlight that, despite being a primary goal of GR, restoring participation levels during the inpatient- and subsequent home-based GR phase receives limited attention. Focussing on participation may improve participation-related outcomes in home-based GR [ 8 ]. These observations are in line with a recent Delphi study emphasizing the importance of addressing participation goals within GR [ 34 ]. Accordingly, one of the core elements of the Better@Home program was the explicit focus on participation goals during GR. In line with previous recommendations [ 9 ], the Better@Home program was developed as a structured five-component approach to promote greater consensus in the delivery- and optimisation of home-based GR following inpatient GR. Unfortunately, it was not possible to comparatively assess the effects of the Better@Home program on participation outcomes, due to the lack of available data for the historical control group. Consequently, it remains uncertain whether the Better@Home program has favourable effects on participation. Strengths and limitations This study has several strengths. The Better@Home study is a comprehensive multicentre evaluation of a structured home-based GR program developed in co-creation with care professionals and based on evidence from recent literature and best practices. Key strengths include the multicentre design across eight GR facilities, the inclusion of a broad range of diagnostic categories and a relatively large sample size of a frail geriatric population, enhances the generalizability of the findings. In addition, three of the eight participating organisations had little to no prior experience with home-based GR when implementing the Better@Home program. Implementation research indicates that complex interventions, such as home-based GR, undergo a learning curve, during which fidelity and efficiency typically improve as protocols are refined and staff gain experience [ 35 – 37 ]. These varying levels of experience in home-based GR reflect real-world practice and strengthen the external validity. Some limitations must also be addressed. First, the non-randomized design implies that residual confounding could not be fully ruled out, despite multivariable adjustment and frequency matching. Moreover, additional outcome measures (e.g. IADL or participation) could not be included in the analyses, due to the restricted availability of outcome data in the historical control group. A prospective controlled design to include these measures was not ethically possible, as home-based GR was already implemented by several participating facilities and withholding this care from eligible patients could not be enforced. Additionally, selection bias due to excluding patients who received home-based GR in the historical control cohort may have been present. However, by frequency matching per facility within each diagnosis group, this risk is mitigated. Furthermore, the validity of the LMM results depend on the plausibility of the missing-at-random (MAR) assumption. Given the vulnerability of the study population, missingness may have also been dependent on unobserved follow-up measurements of the BI. However, the proportion of missing data was relatively small for this population (15% at discharge), and did not significantly differ between groups ( p =.121). Finally, the structure and definition of “GR-completion” differed between groups; for the control group, GR-completion signified discharge from the inpatient facility; whereas in the Better@Home group, GR-completion signified discharge after the full inpatient- and home-based phase. Since BI-scores were only assessed at admission and discharge, the comparison between groups reflects different measurement time points and may be affected by exposure-time differences. However, factors associated with GR-duration were identified using Cox regression and subsequently included as covariates in the LMM when estimating the intervention effects, which revealed no significant group differences. Moreover, recent evidence in post-acute and GR populations show that most functional gains occur during the early, inpatient rehabilitation period [ 38 , 39 ]. Home-based GR is primarily focussed on transferring functional gains into everyday activities and consolidating independence in the home environment, rather than continued gains in independence in ADL [ 40 , 41 ]. These findings indicate that the longer GR-duration of the Better@Home group may not have translated into higher scores of independence in ADL. Conclusions and future research The Better@Home study demonstrates that a structured home-based GR program, replacing part of inpatient GR, can achieve levels of independence in activities of daily living comparable to conventional inpatient GR. While the present findings indicate a clear potential for home-based GR as part of routine GR care, they currently provide insufficient evidence to recommend widespread implementation. Data of the ongoing economic-, feasibility- and follow-up evaluations of the Better@Home study are required to comprehensively assess the (cost-)effectiveness and feasibility of the Better@Home program and to inform evidence-based implementation strategies. Future studies in the field of home-based GR should include participation measures, as it remains uncertain whether the Better@Home program may have achieved superior outcomes in these domains [ 34 ]. Introducing a standard core set of outcome measures, including a participation (c.q. IADL) measure, could facilitate these efforts. Declarations Clinical implication The Better@Home program may be a valid alternative to conventional inpatient geriatric rehabilitation, achieving equivalent outcomes of independence in activities of daily living. Conflict of interest statement: On behalf of all authors, the corresponding author states that there is no conflict of interest. Acknowledgments: This work was supported by ZonMw (The Netherlands Organisation for Health Research and Development), grant number 10020032210004. The funding source had no role in the design of the study; data collection, analysis, or interpretation; writing of the manuscript; or in the decision to submit the article for publication. References van Balen R, Gordon AL, Schols JMGA, Drewes YM, Achterberg WP (2019) What is geriatric rehabilitation and how should it be organized? A Delphi study aimed at reaching European consensus. Eur Geriatr Med 2019/12/01(6):977–987. 10.1007/s41999-019-00244-7 Grund S, Gordon AL, van Balen R et al (2020) European consensus on core principles and future priorities for geriatric rehabilitation: consensus statement. Eur Geriatr Med Apr 11(2):233–238. 10.1007/s41999-019-00274-1 Pol M, Peek S, van Nes F, van Hartingsveldt M, Buurman B, Kröse B (2019) Everyday life after a hip fracture: what community-living older adults perceive as most beneficial for their recovery. Age Ageing . May 1. ;48(3):440–447. 10.1093/ageing/afz012 Organization WH, Aging and Health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=By%202050%2C%20the%20world's%20population,in%20this%20age%20group%20worldwide Achterberg WP, Cameron ID, Bauer JM, Schols JM (2019) Geriatric Rehabilitation-State of the Art and Future Priorities. J Am Med Dir Assoc Apr 20(4):396–398. 10.1016/j.jamda.2019.02.014 Krabbe-Alkemade Y, Makai P, Shestalova V, Voesenek T (2020) Containing or shifting? Health expenditure decomposition for the aging Dutch population after a major reform. Health Policy 124(3):268–274 2020/03/01. https://doi.org/10.1016/j.healthpol.2019.12.016 Jon Kaplan AB, Thom S, Baker J An Aging-in-Place Strategy for the Next Generation. Updated 23-02-2022. https://www.bcg.com/publications/2022/aging-in-place-plan-for-next-generation Preitschopf A, Holstege M, Ligthart A et al (2023) Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis. Age Ageing 52(1). 10.1093/ageing/afac300 Stolee P, Lim SN, Wilson L, Glenny C (2012) Inpatient versus home-based rehabilitation for older adults with musculoskeletal disorders: a systematic review. Clin Rehabil May 26(5):387–402. 10.1177/0269215511423279 Ramsey KA, Loveland P, Rojer AGM et al (2021) Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings. J Am Med Dir Assoc Dec 22(12):2432–2439e1. 10.1016/j.jamda.2021.04.018 Tijsen LM, Derksen EW, Achterberg WP, Buijck BI (2019) Challenging rehabilitation environment for older patients. Clin Interv Aging. :1451–1460 Skoumal M, Lindner-Rabl S, Honegger M et al (2024) Goal Setting for Participatory Person-Centered Geriatric Rehabilitation-From Function-Centered Rehabilitation towards Digitally Supported Personalized and Integrated Care for Older People. J Clin Med Jul 15(14). 10.3390/jcm13144134 Grund S, van Wijngaarden JP, Gordon AL, Schols JM, Bauer JM (2020) EuGMS survey on structures of geriatric rehabilitation across Europe. Eur Geriatr Med 11:217–232 Prins LAP, Gamble CJ, van Dam EF et al (2023) An Exploratory Study Investigating Factors Influencing the Outpatient Delivery of Geriatric Rehabilitation. J Clin Med Jul 31(15). 10.3390/jcm12155045 Verweij L, van de Korput E, Daams JG et al (2019) Effects of Postacute Multidisciplinary Rehabilitation Including Exercise in Out-of-Hospital Settings in the Aged: Systematic Review and Meta-analysis. Arch Phys Med Rehabil Mar 100(3):530–550. 10.1016/j.apmr.2018.05.010 Pol MC, van Isselt E, Doornebosch AJ et al (2025) Evaluation of outcomes, costs, and feasibility of home-based geriatric rehabilitation after inpatient rehabilitation: study protocol of the Better@Home multicentre prospective cohort study with historical control group. BMC Geriatr Nov 28(1):980. 10.1186/s12877-025-06573-6 Gamble CJ, van Haastregt J, van Dam EF, Zwakhalen S, Schols J (2024) Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review. Clin Rehabil Apr 38(4):457–477. 