# Advancing Rehabilitation Paradigms for Older Adults in Skilled Nursing Facilities

> **NIH NIH R01** · UNIVERSITY OF COLORADO DENVER · 2023 · $562,515

## Abstract

Project Summary/Abstract
In the U.S., 8.37 million adults over age 65 will experience a hospital stay during the next year, which often
has serious and long-lasting consequences including profound deterioration in physical function. Following a
hospital stay, around 1.35 million patients with deconditioning require rehabilitation in a skilled nursing facility
(SNF) each year to address the deleterious musculoskeletal and functional deficits from deconditioning.
Unfortunately, current rehabilitation paradigms in SNFs do not adequately restore physical function, which
directly contributes to poor community discharge rates. Strikingly, only 52% of all patients admitted to SNFs
are discharged to a community setting (e.g., home), which suggests a paradigm shift is required to optimize
rehabilitation within SNFs. Currently, usual care rehabilitation in SNFs consists of low-intensity rehabilitation
interventions, which are physiologically inadequate to induce meaningful changes in skeletal muscle strength
and physical function. To address these pitfalls, a high-intensity resistance rehabilitation paradigm has been
shown to improve outcomes including better physical function, increased community discharge rates, and
cost-effective reductions in length of stay. The proposed pragmatic study seeks to apply this rehabilitation
paradigm to multiple SNFs to further evaluate the effectiveness of high-intensity resistance rehabilitation (Aim
1), while evaluating processes, mechanisms, and determinants of successful implementation (Aim 2). We
propose a cluster randomized pragmatic trial design in which a high-intensity intervention (15 SNFs) will be
compared to usual care (15 SNFs). Effectiveness in terms of physical function will be determined via change
in patient gait speed (primary outcome) from admission to discharge. Implementation strategies will be
evaluated by reach (proportion of patients treated with the intervention), adoption (proportion of therapists
appropriately adopting the intervention), implementation (fidelity assessments), and maintenance (long-term
fidelity assessments) of the intervention. This study will provide the first large-scale evaluation of high-
intensity rehabilitation for patients admitted to SNFs following hospitalization. Additionally, through systematic
comparison and in-depth analysis of implementation across a variety of SNFs, this study will provide critical
insight regarding barriers and facilitators of implementation. Overall findings from this study have the potential
to 1) shift SNF rehabilitation care paradigms; 2) optimize patient outcomes and independence and 3) critically
inform future work aimed at wide-scale implementation of high-intensity rehabilitation across post-acute
settings.

## Key facts

- **NIH application ID:** 10659131
- **Project number:** 5R01AG072693-03
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Jennifer E. Stevens-Lapsley
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $562,515
- **Award type:** 5
- **Project period:** 2021-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10659131

## Citation

> US National Institutes of Health, RePORTER application 10659131, Advancing Rehabilitation Paradigms for Older Adults in Skilled Nursing Facilities (5R01AG072693-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10659131. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*