Impact of Physiotherapist and Occupational Therapist Allocation in Adult Day Services (ADS) on 24-Month ADL Trajectories Among Community-Dwelling Older Adults

OBJECTIVES: To examine whether the presence of physical therapists (PTs) and occupational therapists (OTs) in adult day services (ADS) is associated with differences in 24-month trajectories of activities of daily living among community-dwelling older adults. DESIGN: Retrospective longitudinal observational study using propensity score-matched analysis. SETTING AND PARTICIPANTS: A total of 1908 community-dwelling older adults aged ≥65 years who continuously used ADS for at least 24 months in Japan were included. Participants were enrolled in the Tsukui Ordered Useful Care for Health program and were divided into PT/OT-staffed ADS facilities (PTOT group) and facilities without rehabilitation professionals (control group). METHODS: After propensity score matching, 954 participants in the PTOT group were compared with 954 participants in the control group. Motor Functional Independence Measure (mFIM) scores were assessed at baseline and at 6, 12, 18, and 24 months. Longitudinal changes were analyzed using repeated-measures analysis of variance. Minimal detectable change thresholds were calculated to determine clinically meaningful decline. RESULTS: Both groups showed significant declines in mFIM and transfer scores over 24 months. However, deterioration occurred earlier in the control group than in the PTOT group. At 24 months, the PTOT group demonstrated significantly smaller declines in mFIM and transfer scores compared with the control group (P < .05), and between-group differences exceeded minimal detectable change thresholds. CONCLUSIONS AND IMPLICATIONS: The presence of PTs and OTs in ADS was associated with a slower rate of activities of daily living decline, particularly in transfer ability, among community-dwelling older adults. Integrating rehabilitation professionals into ADS may contribute to safer mobility, maintenance of functional independence, and potentially reduced risk of falls and hospitalization. Further research is needed to clarify intervention mechanisms and long-term outcomes.