10.1177/02692155231217411 Kraaijkamp JJM, van Dam EF, Persoon A, Versluis A, Chavannes NH, Achterberg WP (2021) eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability. J Med Internet Res Aug 19(8):e24015. 10.2196/24015 Pol MC, Ter Riet G, van Hartingsveldt M, Kröse B, Buurman BM (2019) Effectiveness of sensor monitoring in a rehabilitation programme for older patients after hip fracture: a three-arm stepped wedge randomised trial. Age Ageing Sep 1(5):650–657. 10.1093/ageing/afz074 Mouchaers I, Verbeek H, Kempen G et al (2023) Development and content of a community-based reablement programme (I-MANAGE): a co-creation study. BMJ Open Aug 30(8):e070890. 10.1136/bmjopen-2022-070890 Buma LE, Vluggen S, Zwakhalen S, Kempen G, Metzelthin SF (2022) Effects on clients' daily functioning and common features of reablement interventions: a systematic literature review. Eur J Ageing Dec 19(4):903–929. 10.1007/s10433-022-00693-3 Association WM (2013) World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA 310(20):2191–2194. 10.1001/jama.2013.281053 Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Maryland State Med J Collin C, Wade D, Davies S, Horne V (1988) The Barthel ADL Index: a reliability study. Int Disabil Stud 10(2):61–63 Bouwstra H, Smit E, Wattel E et al (2018) Measurement Properties of the Barthel Index in Geriatric Rehabilitation. J Am Med Dir Assoc 11/01. 10.1016/j.jamda.2018.09.033 Jansen M, Doornebosch AJ, de Waal MW et al (2021) Psychometrics of the observational scales of the Utrecht Scale for Evaluation of Rehabilitation (USER): Content and structural validity, internal consistency and reliability. Arch Gerontol Geriatr 97:104509 de Waal MW, Jansen M, Bakker LM et al (2024) Construct validity, responsiveness, and interpretability of the Utrecht Scale for Evaluation of Rehabilitation (USER) in patients admitted to inpatient geriatric rehabilitation. Clin Rehabil 38(1):98–108 Utrecht DHU Barthel Index User 1.3–1.5 SPSS syntax Post MWM, van de Port MWIGL, Berdenis SH, van Berlekom L Kasius de Jong De USER (Utrechtse Schaal voor de Evaluatie van Klinische Revalidatie) is een meetinstrument om het resultaat van de klinische revalidatie te meten. https://www.kcrutrecht.nl/producten/user/ Langhorne P, Taylor G, Murray G et al (2005) Early supported discharge services for stroke patients: a meta-analysis of individual patients' data. Lancet 365(9458):501–506. 10.1016/S0140-6736(05)17868-4 Williams S, O'Riordan C, Morrissey AM, Galvin R, Griffin A (2024) Early supported discharge for older adults admitted to hospital after orthopaedic surgery: a systematic review and meta-analysis. BMC Geriatr Feb 9(1):143. 10.1186/s12877-024-04775-y Freitas MM, Antunes S, Ascenso D, Silveira A (2021) Outpatient and Home-Based Treatment: Effective Settings for Hip Fracture Rehabilitation in Elderly Patients. Geriatrics 6(3):83 van der Putten JJMF, Hobart JC, Freeman JA, Thompson AJ (1999) Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry 66(4):480–484. 10.1136/jnnp.66.4.480 Preitschopf A, Vaz M, Holstege M, Pol M, Buurman B, Groen W International Delphi study on terminology, organisation and outcomes of geriatric rehabilitation for older people living at home. Eur Geriatr Med. 2025/10/01 2025;16(5):1839–1850. 10.1007/s41999-025-01241-9 Preitschopf AD, Pol M, Buurman B, Holstege M (2025) Home-based geriatric rehabilitation after inpatient rehabilitation: a redesign and feasibility study. BMC Geriatr 06(1):398. 10.1186/s12877-025-06043-z . /02 2025 Roth C, Maier L, Abel B et al (2024) Implementation of a multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): an early qualitative process evaluation. BMC Geriatrics . /08/29 2024;24(1):720. 10.1186/s12877-024-05277-7 Everink IHJ, van Haastregt JCM, Tan FES, Schols J, Kempen G (2018) The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study. BMC Geriatr Nov 16(1):285. 10.1186/s12877-018-0971-4 Soh CH, Reijnierse EM, Tuttle C et al (2021) Trajectories of functional performance recovery after inpatient geriatric rehabilitation: an observational study. Med J Aust Aug 16(4):173–179. 10.5694/mja2.51138 van Tol LS, Lin T, Caljouw MAA et al (2024) Post-COVID-19 recovery and geriatric rehabilitation care: a European inter-country comparative study. Eur Geriatr Med Oct 15(5):1489–1501. 10.1007/s41999-024-01030-w Li X, Zheng T, Guan Y et al (2020) ADL recovery trajectory after discharge and its predictors among baseline-independent older inpatients. BMC Geriatrics . /03/04 2020;20(1):86. 10.1186/s12877-020-1481-8 Musa KI, Keegan TJ (2018) The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model. PLoS ONE 13(12):e0208594. 10.1371/journal.pone.0208594 Supplementary Files HomebasedGRAppendices14.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 21 Apr, 2026 Reviewers invited by journal 20 Apr, 2026 Editor invited by journal 30 Mar, 2026 Editor assigned by journal 27 Mar, 2026 First submitted to journal 24 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9213809","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626472735,"identity":"1bfabafd-932f-42c0-ba7b-f2ace60181e4","order_by":0,"name":"C.J. Gamble","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-5103-134X","institution":"Maastricht University Faculty of Health Medicine and Life Sciences: Universiteit Maastricht Faculty of Health Medicine and Life Sciences","correspondingAuthor":true,"prefix":"","firstName":"C.J.","middleName":"","lastName":"Gamble","suffix":""},{"id":626472736,"identity":"d0f8849b-c08d-412f-8e37-d1998416ec09","order_by":1,"name":"M. Vaz","email":"","orcid":"","institution":"Amsterdam UMC - Locatie VUMC: Amsterdam UMC Locatie VUmc","correspondingAuthor":false,"prefix":"","firstName":"M.","middleName":"","lastName":"Vaz","suffix":""},{"id":626472737,"identity":"ff578fe7-83df-44a1-b103-0c1dd53afa2f","order_by":2,"name":"M.W.M. de Waal","email":"","orcid":"","institution":"LUMC: Leids Universitair Medisch Centrum","correspondingAuthor":false,"prefix":"","firstName":"M.W.M.","middleName":"","lastName":"de Waal","suffix":""},{"id":626472738,"identity":"c44678d8-2bff-45ec-abc8-db43a392b538","order_by":3,"name":"W.G. Groen","email":"","orcid":"","institution":"Amsterdam UMC - Locatie VUMC: Amsterdam UMC Locatie VUmc","correspondingAuthor":false,"prefix":"","firstName":"W.G.","middleName":"","lastName":"Groen","suffix":""},{"id":626472739,"identity":"ff22bd38-8854-4908-8052-01409b85995a","order_by":4,"name":"M.C. Pol","email":"","orcid":"","institution":"Amsterdam UMC - Locatie VUMC: Amsterdam UMC Locatie VUmc","correspondingAuthor":false,"prefix":"","firstName":"M.C.","middleName":"","lastName":"Pol","suffix":""},{"id":626472740,"identity":"514ba2b8-8fe4-440c-9404-6f09d89af098","order_by":5,"name":"E.F van Dam van Isselt","email":"","orcid":"","institution":"LUMC: Leids Universitair Medisch Centrum","correspondingAuthor":false,"prefix":"","firstName":"E.F","middleName":"van Dam van","lastName":"Isselt","suffix":""},{"id":626472741,"identity":"b1583199-bcd2-4feb-83ca-162f759feef7","order_by":6,"name":"F. Innocenti","email":"","orcid":"","institution":"Maastricht University Faculty of Health Medicine and Life Sciences: Universiteit Maastricht Faculty of Health Medicine and Life Sciences","correspondingAuthor":false,"prefix":"","firstName":"F.","middleName":"","lastName":"Innocenti","suffix":""},{"id":626472742,"identity":"e54be248-141c-4f75-b4b5-d56470875883","order_by":7,"name":"S.M.G Zwakhalen","email":"","orcid":"","institution":"Maastricht University Faculty of Health Medicine and Life Sciences: Universiteit Maastricht Faculty of Health Medicine and Life Sciences","correspondingAuthor":false,"prefix":"","firstName":"S.M.G","middleName":"","lastName":"Zwakhalen","suffix":""},{"id":626472743,"identity":"3e744c84-b4f2-4cc1-bbc8-88bc0d8fc7b2","order_by":8,"name":"J.C.M. van Haastregt","email":"","orcid":"","institution":"Maastricht University Faculty of Health Medicine and Life Sciences: Universiteit Maastricht Faculty of Health Medicine and Life Sciences","correspondingAuthor":false,"prefix":"","firstName":"J.C.M.","middleName":"van","lastName":"Haastregt","suffix":""}],"badges":[],"createdAt":"2026-03-24 15:21:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9213809/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9213809/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108031085,"identity":"9dc4e1a1-f0ee-4ec8-9a2f-bf0d3c4142ab","added_by":"auto","created_at":"2026-04-28 15:55:11","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":958626,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart Better@Home study.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9213809/v1/a3b9d5b26e25f50976a84d8d.jpeg"},{"id":108031083,"identity":"f8171da6-35b4-470b-8e9c-70e817d69075","added_by":"auto","created_at":"2026-04-28 15:55:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22704,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Mean Barthel Index scores at baseline (T0) and discharge (T1).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMean BI-difference at T0, ∆=.18, p=.740; Mean BI-difference at T1, ∆=11, p=.70. Significant differences in BI-scores were found for both groups between T0 and T1 (p\u0026lt;.001, paired-samples t-test).