额外的结构化身体活动并不能改善接受住院康复治疗的老年人（>60 岁）的步行能力：一项随机试验。

Additional structured physical activity does not improve walking in older people (>60years) undergoing inpatient rehabilitation: a randomised trial.

机构信息

Physiotherapy Department, Austin Health, Melbourne; Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne; La Trobe Centre for Exercise and Sports Medicine Research, School of Allied Health, La Trobe University, Melbourne.

La Trobe Centre for Exercise and Sports Medicine Research, School of Allied Health, La Trobe University, Melbourne; Northpark Private Hospital, Healthscope Australia, Melbourne.

出版信息

J Physiother. 2018 Oct;64(4):237-244. doi: 10.1016/j.jphys.2018.08.006. Epub 2018 Sep 17.

DOI:10.1016/j.jphys.2018.08.006

PMID:30236471

Abstract

QUESTIONS

Among older people receiving inpatient rehabilitation, does additional supervised physical activity lead to faster self-selected gait speed at discharge? Does additional supervised physical activity lead to better mobility, function and quality of life at discharge and 6 months following discharge?

DESIGN

Multi-centre, parallel-group, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

PARTICIPANTS

Older people (age>60years) from two Australian hospitals undergoing rehabilitation to improve mobility.

INTERVENTION

Participants received multidisciplinary care, including physiotherapy. During hospital rehabilitation, the experimental group (n=99) spent additional time daily performing physical activities that emphasised upright mobility tasks; the control group (n=99) spent equal time participating in social activities.

OUTCOME MEASURES

Self-selected gait speed was the primary outcome at discharge and a secondary outcome at the 6-month follow-up. Timed Up and Go, De Morton Mobility Index, Functional Independence Measure and quality of life were secondary outcomes at discharge and tertiary outcomes at the 6-month follow-up.

RESULTS

The experimental group received a median of 20 additional minutes per day (IQR 15.0 to 22.5) of upright activities for a median of 16.5days (IQR 10.0 to 25.0). Gait speed did not differ between groups at discharge. Mean gait speed was 0.51m/s (SD 0.29) in the experimental group and 0.56m/s (SD 0.28) in the control group (effect size -0.06m/s, 95% CI -0.12 to 0.01, p=0.096). No significant differences were detected in other secondary measures.

CONCLUSION

While substantial gains in mobility were achieved by older people receiving inpatient rehabilitation, additional physical activity sessions did not lead to better walking outcomes at discharge or 6 months.

TRIAL REGISTRATION

ACTRN12613000884707. [Said CM, Morris ME, McGinley JL, Szoeke C, Workman B, Liew D, Hill KD, Woodward M, Wittwer JE, Churilov L, Danoudis M, Bernhardt J (2018) Additional structured physical activity does not improve walking in older people (> 60 years) undergoing inpatient rehabilitation: a randomised trial. Journal of Physiotherapy 64: 237-244].

摘要

问题

在接受住院康复治疗的老年人中，额外的监督性身体活动是否会导致出院时的自我选择步行速度更快？额外的监督性身体活动是否会导致出院时以及出院后 6 个月时更好的移动能力、功能和生活质量？

设计

多中心、平行组、随机对照试验，采用隐蔽分组、评估者盲法和意向治疗分析。

参与者

来自澳大利亚两家医院的老年人（年龄>60 岁），正在接受康复治疗以提高活动能力。

干预

参与者接受多学科护理，包括物理治疗。在住院康复期间，实验组（n=99）每天额外花费时间进行强调直立移动任务的身体活动；对照组（n=99）花费相等的时间参加社交活动。

结果

自我选择的步行速度是出院时的主要结果，也是 6 个月随访时的次要结果。在出院时，计时起立行走测试、德莫顿移动指数、功能独立性测量和生活质量是次要结果，在 6 个月随访时是次要结果。

实验组每天接受中位数 20 分钟（IQR 15.0 至 22.5）的额外直立活动，中位数为 16.5 天（IQR 10.0 至 25.0）。出院时两组之间的步行速度没有差异。实验组的平均步行速度为 0.51m/s（SD 0.29），对照组为 0.56m/s（SD 0.28）（效应大小为-0.06m/s，95%CI-0.12 至 0.01，p=0.096）。在其他次要措施中没有发现显著差异。

结论

尽管接受住院康复治疗的老年人在移动能力方面取得了实质性的提高，但额外的身体活动课程并没有导致出院时或 6 个月时更好的步行结果。

试验注册

ACTRN12613000884707。[Said CM, Morris ME, McGinley JL, Szoeke C, Workman B, Liew D, Hill KD, Woodward M, Wittwer JE, Churilov L, Danoudis M, Bernhardt J (2018) 额外的结构化身体活动并不能改善老年人（>60 岁）住院康复治疗中的行走能力：一项随机试验。物理治疗杂志 64: 237-244]。