Catherine M Said1,2,3,4, Jennifer L McGinley5, Cassandra Szoeke6,7,8, Barbara Workman9,10, Keith D Hill11, Joanne E Wittwer12, Michael Woodward13,14, Danny Liew15, Leonid Churilov16, Julie Bernhardt17,18, Meg E Morris12,19. 1. Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia. csaid@unimelb.edu.au. 2. Physiotherapy Department, Western Health, St Albans, Australia. csaid@unimelb.edu.au. 3. Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital, St Albans, Australia. csaid@unimelb.edu.au. 4. Physiotherapy Department Austin Health, Heidelberg, Australia. csaid@unimelb.edu.au. 5. Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia. 6. Healthy Ageing Program, Department of Medicine, The University of Melbourne, Centre for Medical Research, Parkville, Australia. 7. The Royal Melbourne Hospital, Parkville, Australia. 8. Institute for Health and Ageing, Australian Catholic University, Fitzroy, Australia. 9. Rehabilitation and Aged Care Services, Monash Health, Cheltenham, Australia. 10. Monash Ageing Research Centre (MONARC), Monash University, Cheltenham, Australia. 11. Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia. 12. La Trobe Centre for Exercise and Sports Medicine Research, School of Allied Health, La Trobe University, Bundoora, Australia. 13. Aged Care Services, Austin Health, Heidelberg, Australia. 14. Department of Medicine, The University of Melbourne, Parkville, Australia. 15. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. 16. Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, The University of Melbourne, Heidelberg, Australia. 17. Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, Australia. 18. CRE Stroke Rehabilitation and Recovery, Heidelberg, Australia. 19. Victorian Rehabilitation Centre, Healthscope Australia, Melbourne, Australia.
Abstract
BACKGROUND:Older 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. METHODS: This 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. RESULTS: Responding 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. CONCLUSION: In 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 REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740 .
RCT Entities:
BACKGROUND: Older 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. METHODS: This 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. RESULTS: Responding 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. CONCLUSION: In 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 REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740 .
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