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9213809/v1/e7910114f9fb6807ebccecb1.png"},{"id":108031119,"identity":"51a1941e-85fa-4399-91e4-18f7eaad6e89","added_by":"auto","created_at":"2026-04-28 15:55:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1386633,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9213809/v1/00ba3c57-f8fc-4123-976a-0e5c905c8e7d.pdf"},{"id":108031086,"identity":"d7399caf-da2b-4ace-ac71-d136288df2a1","added_by":"auto","created_at":"2026-04-28 15:55:11","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":153949,"visible":true,"origin":"","legend":"","description":"","filename":"HomebasedGRAppendices14.docx","url":"https://assets-eu.researchsquare.com/files/rs-9213809/v1/f51fd55883b660863c0e0e97.docx"}],"financialInterests":"","formattedTitle":"Independence in activities of daily living for home-based geriatric rehabilitation after shortened inpatient rehabilitation: The “Better@Home” multicentre prospective cohort study with a matched historical control group.","fulltext":[{"header":"Key summary points","content":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e To compare the level of independence in activities of daily living between patients receiving the \u0026ldquo;Better@Home\u0026rdquo; program and those undergoing conventional inpatient geriatric rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings:\u0026nbsp;\u003c/strong\u003eA total of 350 participants were included (Better@Home \u003cem\u003en\u003c/em\u003e = 110; control \u003cem\u003en\u003c/em\u003e = 240). No significant differences were found between the Better@Home and the control group on independence in activities of daily living at discharge (mean Barthel Index score difference: 0.48 points, 95% CI: \u0026ndash;0.323 - 1.282; \u003cem\u003ep\u003c/em\u003e=.240).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMessage:\u003c/strong\u003e The Better@Home program may be a valid alternative to conventional inpatient geriatric rehabilitation, achieving equivalent outcomes of independence in activities of daily living.\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eOlder adults who are faced with (sub)acute medical conditions and functional declines, admission to a geriatric rehabilitation (GR) facility may be required [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. GR is defined as \u0026ldquo;\u003cem\u003ea multidimensional approach of diagnostic and therapeutic interventions, the purpose of which is to optimize functional capacity, promote activity and preserve functional reserve and social participation in older people with disabling impairments\u0026rdquo;\u003c/em\u003e [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Thus, GR facilities provide multidisciplinary care aimed at restoring functional independence and facilitating a safe transition back to the home environment. However, in current inpatient GR programs, the transition towards the home environment can be very challenging and may lack sufficient preparation for independent functioning after discharge [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In addition to the rising demand for GR due to population aging, shortages of trained personnel and increasing budgetary pressures are straining the system\u0026rsquo;s quality, accessibility, and affordability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. To reduce the need for prolonged inpatient GR and better align rehabilitation with the functional demands of daily life at home, a shift towards \u003cem\u003ehome-based\u003c/em\u003e GR is being proposed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdapting GR to the changing landscape of older adult care is essential for its long-term sustainability. The \"Aging in Place\" policy, which recognises the value of delivering rehabilitation services within familiar environments [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], highlights the potential of delivering rehabilitation in home-based settings [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Current evidence suggests that home-based GR shows comparable outcomes on readmission- and mortality rates, functional performance and quality of life as conventional inpatient GR [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, home-based GR is associated with reduced inpatient length-of stay, reduced sedentary behaviour and higher levels of physical activity when compared to conventional inpatient GR [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The main difference between home-based GR and conventional inpatient GR is the rehabilitation environment. Home-based GR typically involves treatment either through clinical outpatient visits or by in-home sessions; however, in both cases, patients reside and sleep at home throughout the rehabilitation period. Home-based GR thus offers opportunities to stimulate and practice activities of daily living (ADL) in a familiar environment, which may ease the transition from a care facility to daily functioning at home [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. By stimulating active behaviour and engagement in meaningful activities in the home environment, home-based GR may assist in reaching participation-oriented goals [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInternationally, home-based GR is organised in various ways, with no universal agreement on the primary principles [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In a recent European DELPHI study on the organization of GR, consensus was reached that GR should preferably include a home-based component [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite the potential benefits of home-based GR and the broad consensus to increase its utilization, home-based GR is applied on a small-scale in The Netherlands. Barriers to implementation include regulatory and reimbursement issues as well as workforce skill gaps, which may hinder implementation in daily practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, knowledge is lacking of how home-based GR following shortened inpatient GR can be provided in a feasible and (cost-)effective way [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address these challenges, we developed and implemented a structured GR program in which the duration of the inpatient GR phase is reduced and replaced by home-based GR [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This program, called Better@Home, is developed in co-creation with GR-professionals, based on current best practices in GR facilities in the Netherlands and evidence from previous research [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18 CR19 CR20\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The program strives to achieve outcomes in daily activities and participation that are equivalent or superior to those of conventional inpatient GR. Therefore, the aim of the present study is to compare the level of independence in activities of daily living between patients receiving the \u0026ldquo;Better@Home\u0026rdquo; program and those undergoing conventional inpatient GR.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe Better@Home study is a prospective cohort study and includes an outcome- and economic evaluation. Additionally, the study incorporates a mixed methods feasibility study. Details on the study protocol are described elsewhere [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this paper, we present the results of the comparative outcome evaluation, to assess the effect of the Better@Home program on the level of independence in activities of daily living (ADL) from GR-admission to discharge in the prospective Better@Home cohort, compared to a historical control group receiving conventional inpatient GR. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines were followed for this study, reported in appendix A.\u003c/p\u003e \u003cp\u003e The Better@Home study was assessed by the Medical Ethics Committee of University Hospital Maastricht/Maastricht University (reference number 2023\u0026ndash;3744). The Medical Research Involving Human Subjects ACT (WMO) does not apply to this study and an official approval of this study by the Medical Ethics Committee is not required. All procedures in this study involving human participants are in accordance with the recent version of the Declaration of Helsinki [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Written informed consent of all participants was obtained during inpatient rehabilitation before study inclusion and baseline assessment in the Better@Home cohort.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and population\u003c/h3\u003e\n\u003cp\u003eThe Better@Home study was performed in eight GR facilities in the Netherlands, embedded in three university networks for the care for older people. GR facilities were invited to participate if they were willing to co-create and implement the Better@Home program in their GR facility. Prior experience with home-based GR was not a prerequisite to join. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the inclusion criteria for participation in the prospective Better@Home cohort, displayed as criteria for the Better@Home program and criteria for the Better@Home study.