EVALUATION COMMITTEE

The Faculty Council has appointed the following adjudication committee to evaluate the thesis and the associated lecture: 

• Professor Victoria Ann Goodwin,  MBE PhD FCSP. Professor of Ageing and Rehabilitation & NIHR Senior Investigator, University of Exeter
• Senior Researcher Mette Merete Pedersen, within Physical Medicine & Rehabilitation Research –Copenhagen (PMR-C), Associate Professor, University of Copenhagen

Chairman: Associate Professor Birgitte Schantz Laursen, Department of Clinical Medicine (KI), Aalborg Universitet

Moderator: Associate Professor Thorvaldur Skuli Palsson, Department of Clinical Medicine (KI), Aalborg Universitet

ABSTRACT

Background

Frailty is a prevalent and multidimensional condition among older adults, associated with increased vulnerability to stressors and a heightened risk of functional decline, hospitalisation, and mortality. Acute hospital admission often accelerates frailty progression, and the subsequent transition from hospital to home represents a particularly vulnerable period. During this phase, rehabilitation pathways are frequently fragmented across healthcare sectors. Despite growing recognition of frailty as a dynamic condition, rehabilitation interventions for frail older adults after acute hospitalisation remain insufficiently coordinated and are often limited to single components.

Aims

The overall aim of this PhD project was to develop, test, and evaluate a pragmatic, multicomponent, cross-sectoral rehabilitation intervention for frail older adults following acute hospital admission. Specifically, the PhD project aimed to develop a theory-informed intervention, assess its feasibility and acceptability, and evaluate its effectiveness compared with usual care in improving physical function and related outcomes.

Methods

The PhD project followed the Medical Research Council framework for complex interventions and comprised three studies. Study I focused on systematic intervention development based on evidence synthesis, theory, and stakeholder involvement. Study II evaluated feasibility and acceptability using a mixed-methods design among frail older adults recently discharged to home. Study III was a pragmatic, assessor-blinded randomised controlled trial comparing the multicomponent intervention with usual physiotherapy care. Physical function measured by the Short Physical Performance Battery was the primary outcome, with secondary outcomes including frailty, muscle strength, and health-related quality of life.

Results

The intervention was successfully developed and implemented within existing municipal rehabilitation structures. Feasibility findings indicated that the intervention was acceptable and safe, although recruitment and adherence were influenced by contextual factors. In the randomised trial, no statistically significant differences were observed between the intervention and usual care groups for physical function or quality of life at follow-up, despite high intervention fidelity.

Discussion and conclusions

This PhD project demonstrates that multicomponent, cross-sectoral rehabilitation for frail older adults after acute hospitalisation is feasible in routine practice. However, the findings suggest limited additional benefit compared with usual care. Future research should focus on optimising intervention intensity, targeting, and integration to better address the complex rehabilitation needs of frail older adults.