Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-1137, USA.
Phys Ther. 2010 Nov;90(11):1591-7. doi: 10.2522/ptj.20100018. Epub 2010 Aug 12.
Walking speed norms and several risk thresholds for poor health outcomes have been published for community-dwelling older adults. It is unclear whether these values apply to hospitalized older adults.
The purpose of this study was to determine the in-hospital walking speed threshold that best differentiates walking-independent from walking-dependent older adults.
This was a cross-sectional study.
This study recruited a convenience sample of 174 ambulatory adults aged 65 years and older who had been admitted to a medical-surgical unit of a university hospital. The participants' mean (SD) age was 75 (7) years. Fifty-nine percent were women, 66% were white, and more than 40% were hospitalized for cardiovascular problems. Usual-pace walking speed was assessed over 2.4 m. Walking independence was assessed through self-report. Several methods were used to determine the threshold speed that best differentiated walking-independent patients from walking-dependent patients. Approaches included a receiver operating characteristic (ROC) curve, sensitivity and specificity, and frequency distributions.
The participants' mean (SD) walking speed was 0.43 (0.23) m/s, and 62% reported walking independence. Nearly 75% of the patients walked more slowly than the lowest community-based risk threshold, yet 90% were discharged home. Overall, cut-point analyses suggested that 0.30 to 0.35 m/s may be a meaningful threshold for maintaining in-hospital walking independence. For simplicity of clinical application, 0.35 m/s was chosen as the optimal cut point for the sample. This threshold yielded a balance between sensitivity and specificity (71% for both). Limitations The limitations of this study were the small size of the convenience sample and the single health outcome measure.
Walking speeds of older adults who are acutely ill are substantially slower than established community-based norms and risk thresholds. The threshold identified, which was approximately 50% lower than the lowest published community-based risk threshold, may serve as an initial risk threshold or target value for maintaining in-hospital walking independence.
已为社区居住的老年人发布了行走速度标准和多个与健康不良结局相关的风险阈值。但这些数值是否适用于住院老年人还不清楚。
本研究旨在确定最佳区分住院老年人中能独立行走和依赖行走的住院患者的院内行走速度阈值。
这是一项横断面研究。
本研究招募了 174 名年龄在 65 岁及以上、曾入住大学医院内科-外科病房的活动能力正常的成年人作为便利样本。参与者的平均（SD）年龄为 75（7）岁。59%为女性，66%为白人，超过 40%因心血管问题住院。采用 2.4 米的距离评估常速行走速度。通过自我报告评估行走独立性。采用多种方法确定最佳阈值速度，该速度可最佳区分独立行走患者和依赖行走患者。方法包括受试者工作特征（ROC）曲线、敏感性和特异性以及频率分布。
参与者的平均（SD）行走速度为 0.43（0.23）m/s，62%报告能独立行走。近 75%的患者行走速度慢于基于社区的最低风险阈值，但 90%出院回家。总体而言，截止值分析表明，0.30 至 0.35 m/s 可能是维持院内行走独立性的有意义的阈值。为便于临床应用，选择 0.35 m/s 作为样本的最佳截止点。该阈值在敏感性和特异性方面取得了平衡（均为 71%）。局限性：本研究的局限性是便利样本量小，且只有单一的健康结果测量。
急性病老年人的行走速度明显慢于既定的基于社区的标准和风险阈值。确定的阈值比最低的已发表的基于社区的风险阈值低约 50%，可以作为维持院内行走独立性的初始风险阈值或目标值。