\u003c/p\u003e \u003cp\u003eThe historical control group represents patients who received conventional inpatient GR. Control group patients were admitted to the participating GR facilities between January 2022 and June 2023, at least six months prior to implementing the Better@Home program, thereby minimizing the risk of contamination bias while ensuring a similar context of care. As several facilities had already introduced home-based GR on a limited scale during this period, patients who received home-based GR were excluded from the historical control group to ensure the validity of the comparison. Participants of the historical control group were matched, based on the scores of independence in ADL, as measured by the Barthel Index (BI) at admission. BI strata (0\u0026ndash;4; 5\u0026ndash;9; 10\u0026ndash;14; 15\u0026ndash;19; 20) were constructed per diagnosis group in each facility. Subsequently, frequency matching was conducted, whereby patients for the historical control group were matched and randomly selected per facility from each BI stratum within a diagnosis group. Data on diagnosis and BI at admission for the historical control group were obtained from electronic patient files. Randomization of the matched participants of the historical control group was conducted using an online randomization tool with two arms, a permuted block algorithm, and a fixed block size of 1. All patients' data in the historical control group were received anonymised from the GR facilities. Further details of the study procedures can be found in the study protocol [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInclusion criteria of the Better@Home program \u0026amp; study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInclusion criteria of the Better@Home program\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary criteria\u003c/p\u003e \u003cp\u003e\u0026bull; Admission to one of the eight participating GR facilities to implement the Better@Home program;\u003c/p\u003e \u003cp\u003e\u0026bull; Considered eligible for the Better@Home program judged by the facility\u0026rsquo;s multidisciplinary team; based on physical, cognitive, and psychological functioning;\u003c/p\u003e \u003cp\u003e\u0026bull; Living in the community prior to admission.\u003c/p\u003e \u003cp\u003eSecondary criteria (based on organizational differences in local GR facility protocols)\u003c/p\u003e \u003cp\u003e\u0026bull; Primary medical diagnosis designated by the local GR facility as eligible for the Better@Home program (ranging from a single diagnosis, e.g. trauma, to several diagnosis groups or all GR admissions);\u003c/p\u003e \u003cp\u003e\u0026bull; Practical criteria, e.g. maximum travel distance between GR facility and patients\u0026rsquo; home;\u003c/p\u003e \u003cp\u003e\u0026bull; Patient-related criteria, e.g. availability of professional home care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInclusion criteria of the Better@Home study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Able to participate in an interview;\u003c/p\u003e \u003cp\u003e\u0026bull; Able to speak and understand Dutch;\u003c/p\u003e \u003cp\u003e\u0026bull; Able to provide informed consent.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eThe Better@Home program\u003c/h3\u003e\n\u003cp\u003eThe Better@Home program was co-created by the eight participating GR facilities, based on previous research and current best practices in GR facilities, in close collaboration with a learning network [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The following five core components are present in the Better@Home program 1) Replacing part of inpatient GR by home-based GR [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]; 2) Focusing on participation goals during GR [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; 3) Using eHealth to support rehabilitation [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; 4) Promoting patients\u0026rsquo; self-management skills by applying Reablement strategies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]; and 5) Close collaboration between all relevant care partners involved in the GR trajectory. Further details of the Better@Home program can be found in Appendix B and the study protocol [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The Better@Home program was gradually implemented between December 2023 and February 2024, and continued until November 2024.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the baseline characteristics and outcome measured at GR-admission and discharge, as well as the data collection method. The outcome measure of interest was independence in ADL, assessed with the BI [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The BI was measured within two weeks after admission and discharge from the GR facility. The BI, initially described by Mahoney and Barthel, is a 10-item measure of activities of daily living used in clinical practice to assess baseline abilities, quantify functional change after rehabilitation, and inform discharge planning [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The scoring on the modified version of the BI used in the present study ranges from 0 to 20. Higher scores indicate greater independence [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The BI's structural validity, reliability, and interpretability are sufficient for measuring and interpreting changes in physical functioning of GR patients [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn two of the participating facilities, the Utrecht Scale for Evaluation of Rehabilitation (USER) was used as an alternative for the BI [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], which is common practise in GR-facilities in The Netherlands. In these organizations, scores were converted from USER to BI [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This conversion is performed on a per-item level, as documented by Utrecht Rehabilitation Medicine Knowledge Center (Kenniscentrum Revalidatiegeneeskunde Utrecht), using a template file [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. For each BI-item, relevant scores on USER-items are matched, with the derived BI-item scores summed to the BI-total score.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcome and baseline characteristics measured per time point\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMeasurement time points\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eGR admission\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eGR discharge\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBH\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eCG\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eBH\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eCG\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003eOutcome measure\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependence in activities of daily living (BI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEPF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEPF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEPF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eB\u003c/span\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003easeline characteristics\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEPF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEPF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving arrangement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEPF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical diagnosis (cause of admission)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEPF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBH=Better@Home group; CG=Control group;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eEPF=Electronic Patient File; FI=Face-to-face interview patient; RF=registration form care professionals; BI\u003cem\u003e=\u003c/em\u003eBarthel-index;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using the statistical software package IBM SPSS Statistics version 29.0.2.0, R version 4.5.2 and RStudio version 2026.01.0-392. Descriptive statistics were used to describe the baseline characteristics and scores on the BI at admission to the GR facility. Unadjusted differences in BI-scores between the Better@Home and historical control group were initially examined using independent-samples t-tests. Additionally, two complementary models were used for the main analyses; 1) a Cox regression model to establish factors associated with GR-duration, beyond GR-group assignment. For the historical control group, GR-duration reflected the inpatient length-of-stay; for the Better@Home group, GR-duration reflected the combined duration of inpatient GR and home-based GR. Due to the addition of the home-based phase, GR-duration was expected to be prolonged for the Better@Home group; and 2) a linear mixed-effects model (LMM) to evaluate the treatment effect on the BI. The LMM allowed adjustment for relevant confounders and inclusion of participants with missing BI-scores at follow-up. All factors that were statistically significant in the Cox regression model were included as covariates in the LMM. With the continuous nature of GR-duration already modelled in the Cox regression, time was treated as a dichotomous variable (admission versus discharge), which improved interpretability of the treatment effect and avoided inappropriate causal assumptions.\u003c/p\u003e \u003cp\u003eThe Cox regression model was specified as follows: 1) The dependant variable was GR-duration (time in days); 2) The independent variables were: GR group, age (entered as linear and quadratic terms), BI at admission (entered as linear and quadratic terms), diagnosis, living situation, sex, facility; and all possible two-way interactions between GR-group and each independent variable (including quadratic terms for age and BI at admission), as well as the interactions GR-group x time, facility x time, and BI at admission x time; 3) Participants were censored if they did not complete GR within the follow-up period (24% of the sample).