Centre de Recherche, Institut Universitaire de Gériatrie de Montréal (IUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; Département des Sciences de l'Activité Physique, Faculté des Sciences, Université du Québec à Montréal, Montreal, Canada.
Centre de Recherche, Institut Universitaire de Gériatrie de Montréal (IUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; Faculté de Médecine, Université de Montréal, Montreal, Canada.
J Am Med Dir Assoc. 2019 Oct;20(10):1287-1293. doi: 10.1016/j.jamda.2019.01.143. Epub 2019 Mar 11.
Older patients experience increased loss of mobility after hospitalization, largely because of physical disabilities and inactivity. There are, however, no current recommendations for prescribing physical activity (PA) at hospital discharge.
Develop a decisional tree for the systematic prescription of an individualized, adapted, nonsupervised home-based PA program for older adults after hospital discharge; investigate its feasibility, acceptability, and safety; and estimate its efficacy at improving physical function and mobility.
Pragmatic prospective single-arm pilot study.
Geriatric assessment unit (GAU).
Age ≥65 years, Mini-Mental State Examination score ≥18, hospitalization >7 days, discharge to home, no PA contraindications, understand French or English.
Development of a decisional tree for prescription of home-based exercise programs (Preventing loss of Autonomy by Treatment Post-Hospitalization: PATH tool) through meetings with a group of experts. The PATH tool was implemented in a short-term geriatric hospital. Feasibility, acceptability, and safety outcomes were measured and potential efficacy estimated after a 12-week period.
The decisional tree has 3 main components (cognitive, cardio strength, and balance) and comprises 27 different mobility profiles and PA programs. Fifty-six of the first 100 successively admitted GAU patients were found eligible, of whom 29 agreed to participate and 17 completed the protocol. Most were satisfied (14/17) and enjoyed (13/17) the program, and most health professionals found it relevant to patients (7/8) without extra burden (6/8) to patient care. Adherence to the PA program was 5 sessions/wk, and a medium to large effect size on walking speed (P < .01, d = 1.04), chair stand performance (P = .04, d = 0.75), and PA level (P = .07, d = 0.56) was observed after a 12-week period.
This study suggests that implementing the PATH tool might be feasible across GAUs, as well as safe and acceptable for patients and health care professionals. If this intervention proves beneficial after conducting a randomized controlled trial, this hospital-initiated care transition strategy should be implemented in short-term geriatric hospitals to prevent long-term mobility disability.
老年人在住院后会经历更大程度的活动能力丧失，主要原因是身体残疾和缺乏活动。然而，目前并没有关于出院时开具体力活动（PA）处方的建议。
为老年人制定一个出院后个体化、适应性、非监督的家庭 PA 计划的决策树；调查其可行性、可接受性和安全性；并评估其在改善身体功能和活动能力方面的疗效。
实用前瞻性单臂试点研究。
老年评估病房（GAU）。
年龄≥65 岁，简易精神状态检查评分≥18，住院时间>7 天，出院回家，无 PA 禁忌，能理解法语或英语。
通过与一组专家的会议，制定出院后家庭锻炼计划处方的决策树（治疗后防止自主能力丧失：PATH 工具）。PATH 工具在一家短期老年医院实施。在 12 周后，评估可行性、可接受性和安全性结果，并估计潜在疗效。
决策树有 3 个主要部分（认知、心肺力量和平衡），包含 27 种不同的活动能力和 PA 方案。前 100 位连续入院 GAU 患者中有 56 位符合条件，其中 29 位同意参加，17 位完成了方案。大多数患者（14/17）对方案满意，（13/17）喜欢该方案，大多数卫生专业人员认为该方案与患者相关（7/8），对患者护理没有额外负担（6/8）。PA 方案的依从性为每周 5 次，12 周后，步行速度（P<0.01，d=1.04）、坐站表现（P=0.04，d=0.75）和 PA 水平（P=0.07，d=0.56）有中等至较大的效果。
本研究表明，在 GAUs 实施 PATH 工具可能是可行的，并且对患者和卫生保健专业人员来说是安全和可接受的。如果这项干预措施在进行随机对照试验后被证明是有益的，那么这种由医院发起的护理过渡策略应该在短期老年医院实施，以预防长期的活动能力丧失。
