Mathew Saira A, Varghese Paul, Kuys Suzanne S, Heesch Kristiann C, McPhail Steven M
School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia.
BMJ Open. 2017 Jul 20;7(7):e016628. doi: 10.1136/bmjopen-2017-016628.
This study aimed to describe gait speed at admission and discharge from inpatient hospital rehabilitation among older adults recovering from orthopaedic trauma and factors associated with gait speed performance and discharge destination.
A longitudinal cohort study was conducted.
Australian tertiary hospital subacute rehabilitation wards.
Patients aged ≥60 years recovering from orthopaedic trauma (n=746, 71% female) were eligible for inclusion.
Usual care (multidisciplinary inpatient hospital rehabilitation).
Gait speed was assessed using the timed 10 m walk test. The proportion of patients exceeding a minimum gait speed threshold indicator (a priori 0.8 m/s) of community ambulation ability was calculated. Generalised linear models were used to examine associations between patient and clinical factors with gait speed performance and being discharged to a residential aged care facility.
At discharge, 18% of patients (n=135) exceeded the 0.8 m/s threshold indicator for community ambulation ability. Faster gait speed at discharge was found to be associated with being male (B=0.43, 95% CI -0.01 to 0.87), admitted with pelvic (B=0.76, 95% CI 0.14 to 1.37) or multiple fractures (B=1.13, 95% CI 0.25 to 2.01) (vs hip fracture), using no mobility aids (B=-0.93, 95% CI -1.89 to 0.01) and walking at a faster gait speed at admission (B=5.77, 95% CI 5.03 to 6.50). Factors associated with being discharged to residential aged care included older age (OR 1.06, 95% CI 1.03 to 1.10), longer length of stay (OR 1.01, 95% CI 1.01 to 1.02), having an upper limb fracture (vs hip fracture) (OR 2.81, 95% CI 1.32 to 5.97) and lower Functional Independence Measure cognitive score (OR 0.89, 95% CI 0.86 to 0.92).
Patients with a range of injury types, not only those presenting to hospital with hip fractures, are being discharged with slow gait speeds that are indicative of limited functional mobility and a high risk of further adverse health events.
本研究旨在描述骨科创伤康复的老年人住院康复入院时和出院时的步态速度，以及与步态速度表现和出院目的地相关的因素。
进行了一项纵向队列研究。
澳大利亚三级医院亚急性康复病房。
年龄≥60岁且正在从骨科创伤中康复的患者（n = 746，71%为女性）符合纳入条件。
常规护理（多学科住院康复）。
使用定时10米步行测试评估步态速度。计算超过社区行走能力最低步态速度阈值指标（预先设定为0.8米/秒）的患者比例。使用广义线性模型检查患者和临床因素与步态速度表现以及出院至老年护理机构之间的关联。
出院时，18%的患者（n = 135）超过了社区行走能力的0.8米/秒阈值指标。发现出院时步态速度较快与男性（B = 0.43，95%置信区间 -0.01至0.87）、因骨盆骨折（B = 0.76，95%置信区间0.14至1.37）或多处骨折（B = 1.13，95%置信区间0.25至2.01）（与髋部骨折相比）入院、不使用助行器具（B = -0.93，95%置信区间 -1.89至0.01）以及入院时步态速度较快（B = 5.77，95%置信区间5.03至6.50）有关。与出院至老年护理机构相关的因素包括年龄较大（比值比1.06，95%置信区间1.03至1.10）、住院时间较长（比值比1.01，95%置信区间1.01至1.02）、上肢骨折（与髋部骨折相比）（比值比2.81，95%置信区间1.32至5.97）以及较低的功能独立性测量认知得分（比值比0.89，95%置信区间0.86至0.92）。
一系列损伤类型的患者，不仅是那些因髋部骨折入院的患者，出院时步态速度较慢，这表明功能活动受限且有进一步发生不良健康事件的高风险。