\u003c/p\u003e \u003cp\u003eThe LMM was specified as follows: 1) The dependent variable was independence in activities of daily living (BI); 2) The independent variables were: GR-group, time (dichotomous: admission versus discharge of GR), age (linear and quadratic), sex, living situation, diagnosis category, facility; the three-way interaction GR-group x time x facility and its associated two-way interactions; and all possible two-way interactions between time and each independent variable; 3) a marginal model with unstructured covariance matrix for the repeated BI measurements. The LMM retains dropouts through a likelihood-based approach to missing outcome data, which is valid under the missing at random (MAR) assumption. Factors associated with dropout were examined through a logistic regression with missing BI at GR-discharge as the outcome, and the following predictors: GR-group, BI at admission, GR-duration, age, sex, living situation, diagnosis category, and facility. Dropout was significantly associated with baseline BI-scores (OR\u0026thinsp;=\u0026thinsp;0.806) and sex (OR\u0026thinsp;=\u0026thinsp;0.485, with male sex as reference). To strengthen the plausibility of the MAR assumption, the LMM adjusted for these factors. Lastly, a sample size justification for this study was provided in the study protocol paper by Pol et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Additional information for both the LMM and Cox regression analyses are displayed in Appendix C.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays the flowchart for the Better@Home study. A total of 1139 patients admitted to the eight participating GR facilities were assessed, of which 712 patients were excluded due to not meeting the eligibility criteria for the Better@Home program. Furthermore, 317 patients were excluded due to not meeting the eligibility criteria for participating in the study. Finally, 110 participants were included in the Better@Home group, for which 240 matched participants were recruited in the historical control group (350 total participants, Better@Home \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;110; control \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;240). Of the 110 participants in the Better@Home group, 15 participants did not start the home-based phase and 12 participants discontinued the home-based phase.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the baseline characteristics of the study participants. The Better@Home and historical control group were comparable on all characteristics. Furthermore, the mean inpatient GR-duration was 38 days for the control group and 33 days for the Better@Home group, after which only the Better@Home group received home-based GR (mean of 36 days). During the home-based phase, an average of 10 sessions per participant were provided. Almost all patients (97%) received treatment sessions at home, 76% of patients received remote sessions and 14% received outpatient sessions. Three of the eight participating facilities had little to no prior experience with home-based GR, defined as the routine provision of home-based GR trajectories prior to the implementation of the Better@Home program. At GR-discharge, 35% of participants had a BI-score of 19 (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19 Better@Home, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25 control) or 20 (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21 Better@Home, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;53 control), indicating a potential ceiling effect.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of participants in the Better@Home and control group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBetter@Home (n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;240)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.4 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.8 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (58.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (56.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary medical diagnosis for admittance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVA, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElective surgery, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003csup\u003ea\u003c/sup\u003e, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary outcome (at baseline)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependence in activities of daily living (BI), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.3 (4\u003cem\u003e.9\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.5 (\u003cem\u003e4.7\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBI-category 0\u0026ndash;4, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBI-category 5\u0026ndash;9, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBI-category 10\u0026ndash;14, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBI-category 15\u0026ndash;19, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBI-category 20, no (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBI\u003cem\u003e=\u003c/em\u003eBarthel-index; SD=Standard Deviation, CVA=Cerebral vascular accident.\u003c/p\u003e \u003cp\u003ea\u0026thinsp;=\u0026thinsp;For example amputation, oncological and/or cardiovascular conditions.\u003c/p\u003e \u003cp\u003eThe results of the final Cox regression model with details on the hazard ratio (HR) are displayed in appendix D. This model shows that the control group had a significantly shorter GR-duration when compared to the Better@Home group, although this difference diminished over time (appendix C). In addition to GR-group, GR-duration was significantly influenced by age (including a quadratic effect), BI at admission, facility, living situation, and diagnosis. Several interactions were significant; GR-group \u0026times; time; GR-group \u0026times; facility; facility x time, and baseline BI \u0026times; time, which are shown in more detail in appendix C. Sensitivity analyses indicated that the results were affected by how censored observations were handled; therefore, the findings should be interpreted with caution.\u003c/p\u003e \u003cp\u003eThe results of the final LMM with details on the mean difference in BI-scores between the Better@Home and the historical control group is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The adjusted mean difference in BI-scores between the Better@Home and the control group at GR discharge was ∆=0.48 points (95% CI: \u0026minus;\u0026thinsp;0.32 to 1.28), which was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.24). The unadjusted mean differences in BI-scores are shown in Fig.\u0026nbsp;2.\u003c/p\u003e \u003cp\u003e \u003cp\u003eTable 4 Linear Mixed Model with independence in activities of daily living as the dependant variable\u003c/p\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003e\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003c/div\u003e \u003c/caption\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eFactor\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eEstimate\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eStd. Error\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eSignificance\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eLower\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eUpper\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-5.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving situation\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.936\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; A\u003c/p\u003e \u003cp\u003e\u0026bull; B\u003c/p\u003e \u003cp\u003e\u0026bull; C\u003c/p\u003e \u003cp\u003e\u0026bull; D\u003c/p\u003e \u003cp\u003e\u0026bull; E\u003c/p\u003e \u003cp\u003e\u0026bull; F\u003c/p\u003e \u003cp\u003e\u0026bull; G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.546\u003c/p\u003e \u003cp\u003e2.755\u003c/p\u003e \u003cp\u003e.546\u003c/p\u003e \u003cp\u003e1.585\u003c/p\u003e \u003cp\u003e1.524\u003c/p\u003e \u003cp\u003e3.411\u003c/p\u003e \u003cp\u003e.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.098\u003c/p\u003e \u003cp\u003e.753\u003c/p\u003e \u003cp\u003e.572\u003c/p\u003e \u003cp\u003e.720\u003c/p\u003e \u003cp\u003e.701\u003c/p\u003e \u003cp\u003e1.064\u003c/p\u003e \u003cp\u003e1.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.021\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003cp\u003e.341\u003c/p\u003e \u003cp\u003e.028\u003c/p\u003e \u003cp\u003e.031\u003c/p\u003e \u003cp\u003e.001\u003c/p\u003e \u003cp\u003e.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.385\u003c/p\u003e \u003cp\u003e1.274\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.579\u003c/p\u003e \u003cp\u003e.168\u003c/p\u003e \u003cp\u003e.144\u003c/p\u003e \u003cp\u003e1.317\u003c/p\u003e \u003cp\u003e-2.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.707\u003c/p\u003e \u003cp\u003e4.236\u003c/p\u003e \u003cp\u003e1.671\u003c/p\u003e \u003cp\u003e3.002\u003c/p\u003e \u003cp\u003e2.904\u003c/p\u003e \u003cp\u003e5.505\u003c/p\u003e \u003cp\u003e2.932\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; CVA\u003c/p\u003e \u003cp\u003e\u0026bull; Trauma\u003c/p\u003e \u003cp\u003e\u0026bull; Respiratory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.492\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.496\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.542\u003c/p\u003e \u003cp\u003e.572\u003c/p\u003e \u003cp\u003e.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.364\u003c/p\u003e \u003cp\u003e.386\u003c/p\u003e \u003cp\u003e.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.558\u003c/p\u003e \u003cp\u003e-1.622\u003c/p\u003e \u003cp\u003e-2.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.574\u003c/p\u003e \u003cp\u003e.629\u003c/p\u003e \u003cp\u003e.626\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eInteractions\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003csup\u003eb\u003c/sup\u003e * time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility\u003csup\u003ef\u003c/sup\u003e * time\u003c/p\u003e \u003cp\u003e\u0026bull; A\u003c/p\u003e \u003cp\u003e\u0026bull; B\u003c/p\u003e \u003cp\u003e\u0026bull; C\u003c/p\u003e \u003cp\u003e\u0026bull; D\u003c/p\u003e \u003cp\u003e\u0026bull; E\u003c/p\u003e \u003cp\u003e\u0026bull; F\u003c/p\u003e \u003cp\u003e\u0026bull; G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.204\u003c/p\u003e \u003cp\u003e1.433\u003c/p\u003e \u003cp\u003e-2.025\u003c/p\u003e \u003cp\u003e-1.474\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.132\u003c/p\u003e \u003cp\u003e2.394\u003c/p\u003e \u003cp\u003e2.