IMPORTANCE: Sustaining pulmonary rehabilitation (PR) benefits in community-dwelling individuals with chronic obstructive pulmonary disease (COPD) is challenging. OBJECTIVE: The objective of this study was to explore the...IMPORTANCE: Sustaining pulmonary rehabilitation (PR) benefits in community-dwelling individuals with chronic obstructive pulmonary disease (COPD) is challenging. OBJECTIVE: The objective of this study was to explore the experiences of individuals with COPD participating in a PersonalIzed CommUnity-based Physical Activities program (PICk UP) and to identify which behavioral change techniques (BCTs) supported sustained physical activity (PA). DESIGN: This was a qualitative pre-post intervention study (NCT04223362|NCT04711057). SETTING: The study was conducted in a community setting. PARTICIPANTS: This study recruited individuals with COPD assigned to the PICk UP intervention. INTERVENTION: Participants enrolled in a 6-month, post-PR, community-based program comprising gym, senior exercise classes, pool exercise classes, or Chi Kung. MAIN OUTCOME AND MEASURES: Participants' perspectives on impacts of the PICk UP program, motivators, facilitators, and barriers to adherence were collected through pre-post focus groups. Data were analyzed using deductive and inductive reflexive thematic analysis. The "capability, opportunity, motivation, behavior" framework was used to identify BCTs. RESULTS: Fifteen individuals with COPD participated (14 male, 70 [8] years, FEV1 57.1% [18.1%] predicted). Five main themes emerged, focusing on PA choice, barriers, facilitators, effects, and suggestions: (1) one size doesn't fit all; (2) organizational factors and system-level support enabling adherence; (3) it doesn't come easy; (4) a positive feedback cycle sustained physical, psychological, and social benefits; and (5) the more, the merrier. The PICk UP intervention supported PA through 13 BCTs, across 5 intervention types (education, persuasion, training, environmental restructuring, and enablement), collectively addressing all 6 components influencing behavior. CONCLUSIONS: Individuals with COPD reported lasting PR benefits after the PICk UP and were willing to remain physically active. Participants emphasized the importance of diverse PA options and support from peers, health, and fitness professionals. RELEVANCE: To sustain PA beyond PR, interventions should prioritize intersectoral partnerships and embed ongoing social support. These findings underscore PICk UP's effectiveness, positioning it as a promising and replicable model for promoting long-term PA in individuals with COPD.
IMPORTANCE: Dry needling (DN) is widely used in musculoskeletal practice. However, the incidence and severity of adverse events (AEs) associated to DN remain unclear. OBJECTIVE: The objective was to report the frequency...IMPORTANCE: Dry needling (DN) is widely used in musculoskeletal practice. However, the incidence and severity of adverse events (AEs) associated to DN remain unclear. OBJECTIVE: The objective was to report the frequency and severity of AEs related to DN. DESIGN: This was a systematic review with meta-analysis. SETTING: Following the PRISMA checklist, PubMed, Web of Science, and Scopus databases were systematically searched from September 2024 to April 2025. STUDIES AND INTERVENTION: Case reports, case series, surveys, observational studies, and randomized clinical trials conducted on humans, applying DN and assessing associated AEs, were collected. MAIN OUTCOMES AND MEASURES: Methodological quality and risk of bias were assessed using the Joanna Briggs Institute tool, the AXIS tool, the PEDro scale and the Newcastle-Ottawa scale. Data were screened and extracted by 2 independent investigators, consulting a third researcher in case of doubts. The information was analyzed and classified in separate tables detailing the characteristics of the sample, the interventions, the AEs, and the methodological quality from the different types of studies. RESULTS: A total of 59 articles were included, comprising 25 patients in case reports and case series, 1947 patients in randomized clinical trials and prospective observational studies and 2380 professionals in surveys. DN was found to commonly produce minor AEs, ranging from 0% to 48.15% per treatment and from 2.56% to 72.73% throughout a clinician's career. Major AEs per treatment are uncommon (0%-0.43%) but are reported by 0.98% to 39.14% of professionals when assessing their complete clinical practice. CONCLUSIONS AND RELEVANCE: While DN is widely used and generally associated with minor AEs, this review highlights the potential for rare although serious complications.
