Mudge Alison M, Giebel Andrea J, Cutler Alison J
Department of Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
J Am Geriatr Soc. 2008 Apr;56(4):630-5. doi: 10.1111/j.1532-5415.2007.01607.x. Epub 2008 Jan 16.
To evaluate the effect of a structured, multi-component, early rehabilitation program on functional status, delirium, and discharge outcomes of older acute medical inpatients.
Prospective controlled trial with blinded outcome evaluation.
Internal medicine service of a metropolitan tertiary teaching hospital in Brisbane, Australia.
One hundred twenty-four consecutive inpatients aged 65 and older admitted from the emergency department to control or intervention medical ward. Exclusions included patients completely dependent before admission or admitted from a nursing home, patients too ill to participate or terminally ill, and patients with length of stay less than 72 hours.
Early physiotherapy review with provision of an individualized graduated exercise program and activity diary, progressive encouragement of functional independence by nursing staff and other members of the multidisciplinary team, and cognitive stimulation sessions.
Modified Barthel Index (MBI) at admission and discharge, timed up-and-go at admission and discharge, incidence of delirium and falls, measured activity, length of hospital stay, discharge destination, 30-day readmission rate.
Intervention and control participants were well matched in terms of age, sex, diagnosis, and functional status. The intervention group had greater improvement in functional status than the control group, with a median MBI improvement of 8.5 versus 3.5 points (P=.03). In the intervention group, there was a reduction in delirium (19.4% vs 35.5%, P=.04) and a trend to reduced falls (4.8% vs 11.3%, P=.19). Length of stay, timed up-and-go, discharge destination, and readmissions did not differ between the groups.
This intervention was effective in improving function in a vulnerable patient group.
评估一项结构化、多组分的早期康复计划对老年急性内科住院患者功能状态、谵妄及出院结局的影响。
采用盲法结局评估的前瞻性对照试验。
澳大利亚布里斯班一家大都市三级教学医院的内科。
124名连续从急诊科收治至对照或干预内科病房的65岁及以上住院患者。排除标准包括入院前完全依赖他人或从养老院收治的患者、病情过重无法参与或处于终末期的患者以及住院时间少于72小时的患者。
早期物理治疗评估，提供个性化的渐进性运动计划和活动日记，护理人员及多学科团队其他成员逐步鼓励功能独立，以及认知刺激课程。
入院及出院时的改良Barthel指数（MBI）、入院及出院时的计时起立行走测试、谵妄和跌倒的发生率、测量的活动量、住院时间、出院去向、30天再入院率。
干预组和对照组在年龄、性别、诊断及功能状态方面匹配良好。干预组的功能状态改善程度大于对照组，MBI中位数改善分别为8.5分和3.5分（P = 0.03）。干预组谵妄发生率降低（19.4%对35.5%，P = 0.04），跌倒发生率有降低趋势（4.8%对11.3%，P = 0.19）。两组在住院时间、计时起立行走测试、出院去向及再入院方面无差异。
该干预措施对改善脆弱患者群体的功能有效。