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.195\u003c/p\u003e \u003cp\u003e.781\u003c/p\u003e \u003cp\u003e.601\u003c/p\u003e \u003cp\u003e.671\u003c/p\u003e \u003cp\u003e.757\u003c/p\u003e \u003cp\u003e.921\u003c/p\u003e \u003cp\u003e1.455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.341\u003c/p\u003e \u003cp\u003e.067\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003cp\u003e.029\u003c/p\u003e \u003cp\u003e.862\u003c/p\u003e \u003cp\u003e.010\u003c/p\u003e \u003cp\u003e.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.147\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.103\u003c/p\u003e \u003cp\u003e-3.208\u003c/p\u003e \u003cp\u003e-2.793\u003c/p\u003e \u003cp\u003e-1.620\u003c/p\u003e \u003cp\u003e.582\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.554\u003c/p\u003e \u003cp\u003e2.970\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.843\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.154\u003c/p\u003e \u003cp\u003e1.357\u003c/p\u003e \u003cp\u003e4.207\u003c/p\u003e \u003cp\u003e5.668\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ea\u0026thinsp;=\u0026thinsp;Age centered at 79 years; b= Control group used as reference. At GR-discharge, the BI in the Better\u0026amp;Home group is, on average, 0.48 points higher than in the control group; c= T1 (GR-discharge) used as reference. The mean BI at T0 is, on average, 4.731 points lower than at T1; d= Female used as reference; e= Living alone is used as reference; f=Facility H used as reference; g= \u0026rsquo;Other diagnoses\u0026rsquo; is the reference category.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis multicentre cohort study evaluated the Better@Home program, in which part of conventional inpatient rehabilitation is replaced by structured home-based GR. No statistically significant difference in independence in ADL at GR-discharge was observed between groups (Δ\u0026thinsp;=\u0026thinsp;0.48, \u003cem\u003ep\u003c/em\u003e=.24). These findings suggest that home-based GR may be as effective as conventional inpatient GR in achieving independence in ADL.\u003c/p\u003e \u003cp\u003eThe absence of between-group differences in independence in ADL in the present study aligns with evidence from systematic reviews of home-based GR, demonstrating functional outcomes comparable to conventional inpatient rehabilitation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Considering a broader post-acute care perspective, meta-analyses of early supported discharge models across different diagnostic populations similarly indicate matching functional outcomes, when comparing early discharge to the home environment with conventional inpatient care [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Additionally, a recent observational cohort study by Freitas et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] comparing the efficacy of rehabilitation programs in older patients across different therapeutic settings, also found no significant differences on Barthel Index (BI) scores between inpatient and home-based settings. Together, these studies support the view that similar gains in independence in ADL can be achieved when a substantial portion of GR is delivered in the home environment rather than in an institutional setting.\u003c/p\u003e \u003cp\u003eThe observed comparability of independence in ADL (BI) between home-based and conventional inpatient interventions may partly be explained by a ceiling effect of the BI [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In the present study, 35% of the participants scored 19 or 20 on the BI at discharge. While the BI is useful for screening and rapid assessment of dependency levels, it may be less sensitive to subtle functional changes in (relatively) high-functioning patients or home-based settings [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Improvements in more complex domains, which are particularly relevant in home-based GR, are better assessed by instrumental activities of daily living (IADL) or participation [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, in the review of Preitschopf et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which assesses the effectiveness of outpatient GR after inpatient rehabilitation, participation outcome measures were only used in seven of the 24 included studies. Their data synthesis revealed that three of these seven studies demonstrated a favourable effect of home-based rehabilitation on participation, and four studies observed a neutral effect. The authors highlight that, despite being a primary goal of GR, restoring participation levels during the inpatient- and subsequent home-based GR phase receives limited attention. Focussing on participation may improve participation-related outcomes in home-based GR [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These observations are in line with a recent Delphi study emphasizing the importance of addressing participation goals within GR [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Accordingly, one of the core elements of the Better@Home program was the explicit focus on participation goals during GR. In line with previous recommendations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the Better@Home program was developed as a structured five-component approach to promote greater consensus in the delivery- and optimisation of home-based GR following inpatient GR. Unfortunately, it was not possible to comparatively assess the effects of the Better@Home program on participation outcomes, due to the lack of available data for the historical control group. Consequently, it remains uncertain whether the Better@Home program has favourable effects on participation.\u003c/p\u003e\n\u003ch3\u003eStrengths and limitations\u003c/h3\u003e\n\u003cp\u003eThis study has several strengths. The Better@Home study is a comprehensive multicentre evaluation of a structured home-based GR program developed in co-creation with care professionals and based on evidence from recent literature and best practices. Key strengths include the multicentre design across eight GR facilities, the inclusion of a broad range of diagnostic categories and a relatively large sample size of a frail geriatric population, enhances the generalizability of the findings. In addition, three of the eight participating organisations had little to no prior experience with home-based GR when implementing the Better@Home program. Implementation research indicates that complex interventions, such as home-based GR, undergo a learning curve, during which fidelity and efficiency typically improve as protocols are refined and staff gain experience [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. These varying levels of experience in home-based GR reflect real-world practice and strengthen the external validity.\u003c/p\u003e \u003cp\u003eSome limitations must also be addressed. First, the non-randomized design implies that residual confounding could not be fully ruled out, despite multivariable adjustment and frequency matching. Moreover, additional outcome measures (e.g. IADL or participation) could not be included in the analyses, due to the restricted availability of outcome data in the historical control group. A prospective controlled design to include these measures was not ethically possible, as home-based GR was already implemented by several participating facilities and withholding this care from eligible patients could not be enforced. Additionally, selection bias due to excluding patients who received home-based GR in the historical control cohort may have been present. However, by frequency matching per facility within each diagnosis group, this risk is mitigated. Furthermore, the validity of the LMM results depend on the plausibility of the missing-at-random (MAR) assumption. Given the vulnerability of the study population, missingness may have also been dependent on unobserved follow-up measurements of the BI. However, the proportion of missing data was relatively small for this population (15% at discharge), and did not significantly differ between groups (\u003cem\u003ep\u003c/em\u003e=.121).\u003c/p\u003e \u003cp\u003eFinally, the structure and definition of \u0026ldquo;GR-completion\u0026rdquo; differed between groups; for the control group, GR-completion signified discharge from the inpatient facility; whereas in the Better@Home group, GR-completion signified discharge after the full inpatient- and home-based phase. Since BI-scores were only assessed at admission and discharge, the comparison between groups reflects different measurement time points and may be affected by exposure-time differences. However, factors associated with GR-duration were identified using Cox regression and subsequently included as covariates in the LMM when estimating the intervention effects, which revealed no significant group differences. Moreover, recent evidence in post-acute and GR populations show that most functional gains occur during the early, inpatient rehabilitation period [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Home-based GR is primarily focussed on transferring functional gains into everyday activities and consolidating independence in the home environment, rather than continued gains in independence in ADL [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. These findings indicate that the longer GR-duration of the Better@Home group may not have translated into higher scores of independence in ADL.