(Golden Oldie) Patient-centered physical therapy is (cost-)effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6-months follow-up

Key points

1. 01Moderate-intensity physical activity increased by 17.9 min/day more in the Coach2Move group than usual care at 6 months (P=0.012)
2. 02Frailty scores decreased significantly more with Coach2Move (mean difference -0.03; P=0.027)
3. 03Coach2Move generated average healthcare cost savings of 848.8 euros per patient (P=0.028) and higher QALYs (difference 0.02; P=0.011)
4. 04Mean number of physical therapy sessions was lower in Coach2Move (mean 11) than usual care (mean 17; P=0.003)
5. 0535% of Coach2Move participants who were inactive at baseline met the 30 min/day PA standard by 6 months, versus 18% in usual care (P=0.037)

How it was conducted

Design

Randomized controlled trial with measurements at baseline, 3 months, and 6 months across 13 physical therapy practices

Participants

130 adults aged 70 years or older with mobility problems and sedentary lifestyle or at risk of losing an active lifestyle; mean age approximately 78.5 years

Groups

Coach2Move (n=64): individualized patient-centred physical therapy with motivational interviewing, goal setting, and self-management coaching; Usual care PT (n=65): standard physical therapy without structured coaching protocol

Primary outcome

Physical activity (total and moderate intensity) in minutes per day measured by LASA Physical Activity Questionnaire (LAPAQ) at 6 months

Secondary outcomes

Frailty (Evaluative Frailty Index for PA), walking speed and distance, mobility (Get Up and Go Test), quality of life (SF-36), fatigue, patient-specific complaints

Economic analysis

Healthcare costs and QALYs computed from societal perspective; net monetary benefit (NMB) calculated at multiple willingness-to-pay thresholds

What they found

• Moderate-intensity PA at 6 months: between-group difference 17.9 min/day (95% CI 4.0 to 34.9; P=0.012) in favour of Coach2Move
• Total PA at 6 months: between-group difference 14.1 min/day (95% CI -6.6 to 34.9; P=0.182; not statistically significant)
• Frailty at 6 months: between-group difference -0.03 (95% CI -0.06 to -0.00; P=0.027) in favour of Coach2Move
• Effect size (Cohen's d) for moderate-intensity PA: 0.38 (95% CI 0.01 to 0.74); for total PA: 0.23 (95% CI -0.14 to 0.60); for frailty: -0.23 (95% CI -0.59 to 0.13)
• Total healthcare costs at 6 months: Coach2Move mean 2675.6 euros (95% CI 1911.5 to 3439.7) vs usual care 3524.4 euros (95% CI 2730.2 to 4318.6); mean difference -848.8 euros (95% CI -1607 to -90; P=0.028)
• QALYs at 6 months: mean difference 0.02 (95% CI 0.00 to 0.03; P=0.011) in favour of Coach2Move
• Incremental NMB at willingness-to-pay threshold of 10,000 euros: 905 euros (95% CI 117 to 1993; P=0.024) in favour of Coach2Move
• Probability of Coach2Move being cost effective vs usual care: over 95% across pre-specified WTP range
• Major incidents or deaths: 8% in Coach2Move vs 22% in usual care (P=0.028)
• Mean PT sessions: Coach2Move 11 (SD 4.5) vs usual care 17 (SD 15.0; P=0.003)

Limitations

• No no-treatment control group, so natural recovery cannot be ruled out as a contributor to improvements in both arms
• Follow-up period of only 6 months; long-term durability of gains is unknown
• Informal caregiver costs were excluded from the economic analysis, meaning cost-effectiveness is estimated primarily from a healthcare perspective
• Selection bias is possible because many potential participants declined randomization due to preference for a specific therapist, which may limit generalizability

Why it matters

For patients

Frail older adults with mobility problems can safely increase daily physical activity and reduce frailty through a tailored physical therapy programme, with the additional benefit of fewer total therapy sessions.

For clinicians

Coach2Move offers a structured, patient-centred framework combining motivational interviewing, shared goal-setting, and stratified session profiles that outperforms usual physical therapy on activity, frailty, and cost outcomes in community-dwelling older adults.

For readers

This RCT provides moderate-quality evidence that patient-centred physical therapy is both clinically effective and cost-saving in an older adult population, supporting investment in therapist training and individualized approaches over standard care protocols.