IMPORTANCE: Gait adaptability is essential for safe walking. Impairments after non-progressive neurological conditions contribute to walking limitations and fall risk. Advances in virtual/augmented reality-based treadmil...IMPORTANCE: Gait adaptability is essential for safe walking. Impairments after non-progressive neurological conditions contribute to walking limitations and fall risk. Advances in virtual/augmented reality-based treadmills/walkways have increased interest in gait adaptability assessment and training, making a review timely. OBJECTIVE: The objectives were as follows: (1) Explore the characteristics and outcomes of physical interventions used to improve gait adaptability for individuals with non-progressive neurological conditions; and (2) Identify the outcome measures and tasks used to track changes with interventions incorporating gait adaptability training. DATA SOURCES: A comprehensive search was conducted in 6 databases: CINAHL Complete, Embase, Emcare Nursing, Medline ALL, PEDro, and Web of Science Core Collection, from inception to September 8, 2025. STUDY SELECTION: Studies that involved adults with non-progressive neurological conditions, incorporated walking with environmental/task changes, targeted gait adaptability, and included >2 training sessions were included. DATA EXTRACTION AND SYNTHESIS: Study/participant characteristics, interventions, and outcomes were extracted. Methodological quality was assessed using the Modified Downs and Black checklist. Interventions were categorized into 6 groups, and their alignment with 9 gait adaptability domains was evaluated. Outcome measures were identified and classified based on relevance to gait adaptability. RESULTS: Twenty-nine studies (881 participants: 743 stroke, 132 spinal cord injury, 6 acquired brain injury) were included. The most common interventions were skilled overground/community walking and treadmill training with virtual/augmented reality. Obstacle negotiation was the most frequently targeted gait adaptability domain. Interventions that incorporated gait adaptability training led to improvements in walking outcomes such as speed and endurance. The most common outcome measures-10-Meter Walk Test, Timed Up and Go, and 6-Minute Walk Test-do not directly assess gait adaptability. CONCLUSIONS AND RELEVANCE: Interventions that incorporated gait adaptability training included a broad range of overground and treadmill training approaches, and improved walking ability. Future trials should include measures that directly assess multiple domains of gait adaptability.
Over several decades, the American Physical Therapy Association (APTA) has been prompted with numerous motions in its House of Delegates to elaborate on the role of physical therapists in primary care. The 2025 APTA Hous...Over several decades, the American Physical Therapy Association (APTA) has been prompted with numerous motions in its House of Delegates to elaborate on the role of physical therapists in primary care. The 2025 APTA House of Delegates adopted a motion recognizing primary care physical therapy (PCPT) as an area of specialty and residency practice. One of the most common inquiries presented to the 2022 to 2025 APTA Federal Primary Care Special Interest Group board members was "how is primary care physical therapy (PCPT) defined?" As this practice area develops, it was determined that a consensus definition would prove to be an invaluable resource to ensure consistent language and knowledge translation. Therefore, the purpose of this project was to develop a consensus definition for PCPT. >Impact Statement: As an emerging practice area in the United States, a consensus definition of primary care physical therapy (PCPT) is needed to advance team-based primary care and to conduct valid research regarding the impact of PCPT on the quality and cost of health care services.