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConclusions and future research\u003c/h2\u003e \u003cp\u003eThe Better@Home study demonstrates that a structured home-based GR program, replacing part of inpatient GR, can achieve levels of independence in activities of daily living comparable to conventional inpatient GR. While the present findings indicate a clear potential for home-based GR as part of routine GR care, they currently provide insufficient evidence to recommend widespread implementation. Data of the ongoing economic-, feasibility- and follow-up evaluations of the Better@Home study are required to comprehensively assess the (cost-)effectiveness and feasibility of the Better@Home program and to inform evidence-based implementation strategies.\u003c/p\u003e \u003cp\u003eFuture studies in the field of home-based GR should include participation measures, as it remains uncertain whether the Better@Home program may have achieved superior outcomes in these domains [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Introducing a standard core set of outcome measures, including a participation (c.q. IADL) measure, could facilitate these efforts.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical implication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Better@Home program may be a valid alternative to conventional inpatient geriatric rehabilitation, achieving equivalent outcomes of independence in activities of daily living. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement:\u003cbr\u003e\u003c/strong\u003eOn behalf of all authors, the corresponding author states that there is no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by ZonMw (The Netherlands Organisation for Health Research and Development), grant number 10020032210004. The funding source had no role in the design of the study; data collection, analysis, or interpretation; writing of the manuscript; or in the decision to submit the article for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003evan Balen R, Gordon AL, Schols JMGA, Drewes YM, Achterberg WP (2019) What is geriatric rehabilitation and how should it be organized? A Delphi study aimed at reaching European consensus. Eur Geriatr Med 2019/12/01(6):977\u0026ndash;987. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s41999-019-00244-7\u003c/span\u003e\u003cspan address=\"10.1007/s41999-019-00244-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrund S, Gordon AL, van Balen R et al (2020) European consensus on core principles and future priorities for geriatric rehabilitation: consensus statement. Eur Geriatr Med Apr 11(2):233\u0026ndash;238. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s41999-019-00274-1\u003c/span\u003e\u003cspan address=\"10.1007/s41999-019-00274-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePol M, Peek S, van Nes F, van Hartingsveldt M, Buurman B, Kr\u0026ouml;se B (2019) Everyday life after a hip fracture: what community-living older adults perceive as most beneficial for their recovery. \u003cem\u003eAge Ageing\u003c/em\u003e. May 1. ;48(3):440\u0026ndash;447. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ageing/afz012\u003c/span\u003e\u003cspan address=\"10.1093/ageing/afz012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH, Aging and Health. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=By%202050%2C%20the%20world's%20population,in%20this%20age%20group%20worldwide\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=By%202050%2C%20the%20world's%20population,in%20this%20age%20group%20worldwide\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAchterberg WP, Cameron ID, Bauer JM, Schols JM (2019) Geriatric Rehabilitation-State of the Art and Future Priorities. J Am Med Dir Assoc Apr 20(4):396\u0026ndash;398. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jamda.2019.02.014\u003c/span\u003e\u003cspan address=\"10.1016/j.jamda.2019.02.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrabbe-Alkemade Y, Makai P, Shestalova V, Voesenek T (2020) Containing or shifting? Health expenditure decomposition for the aging Dutch population after a major reform. Health Policy 124(3):268\u0026ndash;274 2020/03/01. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.healthpol.2019.12.016\u003c/span\u003e\u003cspan address=\"10.1016/j.healthpol.2019.12.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJon Kaplan AB, Thom S, Baker J An Aging-in-Place Strategy for the Next Generation. Updated 23-02-2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bcg.com/publications/2022/aging-in-place-plan-for-next-generation\u003c/span\u003e\u003cspan address=\"https://www.bcg.com/publications/2022/aging-in-place-plan-for-next-generation\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePreitschopf A, Holstege M, Ligthart A et al (2023) Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis. Age Ageing 52(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ageing/afac300\u003c/span\u003e\u003cspan address=\"10.1093/ageing/afac300\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStolee P, Lim SN, Wilson L, Glenny C (2012) Inpatient versus home-based rehabilitation for older adults with musculoskeletal disorders: a systematic review. Clin Rehabil May 26(5):387\u0026ndash;402. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0269215511423279\u003c/span\u003e\u003cspan address=\"10.1177/0269215511423279\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamsey KA, Loveland P, Rojer AGM et al (2021) Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings. J Am Med Dir Assoc Dec 22(12):2432\u0026ndash;2439e1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jamda.2021.04.018\u003c/span\u003e\u003cspan address=\"10.1016/j.jamda.2021.04.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTijsen LM, Derksen EW, Achterberg WP, Buijck BI (2019) Challenging rehabilitation environment for older patients. Clin Interv Aging. :1451\u0026ndash;1460\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkoumal M, Lindner-Rabl S, Honegger M et al (2024) Goal Setting for Participatory Person-Centered Geriatric Rehabilitation-From Function-Centered Rehabilitation towards Digitally Supported Personalized and Integrated Care for Older People. J Clin Med Jul 15(14). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm13144134\u003c/span\u003e\u003cspan address=\"10.3390/jcm13144134\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrund S, van Wijngaarden JP, Gordon AL, Schols JM, Bauer JM (2020) EuGMS survey on structures of geriatric rehabilitation across Europe. Eur Geriatr Med 11:217\u0026ndash;232\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrins LAP, Gamble CJ, van Dam EF et al (2023) An Exploratory Study Investigating Factors Influencing the Outpatient Delivery of Geriatric Rehabilitation. J Clin Med Jul 31(15). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm12155045\u003c/span\u003e\u003cspan address=\"10.3390/jcm12155045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerweij L, van de Korput E, Daams JG et al (2019) Effects of Postacute Multidisciplinary Rehabilitation Including Exercise in Out-of-Hospital Settings in the Aged: Systematic Review and Meta-analysis. Arch Phys Med Rehabil Mar 100(3):530\u0026ndash;550. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.apmr.2018.05.010\u003c/span\u003e\u003cspan address=\"10.1016/j.apmr.2018.05.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePol MC, van Isselt E, Doornebosch AJ et al (2025) Evaluation of outcomes, costs, and feasibility of home-based geriatric rehabilitation after inpatient rehabilitation: study protocol of the Better@Home multicentre prospective cohort study with historical control group. BMC Geriatr Nov 28(1):980. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-025-06573-6\u003c/span\u003e\u003cspan address=\"10.1186/s12877-025-06573-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGamble CJ, van Haastregt J, van Dam EF, Zwakhalen S, Schols J (2024) Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review. Clin Rehabil Apr 38(4):457\u0026ndash;477. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/02692155231217411\u003c/span\u003e\u003cspan address=\"10.1177/02692155231217411\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKraaijkamp JJM, van Dam EF, Persoon A, Versluis A, Chavannes NH, Achterberg WP (2021) eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability. J Med Internet Res Aug 19(8):e24015. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/24015\u003c/span\u003e\u003cspan address=\"10.2196/24015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePol MC, Ter Riet G, van Hartingsveldt M, Kr\u0026ouml;se B, Buurman BM (2019) Effectiveness of sensor monitoring in a rehabilitation programme for older patients after hip fracture: a three-arm stepped wedge randomised trial. Age Ageing Sep 1(5):650\u0026ndash;657. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ageing/afz074\u003c/span\u003e\u003cspan address=\"10.1093/ageing/afz074\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMouchaers I, Verbeek H, Kempen G et al (2023) Development and content of a community-based reablement programme (I-MANAGE): a co-creation study. BMJ Open Aug 30(8):e070890. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2022-070890\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2022-070890\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuma LE, Vluggen S, Zwakhalen S, Kempen G, Metzelthin SF (2022) Effects on clients' daily functioning and common features of reablement interventions: a systematic literature review. Eur J Ageing Dec 19(4):903\u0026ndash;929. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10433-022-00693-3\u003c/span\u003e\u003cspan address=\"10.1007/s10433-022-00693-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssociation WM (2013) World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA 310(20):2191\u0026ndash;2194. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2013.281053\u003c/span\u003e\u003cspan address=\"10.1001/jama.2013.281053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Maryland State Med J\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollin C, Wade D, Davies S, Horne V (1988) The Barthel ADL Index: a reliability study. Int Disabil Stud 10(2):61\u0026ndash;63\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouwstra H, Smit E, Wattel E et al (2018) Measurement Properties of the Barthel Index in Geriatric Rehabilitation. J Am Med Dir Assoc 11/01. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jamda.2018.09.033\u003c/span\u003e\u003cspan address=\"10.1016/j.jamda.2018.09.033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJansen M, Doornebosch AJ, de Waal MW et al (2021) Psychometrics of the observational scales of the Utrecht Scale for Evaluation of Rehabilitation (USER): Content and structural validity, internal consistency and reliability. Arch Gerontol Geriatr 97:104509\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Waal MW, Jansen M, Bakker LM et al (2024) Construct validity, responsiveness, and interpretability of the Utrecht Scale for Evaluation of Rehabilitation (USER) in patients admitted to inpatient geriatric rehabilitation. Clin Rehabil 38(1):98\u0026ndash;108\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUtrecht DHU Barthel Index User 1.3\u0026ndash;1.5 SPSS syntax\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePost MWM, van de Port MWIGL, Berdenis SH, van Berlekom L Kasius de Jong De USER (Utrechtse Schaal voor de Evaluatie van Klinische Revalidatie) is een meetinstrument om het resultaat van de klinische revalidatie te meten. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.kcrutrecht.nl/producten/user/\u003c/span\u003e\u003cspan address=\"https://www.kcrutrecht.nl/producten/user/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLanghorne P, Taylor G, Murray G et al (2005) Early supported discharge services for stroke patients: a meta-analysis of individual patients' data. Lancet 365(9458):501\u0026ndash;506. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(05)17868-4\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(05)17868-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams S, O'Riordan C, Morrissey AM, Galvin R, Griffin A (2024) Early supported discharge for older adults admitted to hospital after orthopaedic surgery: a systematic review and meta-analysis. BMC Geriatr Feb 9(1):143. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-024-04775-y\u003c/span\u003e\u003cspan address=\"10.1186/s12877-024-04775-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreitas MM, Antunes S, Ascenso D, Silveira A (2021) Outpatient and Home-Based Treatment: Effective Settings for Hip Fracture Rehabilitation in Elderly Patients. Geriatrics 6(3):83\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Putten JJMF, Hobart JC, Freeman JA, Thompson AJ (1999) Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry 66(4):480\u0026ndash;484. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/jnnp.66.4.480\u003c/span\u003e\u003cspan address=\"10.1136/jnnp.66.4.480\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePreitschopf A, Vaz M, Holstege M, Pol M, Buurman B, Groen W International Delphi study on terminology, organisation and outcomes of geriatric rehabilitation for older people living at home. Eur Geriatr Med. 2025/10/01 2025;16(5):1839\u0026ndash;1850. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s41999-025-01241-9\u003c/span\u003e\u003cspan address=\"10.1007/s41999-025-01241-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePreitschopf AD, Pol M, Buurman B, Holstege M (2025) Home-based geriatric rehabilitation after inpatient rehabilitation: a redesign and feasibility study. BMC Geriatr 06(1):398. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-025-06043-z\u003c/span\u003e\u003cspan address=\"10.1186/s12877-025-06043-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. /02 2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoth C, Maier L, Abel B et al (2024) Implementation of a multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): an early qualitative process evaluation. \u003cem\u003eBMC Geriatrics\u003c/em\u003e. /08/29 2024;24(1):720. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-024-05277-7\u003c/span\u003e\u003cspan address=\"10.1186/s12877-024-05277-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEverink IHJ, van Haastregt JCM, Tan FES, Schols J, Kempen G (2018) The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study. BMC Geriatr Nov 16(1):285. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-018-0971-4\u003c/span\u003e\u003cspan address=\"10.1186/s12877-018-0971-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoh CH, Reijnierse EM, Tuttle C et al (2021) Trajectories of functional performance recovery after inpatient geriatric rehabilitation: an observational study. Med J Aust Aug 16(4):173\u0026ndash;179. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5694/mja2.51138\u003c/span\u003e\u003cspan address=\"10.5694/mja2.51138\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Tol LS, Lin T, Caljouw MAA et al (2024) Post-COVID-19 recovery and geriatric rehabilitation care: a European inter-country comparative study. Eur Geriatr Med Oct 15(5):1489\u0026ndash;1501. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s41999-024-01030-w\u003c/span\u003e\u003cspan address=\"10.1007/s41999-024-01030-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi X, Zheng T, Guan Y et al (2020) ADL recovery trajectory after discharge and its predictors among baseline-independent older inpatients. \u003cem\u003eBMC Geriatrics\u003c/em\u003e. /03/04 2020;20(1):86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-020-1481-8\u003c/span\u003e\u003cspan address=\"10.1186/s12877-020-1481-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMusa KI, Keegan TJ (2018) The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model. PLoS ONE 13(12):e0208594. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0208594\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0208594\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Geriatric Rehabilitation, Home-Based, Activities of Daily Living, Barthel Index, Rehabilitation Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-9213809/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9213809/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePopulation ageing is increasing the demand for geriatric rehabilitation (GR). A transition towards home-based GR could potentially reduce the need for inpatient GR and better align rehabilitation with daily functioning at home. The aim of this study is to compare the level of independence in activities of daily living between patients receiving the \u0026ldquo;Better@Home\u0026rdquo; program and those undergoing conventional inpatient geriatric rehabilitation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe Better@Home study is a multicentre prospective cohort study with a matched historical control group. Eight GR facilities in the Netherlands implemented the Better@Home program, which is a five-component intervention in which home-based GR replaces part of inpatient GR. Data was gathered at GR-admission- and discharge through semi-structured interviews, registration forms, and electronic patient files. The Better@Home group was compared with a matched historical control group receiving conventional inpatient GR on independence in activities of daily living (ADL), assessed by the Barthel Index (BI). Data was analyzed using a Cox- and linear mixed-effects (LMM) regression model.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 350 participants were included (Better@Home \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;110; control \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;240). Groups were comparable on all characteristics at baseline. The LMM-analysis found no significant difference between the Better@Home and the control group on independence in ADL at discharge (mean BI difference: 0.48 points, 95% CI: \u0026minus;\u0026thinsp;0.323\u0026ndash;1.282; \u003cem\u003ep\u003c/em\u003e=.240).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study demonstrates that a structured home-based GR program, replacing part of inpatient GR, can achieve levels of independence in activities of daily living comparable to conventional inpatient GR.\u003c/p\u003e","manuscriptTitle":"Independence in activities of daily living for home-based geriatric rehabilitation after shortened inpatient rehabilitation: The “Better@Home” multicentre prospective cohort study with a matched historical control group.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-28 15:54:18","doi":"10.21203/rs.3.rs-9213809/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-04-21T13:09:49+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-20T16:15:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"European Geriatric Medicine","date":"2026-03-30T18:20:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-27T15:52:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Geriatric Medicine","date":"2026-03-24T11:18:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b960eae2-22fc-4c67-b390-2df1584e65a5","owner":[],"postedDate":"April 28th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T15:54:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-28 15:54:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9213809","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9213809","identity":"rs-9213809","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}