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pandora jewelry Several surveys, however, have found that care home residents in the UK have limited access to rehabilitation services such as physiotherapy and occupational therapy. A 2001 study showed that only 3.3% of elderly nursing home residents receive occupational therapy, whereas only 10% receive physiotherapy, the majority of which is privately funded.1 Physiotherapy and occupational therapy services are far more widely available in other countries,2 3 4 and are much more likely to be requested when costs are reimbursed.5Implementing interventions that focus on behavioural change and mobility training in a frail, frequently cognitively impaired, elderly nursing home population is feasible6 7 8 9 10; however, interventions are difficult to maintain owing to the required treatment intensity and the cost.11 The high levels of staff knowledge and skill required to continue treatment could be absent in the UK as training opportunities are scarce for care home staff.12 13 14Evidence for the benefit of rehabilitation services in this population is conflicting and inconclusive. Nike Air Max 90 Bloemeny Heren&Dame A recent trial concluded that a programme of functional rehabilitation had minimal impact for elderly people in residential care with normal cognition and no benefit for those with poor cognition.15 Similarly, Mozley and colleagues found little or no evidence that occupational therapy reduces depression, dependency, or long term institutionalisation in elderly care home residents pandora bracelets,16 and Mulrow and colleagues found that physiotherapy provided only modest mobility benefits in very frail long stay US nursing home residents with physical disabilities.17 In contrast, a UK study of care home residents with stroke related disability found that occupational therapy was beneficial in terms of maintaining self care independence.18 Furthermore, two relatively recent systematic reviews found evidence that physical training had positive effects on mobility, physical functioning, and cognition in institutionalised elderly patients.19 20 One of these reviews, however, concludes that there is contradictory evidence for the benefits of physical training on gait and activities of daily living.19Physiotherapy and occupational therapy could be cost effective in elderly care home residents, in that therapy costs can be outweighed by a reduction in care requirement, reduced service use costs, and a fall in hospital admission rates.9 However, two US studies found no statistically significant difference and a minor difference in cost between such interventions and routine care.21 22The main objective of this trial was to evaluate the clinical effectiveness of a programme of physiotherapy and occupational therapy against standard care in care home residents with mobility limitations who are dependent on carers in some activities of daily living.MethodsThe register of care homes held by Birmingham City Council social services for 2004 was used to identify, within the boundaries of NHS South Birmingham and NHS Birmingham East and North primary care trusts, homes that had more than five beds and provided the care categories “physical disability” and “older people.” From the register, 24 of 77 nursing and residential homes were selected that catered for residents with mobility limitations who are dependent in activities of daily living pandora jewelry.