The last 20 years have seen an explosion of research devoted to understanding the feasibility, safety, implementation, and patient and system outcomes of physical rehabilitation for patients who are critically ill in the...The last 20 years have seen an explosion of research devoted to understanding the feasibility, safety, implementation, and patient and system outcomes of physical rehabilitation for patients who are critically ill in the intensive care unit (ICU). Multiple systematic reviews and meta-analyses have shown ICU physical rehabilitation to be feasible, safe, contribute to reduced ICU and hospital stays, reduce days on mechanical ventilation, and improve functional level outcomes at ICU and hospital discharge. These data demonstrate that ICU physical rehabilitation offers transformative potential for improving functional independence and quality of life in patients who are critically ill. However, significant barriers persist in translating evidence from randomized controlled trials into routine clinical practice. These barriers include patient heterogeneity, inconsistent intervention protocols and reporting, and systemic obstacles to implementation. This article provides perspective on these key challenges and proposes strategies for designing next-generation trials. Impact: Survivors of critical illness often face lasting physical, cognitive, and mental health challenges, and physical rehabilitation in the ICU can improve recovery. This article explores the importance of tailoring physical rehabilitation to individual needs and proposes new research methods to improve the design and outcomes of future ICU trials. By addressing challenges, the authors provide practical solutions to make ICU rehabilitation more accessible and effective. These insights aim to enhance recovery and quality of life for ICU survivors.
IMPORTANCE: Firearm injury in the United States disproportionately affects marginalized and disadvantaged communities and results in high rates of functional limitations, mobility impairments, and chronic pain. Despite t...IMPORTANCE: Firearm injury in the United States disproportionately affects marginalized and disadvantaged communities and results in high rates of functional limitations, mobility impairments, and chronic pain. Despite the high rates of firearm injury and impact on function, few studies have examined access to rehabilitation care after firearm injury. OBJECTIVE: This study analyzed the use of physical therapy after firearm injuries compared to other traumatic injuries. DESIGN: A retrospective cohort study was performed using medical claims data from a statewide All Payer Claims Database (APCD) linked with an institutional trauma registry (2013-2022). SETTING: The setting was a Level I trauma center. PARTICIPANTS: Patients were identified from our institution's trauma registry to obtain initial injury information, and trauma registry data were linked to the Washington State APCD to identify physical therapy service use. EXPOSURE: The exposure was mechanism of injury (firearm vs other trauma). MAIN OUTCOMES AND MEASURES: The main outcome was the use of physical therapy services in any setting in the year after hospital or emergency department discharge, and the secondary outcome was the total number of physical therapist visits. Covariates included sociodemographic factors (race, ethnicity, insurance, age, and gender) and clinical characteristics indicating the need for physical therapy (injury region, injury severity, and hospital length of stay). Multivariable Poisson regression with robust SEs was used to evaluate the effect of firearm mechanism on outcomes. RESULTS: Among 25,404 patients, the overall rate of physical therapist service use was 37.2%. Firearm injury survivors were less likely to use physical therapy services than survivors of other trauma (21.3% vs 38.4%; adjusted relative risk = 0.79; 95% CI = 0.71-0.88). Firearm injury survivors had fewer total physical therapy visits (8.0 [SD = 11.4] vs 11.9 [SD = 13.8]; adjusted relative risk = 0.79; 95% CI = 0.76-0.82). CONCLUSIONS: Despite a high incidence of serious and disabling physical conditions after firearm injury, there was less use of physical therapy services after firearm injury than after other mechanisms of injury in this single-institution sample. RELEVANCE: Insufficient use of physical therapy services after firearm injury may affect recovery and long-term outcomes among firearm injury survivors, and interventions are needed to support improved access to rehabilitation in this population.
