Intervention trial group

FTE and PPT were compared in an, assessor blinded, randomized controlled trial (RCT), the ‘intervention trial group’ performed from August 2010 to April 2012.

The target population, aged ≥75 years, was selected from 24 primary care practices in the Western part of the Netherlands. The general practitioners (GPs) excluded persons admitted to a nursing home, with a life expectancy of less than three months, or who did not speak Dutch or were otherwise considered not eligible to participate, eg suffering from serious psychiatric illness. Additional exclusion criteria were inability to comprehend and follow instructions and current physical therapy treatment. The remaining persons were invited by their GP by mail to complete a screening questionnaire. (Additional file 1: Appendix 1) The screening questionnaire consisted of 21 items, covering four domains of health: functional, somatic (health and illness), mental and social. The questionnaire has been shown to predict functional decline [16]. A positive answer to ≥2 questions in a domain led to a positive score on the domain. The ISCOPE (Integrated Systematic Care for Older PEople)- screening questionnaire (control group) had a question about managing finances instead of the capability to climb stairs. Non-responders were reminded by telephone and were offered assistance to complete the questionnaire.

Respondents with a positive score on the functional domain and at least one other domain were invited for a further screening home-visit, performed by research assistants. The aim of the screening visit was to obtain socio-demographic and baseline data and to verify the following eligibility criteria: a positive score on the functional domain and at least one other domain (somatic, mental, social), not receiving physiotherapy treatment, a score of > 18 on the Mini Mental State Examination (MMSE) [17], and to check absolute and relative contra-indications for physical exercise according to the Guidelines for Exercise Test Administration’ in de ACSM Guidelines for Exercise Testing and Prescription [18]. Eligible older people were invited to participate in the randomized intervention study.

Study participants were randomly assigned to the intervention conditions. A random number sequence was generated using the software environment R version 2.14 [19].

Both FTE and PPT consisted of individual treatments (30 min) for a maximum of 18 treatments within three months, and were provided to participants with the aim of preventing age-related functional decline. Therapists for either FTE or PPT were not working in the same practice to avoid contamination. In only one out of 28 practices treated both intervention were provided, but by different physiotherapists. FTE was provided in the participant’s home. For more information on FTE: see Additional file 2: Appendix 2. Physiotherapists in the FTE group received extra training for this type of intervention.

The participants in the PPT group were referred to a regular physical therapist. The location of treatment was up to the therapists’ professional opinion. No additional training for the physical therapist for PPT was provided. Twenty percent of therapists already had additional training in elderly care, varying from a course in falls prevention to a master in geriatrics. Therapists received an open referral to help this person with their daily functioning. Any exercises therapy and advise was up to the therapists discretion. Treatment was according to protocols of The Royal Dutch Society for Physical Therapy.