Factors associated with improved walking in older people during hospital rehabilitation: secondary analysis of a randomized controlled trial

BMC Geriatrics

Michael Woodward¹  Leonid Churilov²  Cassandra Szoeke³  Joanne E Wittwer⁴  Meg E Morris⁵  Jennifer L McGinley⁶  Catherine M Said⁷  Barbara Workman⁸  Keith D. Hill⁹  Danny Liew^1,10  Julie Bernhardt^1,11 

[1] Aged Care Services, Austin Health, Heidelberg, Australia;Department of Medicine, The University of Melbourne, Parkville, Australia;Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, The University of Melbourne, Heidelberg, Australia;Healthy Ageing Program, Department of Medicine, The University of Melbourne, Centre for Medical Research, Parkville, Australia;The Royal Melbourne Hospital, Parkville, Australia;Institute for Health and Ageing, Australian Catholic University, Fitzroy, Australia;La Trobe Centre for Exercise and Sports Medicine Research, School of Allied Health, La Trobe University, Bundoora, Australia;La Trobe Centre for Exercise and Sports Medicine Research, School of Allied Health, La Trobe University, Bundoora, Australia;Victorian Rehabilitation Centre, Healthscope Australia, Melbourne, Australia;Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia;Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia;Physiotherapy Department, Western Health, St Albans, Australia;Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital, St Albans, Australia;Physiotherapy Department Austin Health, Heidelberg, Australia;Rehabilitation and Aged Care Services, Monash Health, Cheltenham, Australia;Monash Ageing Research Centre (MONARC), Monash University, Cheltenham, Australia;Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia;School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, Australia;CRE Stroke Rehabilitation and Recovery, Heidelberg, Australia;

关键词: Mobility limitation;    Rehabilitation;    Exercise therapy;    Hospitalization;    Aged;    Aged, 80 and over;   

DOI  :  10.1186/s12877-021-02016-0

来源: Springer

【 摘 要 】

BackgroundOlder people are often admitted for rehabilitation to improve walking, yet not everyone improves. The aim of this study was to determine key factors associated with a positive response to hospital-based rehabilitation in older people.MethodsThis was a secondary data analysis from a multisite randomized controlled trial. Older people (n= 198, median age 80.9 years, IQR 76.6- 87.2) who were admitted to geriatric rehabilitation wards with a goal to improve walking were recruited. Participants were randomized to receive additional daily physical therapy focused on mobility (n = 99), or additional social activities (n = 99). Self-selected gait speed was measured on admission and discharge. Four participants withdrew. People who changed gait speed ≥0.1 m/s were classified as ‘responders’ (n = 130); those that changed <0.1m/s were classified as ‘non-responders’ (n = 64). Multivariable logistic regression explored the association of six pre-selected participant factors (age, baseline ambulation status, frailty, co-morbidities, cognition, depression) and two therapy factors (daily supervised upright activity time, rehabilitation days) and response.ResultsResponding to rehabilitation was associated with the number of days in rehabilitation (OR 1.04; 95% CI 1.00 to 1.08; p = .039) and higher Mini Mental State Examination scores (OR 1.07, 95% CI 1.00 – 1.14; p = .048). No other factors were found to have association with responding to rehabilitation.ConclusionIn older people with complex health problems or multi-morbidities, better cognition and a longer stay in rehabilitation were associated with a positive improvement in walking speed. Further research to explore who best responds to hospital-based rehabilitation and what interventions improve rehabilitation outcomes is warranted.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740.

【 授权许可】

CC BY