Lin LY, Lin AC, Lai PC
… +14 more, Fang CJ, Tu YK, Huang MT, Wu PT, Su WR, Hong CK, Kuan FC, Hsu KL, Chang CW, Lin CJ, Wang JH, Liu ZW, Lee SY, Shih CA
IMPORTANCE: Pediatric flexible flatfoot (PFF) is a common condition affecting children's foot biomechanics. While various conservative treatments exist, their relative effectiveness remains unclear. OBJECTIVE: The object...IMPORTANCE: Pediatric flexible flatfoot (PFF) is a common condition affecting children's foot biomechanics. While various conservative treatments exist, their relative effectiveness remains unclear. OBJECTIVE: The objective was to compare the effectiveness of non-surgical interventions-orthotic devices, active exercise-based interventions, and neuromuscular electrical stimulation (NMES)-for managing PFF. DESIGN: A systematic review and network meta-analysis of randomized controlled trials was conducted and registered in PROSPERO (CRD42024539990). PARTICIPANTS: Eleven trials encompassing 761 children with flexible flatfoot were included. INTERVENTIONS: Non-surgical interventions included orthotic devices (traditional insoles, talus control insoles, corrective shoes, heel cups) and active exercise-based physical therapist interventions (corrective exercises, core stabilization exercises, and NMES combined with corrective exercises). OUTCOME MEASURES: Outcome measures included the Staheli index (static footprint measurement), barefoot radiological measures (anterior-posterior and lateral talocalcaneal angles, calcaneal pitch angle), pain scores, and treatment discontinuation rates. RESULTS: NMES combined with corrective exercises demonstrated significant improvement in the Staheli index compared to no intervention (mean difference [MD] = -0.28, 95% CI = -0.35 to -0.22; certainty of evidence [CoE]: moderate). Talus control insoles showed significant improvements in radiological outcomes compared to conventional flat footwear, including lateral talocalcaneal angle (MD = -5.56°, 95% CI = -9.81 to -1.30; CoE: low) and calcaneal pitch angle (MD = 2.74°, 95% CI = 0.41 to 5.06; CoE: low). Traditional insoles effectively reduced pain scores compared to flat insoles (MD = -2.92 points, 95% CI = -3.73 to -2.11; CoE: very low). Pain outcomes were not assessed in exercise or NMES studies, preventing comparative effectiveness conclusions across intervention types. No significant differences in treatment discontinuation rates were observed among orthotic interventions. CONCLUSIONS: Both active exercise-based and orthotic interventions demonstrated beneficial effects. NMES with corrective exercises improved standing foot alignment by static footprint analysis, while orthotic interventions enhanced radiological alignment (talus control insoles) and pain relief (traditional insoles) compared to conventional footwear. Outcome measurement differences between intervention types limited direct comparisons. Ten studies measuring gait, functional, or developmental outcomes were excluded due to insufficient outcome overlap. RELEVANCE: This network meta-analysis provides evidence-based guidance for selecting conservative PFF interventions based on primary treatment objectives.
IMPORTANCE: Patients with aneurysmal subarachnoid hemorrhage (aSAH) represent a cohort with limited evidence to guide mobilization practices. OBJECTIVE: The objective was to describe acute mobilization practices, outcome...IMPORTANCE: Patients with aneurysmal subarachnoid hemorrhage (aSAH) represent a cohort with limited evidence to guide mobilization practices. OBJECTIVE: The objective was to describe acute mobilization practices, outcomes, and barriers to mobilization in patients following aSAH. DESIGN: The design of the study was a single-center prospective, observational study. SETTING: This study was conducted in the acute ward and intensive care unit of a tertiary neurosurgical referral center. PARTICIPANTS: Participants were adult (≥18 years) patients post-aSAH with secured aneurysms. EXPOSURE: Mobilization practices were delivered during physical therapist sessions up to 14 days post-aneurysm repair. MAIN OUTCOMES AND MEASURES: Severity was classified using the World Federation of Neurological Surgeons scale, dichotomizing into "good" (Grade I to II) and "poor" (Grade III to V) clinical status. Mobilization outcomes were measured using the Mobility Scale for Acute Stroke (MSAS), with independent walking assessed. RESULTS: A total of 102 patients participated with 69 (67.6%) classified as "good" grade and 90 (88.2%) of patients mobilized within the first 14 days. Data were collected from 603 planned mobilization sessions, with barriers to mobilization encountered in 193 (32.0%) of these sessions, primarily due to neurological instability (n = 80, 41.5%) and hemodynamic instability (n = 43, 22.3%). Overall, the highest median MSAS score achieved was 32 (IQR = 10 to 36). By 2 weeks, 65.2% of patients with a "good" clinical status walked independently versus 12.9% in the "poor" group. CONCLUSIONS: While most patients mobilized, physiological instability commonly prevented mobilization activities. Independent walking by 2 weeks was significantly more common in patients with "good" clinical status. These findings underline the importance of careful screening and monitoring during mobilization in the acute period. RELEVANCE: This study underscores the need for further research into optimal mobilization strategies for improving outcomes in patients with aSAH.
