Tan SM1, Han YJ1, Toh X1, Ong SYTC1, Lim J1
1Changi General Hospital, Rehabilitative Services, Singapore, Singapore
Background: Functional decline is the leading complication of hospitalization for older adults. Functional status at point of discharge is also strongly associated with readmission and subsequent loss of function. This poses a major challenge to health care systems internationally. Inpatient exercise programs have been recommended as a strategy to reduce functional decline. However, implementing such programs can be inhibited by the complexities of inpatient processes. Previous attempts at studying inpatient exercise programs have also reported contradicting results. Hence it is worthwhile to study new care models that can slow or reverse functional status decline during hospital stay.
Purpose: To evaluate the effectiveness of a new model of inpatient geriatric physiotherapy management in slowing or reversing functional decline during hospitalization periods. This paper presents the preliminary data for gait speed and 5 chair stands pre and post-program and explored whether this was influenced by factors such as diagnoses, level of assistance and aid needed at admission.
Methods: All patients from an acute geriatric ward received an initial assessment by a physiotherapist. Of which ninety-six patients (M=86.2 years, Range=67-103) were assessed to be suitable for a combination of individual and group exercise sessions. Group exercise focused on balance, mobility training and strength training through use of body and free weights, and graduated from group sizes of 3-6 patients to 6-15 patients per group. 10m walk test, 5 chair stands or any other validated outcome measures were measured by the physiotherapist-in-charge before entry into the groups, and re-measured prior to discharge. Descriptive statistics and paired t-tests were used to analyze whether patients had improved in gait speed and 5 chair stands.
Results: Gait speed and 5 chair stands were faster from initial assessment (M=0.271m/s, SD=0.151 for gait speed, M=29.10sec, SD= 12.275; t(28)= 3.322, p= 0.002 for chair stand) when compared to discharge (M=0.384m/s, SD=0.204 for gait speed, M=22.97sec, SD= 7.028 for 5 chair stands). This improvement was significant in gait speed t(95)= -8.763, p= 0.000 and 5 chair stands t(28)= 3.322, p= 0.002. Using a Kruskall-Wallis Test, the improvements were not found to be influenced by patient diagnoses (p=.642 for gait speed, p=.475 for 5 chair stands), level of assistance needed at admission (p=.779 for gait speed, p= .539 for 5 chair stands), or gait aid needed at admission (p=.172 for gait speed, p= .196 for 5 chair stands).
Conclusion(s): The results show that this new model of inpatient geriatric physiotherapy management can maintain and even improve gait speed and lower limb strength measures for majority of patients at the end of their hospital stays. Future studies with larger sample sizes and having a control group should help to delineate the specific factors that led to this improvement.
Implications: It is possible to implement this new model of physiotherapy management for geriatric inpatients despite the complexities that exists within an acute hospital inpatient setting. This model has the potential to arrest functional decline during hospitalization episodes. This would save both healthcare systems and patients the negative sequelae of hospitalization and readmissions.
Keywords: Functional decline, Older adult, hospitalisation
Funding acknowledgements: Not applicable
Purpose: To evaluate the effectiveness of a new model of inpatient geriatric physiotherapy management in slowing or reversing functional decline during hospitalization periods. This paper presents the preliminary data for gait speed and 5 chair stands pre and post-program and explored whether this was influenced by factors such as diagnoses, level of assistance and aid needed at admission.
Methods: All patients from an acute geriatric ward received an initial assessment by a physiotherapist. Of which ninety-six patients (M=86.2 years, Range=67-103) were assessed to be suitable for a combination of individual and group exercise sessions. Group exercise focused on balance, mobility training and strength training through use of body and free weights, and graduated from group sizes of 3-6 patients to 6-15 patients per group. 10m walk test, 5 chair stands or any other validated outcome measures were measured by the physiotherapist-in-charge before entry into the groups, and re-measured prior to discharge. Descriptive statistics and paired t-tests were used to analyze whether patients had improved in gait speed and 5 chair stands.
Results: Gait speed and 5 chair stands were faster from initial assessment (M=0.271m/s, SD=0.151 for gait speed, M=29.10sec, SD= 12.275; t(28)= 3.322, p= 0.002 for chair stand) when compared to discharge (M=0.384m/s, SD=0.204 for gait speed, M=22.97sec, SD= 7.028 for 5 chair stands). This improvement was significant in gait speed t(95)= -8.763, p= 0.000 and 5 chair stands t(28)= 3.322, p= 0.002. Using a Kruskall-Wallis Test, the improvements were not found to be influenced by patient diagnoses (p=.642 for gait speed, p=.475 for 5 chair stands), level of assistance needed at admission (p=.779 for gait speed, p= .539 for 5 chair stands), or gait aid needed at admission (p=.172 for gait speed, p= .196 for 5 chair stands).
Conclusion(s): The results show that this new model of inpatient geriatric physiotherapy management can maintain and even improve gait speed and lower limb strength measures for majority of patients at the end of their hospital stays. Future studies with larger sample sizes and having a control group should help to delineate the specific factors that led to this improvement.
Implications: It is possible to implement this new model of physiotherapy management for geriatric inpatients despite the complexities that exists within an acute hospital inpatient setting. This model has the potential to arrest functional decline during hospitalization episodes. This would save both healthcare systems and patients the negative sequelae of hospitalization and readmissions.
Keywords: Functional decline, Older adult, hospitalisation
Funding acknowledgements: Not applicable
Topic: Older people; Professional issues
Ethics approval required: No
Institution: SingHealth
Ethics committee: Institution Review Board
Reason not required: This data was extracted as part of routine review of service. It did not involve patient identifying information but outcomes across a large cohort of patients. Therefore, ethics approval was not required for such a service review.
All authors, affiliations and abstracts have been published as submitted.
