M. van Dijk1, L. Saenen2, S. Breuls2, D. Michiels2, L. Vermeulen2, S. Jannes2, Y. Van Kerckhoven2, J. Tournoy3, G. Verheyden2, J. Flamaing3
1UZ Leuven, Campus Pellenberg, Department of Physical Medicine and Rehabilitation, Geriatric Rehabilitation, Pellenberg, Belgium, 2KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium, 3KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium
Background: Regaining functional independence and independent living is challenging in vulnerable older hospitalized patients. Hospitalized geriatric rehabilitation patients have a lower level of functional performance compared to community dwelling older people, but generally receive more physiotherapy (five times a week compared to two-three times for community dwelling). There is a paucity of evidence concerning multicomponent physiotherapy programs for this particular group. Therefore, based on patients’ needs and available literature, we developed the Geriatric Activation Program Pellenberg (GAPP). GAPP is a 5-times a week intensive training program of 45 minutes each day. Specific components of functional performance are emphasized each day ((functional) strength, balance, (walking)-speed, coordination and endurance).
Purpose: The purposes of this study were to evaluate the evolution of functional performance during four weeks of GAPP and if successful rehabilitation with GAPP can be predicted.
Methods: In this prospective, observational study, we recruited participants who were inpatients of the geriatric rehabilitation ward of UZ Leuven, campus Pellenberg. Participants followed GAPP for a period of four weeks. Functional performance (Berg Balance Scale (BBS) and Katz-scale), gait speed (10-Meter Walking Test), strength of elbow and knee extension (handheld dynamometer), cognitive processing speed (Digit Symbol Substitution Test) and mood (Geriatric Depression Scale) were measured at baseline, after two weeks and after four weeks. Comorbidity (Charlson Comorbidity Index) and cognitive function (Montreal Cognitive Assessment) were assessed at baseline.
Secondly, we performed an explorative data-analysis to develop a prediction model of successful rehabilitation with GAPP. Successful rehabilitation was determined by either improvement on the Berg Balance scale over four weeks or the end-score on the BBS. These two different scores were correlated to the following parameters: baseline scores of the Katz-scale, BBS, 10MWT, DSST, GDS and muscle strength; cognition (MoCA); comorbidity (CCI) and prehospital functioning (independent washing, independent dressing and use of a walking aid).
Secondly, we performed an explorative data-analysis to develop a prediction model of successful rehabilitation with GAPP. Successful rehabilitation was determined by either improvement on the Berg Balance scale over four weeks or the end-score on the BBS. These two different scores were correlated to the following parameters: baseline scores of the Katz-scale, BBS, 10MWT, DSST, GDS and muscle strength; cognition (MoCA); comorbidity (CCI) and prehospital functioning (independent washing, independent dressing and use of a walking aid).
Results: From march 2017 till march 2019 111 participants were recruited of which 83 followed GAPP for four weeks. Significant positive results on all outcome measures were found after four weeks of GAPP (p=0.000-0.007). Clinically important differences were found for functional performance (BBS mean difference= 12.8, Katz-scale mean difference=3.8 point) and gait speed (mean difference= 0.24m/s).
Linear regression of the data showed that successful rehabilitation with GAPP can be predicted by baseline scores on the BBS and prehospital function (use of a walking aid). The prediction rate is 32.2% (p<0.001) when successful rehabilitation is expressed by the mean difference BBS (T2-T1). The prediction rate increased till 62% (p<0.001), when successful rehabilitation is expressed by the end score of the BBS (T2).
Linear regression of the data showed that successful rehabilitation with GAPP can be predicted by baseline scores on the BBS and prehospital function (use of a walking aid). The prediction rate is 32.2% (p<0.001) when successful rehabilitation is expressed by the mean difference BBS (T2-T1). The prediction rate increased till 62% (p<0.001), when successful rehabilitation is expressed by the end score of the BBS (T2).
Conclusion(s): Our results indicate that geriatric inpatients who participate in GAPP as part of their rehabilitation show a clinically important improvement in functional performance. Furthermore, patients with low baseline scores on the BBS and independent walking prehospital seem to respond better to GAPP.
Future research is needed to compare GAPP with usual therapy and to examine if GAPP can be continued after discharged with help of physiotherapists and caregivers.
Future research is needed to compare GAPP with usual therapy and to examine if GAPP can be continued after discharged with help of physiotherapists and caregivers.
Implications: GAPP is a novel intensive physiotherapy program that can be implemented on geriatric rehabilitation wards.
Funding, acknowledgements: This work was partly funded (time) by the geriatric department of UZ Leuven and the Competency-Centre-Physiotherapy of KU Leuven.
Keywords: geriatric inpatients, functional performance
Topic: Older people
Did this work require ethics approval? Yes
Institution: KU Leuven, UZ Leuven
Committee: Ethics Committee Research UZ / KU Leuven
Ethics number: S59948 / B322201731432 / I / U
All authors, affiliations and abstracts have been published as submitted.