IMPORTANCE: The debate on whether different motor and cognitive profiles of children with autism spectrum disorder (ASD) reflect distinct patterns of comorbidities with significant implications continues in autism resear...IMPORTANCE: The debate on whether different motor and cognitive profiles of children with autism spectrum disorder (ASD) reflect distinct patterns of comorbidities with significant implications continues in autism research. OBJECTIVE: The aim of this study was to determine the motor and cognitive profiles of children with ASD alone as well as those with ASD and comorbid developmental disabilities. Additionally, it was assessed whether the cognitive abilities were linked to the motor performance of children with ASD. DESIGN: This study was a secondary analysis of a retrospective cohort. SETTING: The setting was a multidisciplinary outpatient clinic in Taiwan. PARTICIPANTS: Diagnostic groups included ASD (n = 263), intellectual disability (ID; n = 95), attention deficit hyperactivity disorder (ADHD; n = 222), ASD plus ID (ASD + ID; n = 77), ASD plus ADHD (ASD + ADHD; n = 74), and speech/language delay (SLD; n = 396). MAIN OUTCOMES AND MEASURES: The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition and Movement Assessment Battery for Children-Second Edition were used to examine motor and cognitive profiles and their relationship in 1127 young children who were 36 to 77 months old. RESULTS: Children with ASD, ASD + ADHD, and SLD performed significantly better than those with ID and ASD + ID on the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition test for cognitive abilities. The ASD + ID group exhibited the most pronounced motor deficits, with 89.6% of children experiencing difficulties. Significant associations were found between cognitive abilities and motor skills within the ASD, ASD + ID, and ASD + ADHD groups. Multiple regression revealed that visual-spatial ability predicted motor performance across all groups, while verbal comprehension was a significant predictor of motor performance in the ASD + ID, ID, and SLD groups. Working memory was an important predictor of motor performance in the ASD, ASD + ADHD, and SLD groups. CONCLUSIONS: These findings highlight that children with ASD and comorbid developmental disabilities present unique motor and cognitive profiles. RELEVANCE: The relationship between specific cognitive domains and motor skills suggests that individual cognitive profiles may help identify distinct etiological subtypes of ASD and associated comorbidities and provide a cognitively informed basis for physical therapy decision-making in early childhood.
IMPORTANCE: Older veterans experience higher rates of multimorbidity than their non-veteran peers; multimorbidity negatively impacts physical, mental, and social health necessitating a biopsychosocial approach to physica...IMPORTANCE: Older veterans experience higher rates of multimorbidity than their non-veteran peers; multimorbidity negatively impacts physical, mental, and social health necessitating a biopsychosocial approach to physical rehabilitation programs. OBJECTIVE: The objective is to evaluate the effectiveness of the MultiComponent TeleRehabilitation (MCTR) program for improving physical function compared to general health education. DESIGN: The design was a 2-arm parallel randomized controlled trial. SETTING: This study was conducted within the United States Veterans Health Administration (VHA). PARTICIPANTS: One hundred twenty-six veterans aged ≥60 with ≥3 medical comorbidities defined by the Functional Comorbidity Index and impaired physical function (perform ≤8 repetitions during 30-second sit to stand test) will be enrolled. Exclusion criteria are moderate to severe cognitive impairment without caregiver assistance (telephone Montreal Cognitive Assessment score < 11/22), medical condition precluding safe participation in high-intensity strength training, and life expectancy <12 months. INTERVENTIONS: Veterans will be randomized to either the MCTR program (intervention group) or health education (control group). The MCTR program consists of high-intensity strengthening and functional training, physical activity coaching, social support, and adjunctive technologies. MAIN OUTCOMES AND MEASURES: The primary outcome is the 2-minute step test. Secondary outcomes include: physical function, physical activity, and patient-reported outcome measures related to physical, mental, and social health. RESULTS: Enrollment began April 2024 and results are expected August 2027. CONCLUSIONS: This study serves as an important step in advancement of telerehabilitation and physical therapist interventions for older veterans with multimorbidity. RELEVANCE: This trial addresses a critical gap in rehabilitation for older veterans with multimorbidity by evaluating a comprehensive telerehabilitation program that integrates high-intensity exercise, coaching, social support, and technology. Findings will inform scalable care models within the VHA and similar health care systems.
