Said C1,2,3, Bernhardt J4, McGinley J1, Szoeke C5, Churilov L4, Workman B6, Hill K7, Woodward M8, Liew D9, Wittwer J10, Morris M10,11
1University of Melbourne, Physiotherapy, Melbourne, Australia, 2Western Health, Physiotherapy, St Albans, Australia, 3Austin Health, Physiotherapy, Heidelberg, Australia, 4The Florey Institute of Neuroscience & Mental Health, Heidelberg, Australia, 5University of Melbourne, Department of Medicine, Melbourne, Australia, 6Monash Health, Rehabilitation and Aged Care Services, Cheltenham, Australia, 7Curtin University, School of Physiotherapy and Exercise Science, Curtin, Australia, 8Austin Health, Aged Care Services, Heidelberg, Australia, 9Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia, 10La Trobe University, School of Allied Health, Bundoora, Australia, 11Healthscope Australia, Bundoora, Australia
Background: Older people with a variety of health conditions are often admitted to inpatient rehabilitation to improve mobility following acute hospital admission. However, response to rehabilitation is variable, and not everyone improves. Understanding factors that impact rehabilitation outcomes can help physical therapists identify who is likely to benefit.
Purpose: The purpose of this secondary analysis of data from a larger multisite randomized controlled trial is to explore factors associated with a positive response to hospital-based rehabilitation.
Methods: Older people (n= 198, median age 80.9 years, IQR 76.6- 87.2) undergoing inpatient rehabilitation with a goal to improve mobility were recruited from geriatric rehabilitation units at two Australian hospitals. Participants received multidisciplinary care, including physical therapy, and were randomised to an intervention group (n = 99), which received additional daily physical therapy sessions focused on mobility activities, or control group which received additional social activities (n = 99). Self-selected gait speed was measured at baseline and discharge by a blinded assessor; participants who improved >= .1 m/s were classified as 'responders'; participants who improved .1m/s were classified as non-responders. Multivariate logistic regression was used to explore the impact of age, cognition, baseline mobility, comorbidities, frailty, depression, median time per day of supervised upright physical activity (usual physical therapy plus intervention), additional social interaction and number of days in rehabilitation on response to rehabilitation.
Results: Four people withdrew,130 people were classified as 'responders', 64 as 'non-responders'. At baseline 25% of the group were non-ambulant, 63% scored 27 on the Mini Mental State Examination, 58% had a score of 2 or more on the Charlson Comorbidity Index, 34% had a Fried Frailty score ≥ 3, and 47% had a Geriatric Depression Score ≥ 5. Age showed excessive collinearity and was removed from analysis. Baseline mobility status, frailty, cognition and depression did not impact the odds of responding to rehabilitation. Additional socialization (OR 2.3 95% CI 1.00 - 5.2; p = .050); increased supervised upright physical activity time per day (OR 1.03; 95 % CI 1.00 - 1.06; p = .035) and more days in rehabilitation (OR 1.05; 95% CI 1.01 - 1.09; p = .028) increased the odds of responding to rehabilitation.
Conclusion(s): This sample of older people, deemed suitable for inpatient rehabilitation, had high rates of frailty, co-morbidities, cognitive impairment and depression. Within this cohort, these characteristics did not change the odds of having a positive response to a rehabilitation program to improve walking. Increased upright physical activity and longer rehabilitation length of stay both increased the odds of having a positive improvement in walking. Additional social interaction also increased the odds of having a positive improvement in walking. While the mechanisms for improvement may not be clear, social engagement may be an important component of physical inpatient rehabilitation for older people.
Implications: Within an older population with complex health needs, it can be difficult to identify who is likely to achieve meaningful improvements in gait speed with inpatient rehabilitation. Social engagement may also have a positive impact on physical rehabilitation outcomes in this cohort.
Keywords: walking, rehabilitation, older people
Funding acknowledgements: This work was supported by a National Health and Medical Research Council project grant (NHMRC) (App1042680).
Purpose: The purpose of this secondary analysis of data from a larger multisite randomized controlled trial is to explore factors associated with a positive response to hospital-based rehabilitation.
Methods: Older people (n= 198, median age 80.9 years, IQR 76.6- 87.2) undergoing inpatient rehabilitation with a goal to improve mobility were recruited from geriatric rehabilitation units at two Australian hospitals. Participants received multidisciplinary care, including physical therapy, and were randomised to an intervention group (n = 99), which received additional daily physical therapy sessions focused on mobility activities, or control group which received additional social activities (n = 99). Self-selected gait speed was measured at baseline and discharge by a blinded assessor; participants who improved >= .1 m/s were classified as 'responders'; participants who improved .1m/s were classified as non-responders. Multivariate logistic regression was used to explore the impact of age, cognition, baseline mobility, comorbidities, frailty, depression, median time per day of supervised upright physical activity (usual physical therapy plus intervention), additional social interaction and number of days in rehabilitation on response to rehabilitation.
Results: Four people withdrew,130 people were classified as 'responders', 64 as 'non-responders'. At baseline 25% of the group were non-ambulant, 63% scored 27 on the Mini Mental State Examination, 58% had a score of 2 or more on the Charlson Comorbidity Index, 34% had a Fried Frailty score ≥ 3, and 47% had a Geriatric Depression Score ≥ 5. Age showed excessive collinearity and was removed from analysis. Baseline mobility status, frailty, cognition and depression did not impact the odds of responding to rehabilitation. Additional socialization (OR 2.3 95% CI 1.00 - 5.2; p = .050); increased supervised upright physical activity time per day (OR 1.03; 95 % CI 1.00 - 1.06; p = .035) and more days in rehabilitation (OR 1.05; 95% CI 1.01 - 1.09; p = .028) increased the odds of responding to rehabilitation.
Conclusion(s): This sample of older people, deemed suitable for inpatient rehabilitation, had high rates of frailty, co-morbidities, cognitive impairment and depression. Within this cohort, these characteristics did not change the odds of having a positive response to a rehabilitation program to improve walking. Increased upright physical activity and longer rehabilitation length of stay both increased the odds of having a positive improvement in walking. Additional social interaction also increased the odds of having a positive improvement in walking. While the mechanisms for improvement may not be clear, social engagement may be an important component of physical inpatient rehabilitation for older people.
Implications: Within an older population with complex health needs, it can be difficult to identify who is likely to achieve meaningful improvements in gait speed with inpatient rehabilitation. Social engagement may also have a positive impact on physical rehabilitation outcomes in this cohort.
Keywords: walking, rehabilitation, older people
Funding acknowledgements: This work was supported by a National Health and Medical Research Council project grant (NHMRC) (App1042680).
Topic: Older people; Disability & rehabilitation
Ethics approval required: Yes
Institution: La Trobe University, Austin Health, and Monash Health
Ethics committee: Human Research Ethics Committee
Ethics number: HEC12-122, H2013/05042, 14117X
All authors, affiliations and abstracts have been published as submitted.