IMPORTANCE: Shared decision-making (SDM) appears underutilized in physical therapy despite its potential benefits. Information regarding how SDM occurs in home-care physical therapy is limited. OBJECTIVE: The objective w...IMPORTANCE: Shared decision-making (SDM) appears underutilized in physical therapy despite its potential benefits. Information regarding how SDM occurs in home-care physical therapy is limited. OBJECTIVE: The objective was to describe SDM as experienced by physical therapists during in-home initial evaluation visits with older adults (age 65+) and to recommend SDM improvement strategies. DESIGN: A convergent mixed methods design integrated findings from an anonymous survey and from volunteer interviews. SETTING: The setting was United States home care. PARTICIPANTS: Surveys were completed by 220 home care therapists working in 44 states. Twenty therapists completed interviews. INTERVENTION(S) OR EXPOSURE(S): Participants' SDM-related experiences were examined. MAIN OUTCOME AND MEASURE: The main outcomes were descriptions of SDM contained within 1 theme and practice dilemmas within a second theme. RESULTS: The theme SDM as a Suite of Decisions emerged from 6 subthemes relating to goal setting, treatment planning, and service administration: discovering patients' goals, translating patients' goals into therapy goals, selecting the type of treatment, determining treatment frequency and duration, delineating delivery specifics, and SDM after the evaluation. The theme Balancing Patients', Therapists', and Employers' Needs emerged from 2 subthemes: patient advocacy versus organizational duty and coping with professional distress. Data described SDM actions and actors varying by decision type and therapy allotment decisions shifted from the patient-therapist dyad to include additional actors. Practice dilemmas surfaced related to reimbursement allocations, locus of authority to determine treatment frequency, and care continuity. CONCLUSIONS: Home-care physical therapy SDM is complex and affected by setting-specific contextual factors including competing loyalties that may cause ethical distress. Strategies for improving SDM are provided. RELEVANCE: Knowledge of shared decision-making's complexities can inform strategies for improving its use, potentially increasing patient engagement and patient and therapist satisfaction.
Di-Bonaventura S, Gurdiel-Álvarez F, Reina-Varona Á
… +19 more, Cuenca-Martínez F, Fernández-Carnero J, Grande-Alonso M, Huysmans E, La Touche R, Montero-Cuadrado F, Nuñez-Cortes R, Pardo-Montero J, Paris-Alemany A, Puentedura EL, Reis FJJ, Rossettini G, Ryan CG, Silva AG, Suso-Martí L, van Wilgen P, Wijma A, Zimney K, Ferrer-Peña R
IMPORTANCE: Persistent pain is a global cause of disability, affecting daily life and physical, psychological, and social functioning. While biomedical approaches may alleviate symptoms, they often overlook psychological...IMPORTANCE: Persistent pain is a global cause of disability, affecting daily life and physical, psychological, and social functioning. While biomedical approaches may alleviate symptoms, they often overlook psychological, behavioral, and contextual contributors. Recently, therapeutic pain education has emerged as a key non-pharmacological strategy; however, consensus on its core content and implementation is still lacking. OBJECTIVE: The objective was to reach an international expert consensus on the core components of therapeutic education programs for individuals with persistent pain. DESIGN: The study consisted of a 3-round Delphi consensus study. SETTING: An international, online Delphi modality was performed. PARTICIPANTS: Twenty-one multidisciplinary experts from 10 countries (high- to middle-income ratio: 19/2) were included in the present study. INTERVENTION(S) OR EXPOSURE(S): Participation consisted of a structured Delphi process of 1 open-ended round and 2 structured rounds using a 4-point Likert scale, organized across 8 predefined domains. MAIN OUTCOME AND MEASURE(S): The main outcome was expert agreement on core components of therapeutic pain education, defined as an Aiken V value ≥0.7 with their 95% confidence interval exceeding this threshold. The process was organized around 8 domains: topic areas, patient/learner characteristics, materials and resources, activities, dosage and frequency, learning outcomes, context/environment, and adherence assessment. RESULTS: The experts, with a mean of 20 years of clinical experience (SD = 9.6) and 15 years of research experience (SD = 6.4), reached agreement on 35 items. Experts highlighted core content such as neuroplasticity, pain-related beliefs, emotional regulation, and behavior change. They recommended assessing motivation, readiness to change, expectations, tailoring interventions to patient profiles, using explicit, evidence-based materials, including graded exposure and pacing, adjusting dosage according to engagement, ensuring a safe, welcoming, private environment, and assessing changes in beliefs, functioning, and lifestyle. CONCLUSION: This study provides an internationally validated framework for designing and implementing therapeutic education programs for individuals with persistent pain. RELEVANCE: By translating expert consensus into practical components, it bridges the gap between theory and clinical practice, supporting consistent, patient-centered strategies and informing future implementation and research.
IMPORTANCE: Older patients hospitalized for cardiovascular disease (CVD) are at risk of physical function decline and adverse health outcomes. Cardiac rehabilitation (CR) improves physical functioning but is underutilize...IMPORTANCE: Older patients hospitalized for cardiovascular disease (CVD) are at risk of physical function decline and adverse health outcomes. Cardiac rehabilitation (CR) improves physical functioning but is underutilized by older patients. Home-based CR potentially improves utilization, yet its effectiveness in older patients who are frail remains understudied. OBJECTIVE: The objective of this study was to investigate the effects of a transitional-care integrated home-based CR program on physical functioning in older patients who are frail after CVD hospitalization. DESIGN: This was a prespecified secondary analysis of physical functioning at the 6-month follow-up in the cardiac care bridge multicenter randomized trial. SETTING: A home-based setting was used. PARTICIPANTS: The study participants were patients who were frail and ≥70 years old after CVD hospitalization. INTERVENTION: The intervention was transitional care followed by physical therapist led home-based CR and community nurse visits. MAIN OUTCOMES AND MEASURES: The primary physical function outcome was the Short Physical Performance Battery (SPPB) in cases with complete follow-up data. Secondary outcomes included the 2-min step test, grip strength, and Amsterdam Linear Disability Scale. Sensitivity analyses included an intention-to-treat analysis by multiple imputation of the full cohort. RESULTS: In total, 85 of 153 participants in the intervention group and 85 of 153 participants in the control group were analyzed (mean age = 82.6 [SD = 6.3] years; 46% men; median of 2 [interquartile range = 1-4] comorbidities). At the 6-month follow-up, more participants in the intervention group than in the control group demonstrated SPPB improvement (61% vs 51%) or maintenance (29% vs 12%), and fewer deteriorated (11% vs 37%). The mean SPPB values at 6 months were 6.3 (SD = 0.3) and 5.5 (SD = 0.2), respectively, with a mean difference of 0.8 (95% CI = 0.0-1.6), favoring the intervention group. No between-group differences were observed in the 2-min step test, grip strength, or Amsterdam Linear Disability Scale. CONCLUSIONS: Among older patients who were frail and had CVD, a comprehensive transitional-care program with integrated home-based CR resulted in clinically relevant improvements in physical functioning. RELEVANCE: The results substantiate the effectiveness of home-based CR in older patients who are frail and have CVD.