Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland.
Physiotherapy Department, Mercy University Hospital, Cork, Ireland.
BMC Geriatr. 2020 Feb 7;20(1):46. doi: 10.1186/s12877-020-1436-0.
To measure the effects of an augmented prescribed exercise programme versus usual care, on physical performance, quality of life and healthcare utilisation for frail older medical patients in the acute setting.
This was a parallel single-blinded randomised controlled trial. Within 2 days of admission, older medical inpatients with an anticipated length of stay ≥3 days, needing assistance/aid to walk, were blindly randomly allocated to the intervention or control group. Until discharge, both groups received twice daily, Monday-to-Friday half-hour assisted exercises, assisted by a staff physiotherapist. The intervention group completed tailored strengthening and balance exercises; the control group performed stretching and relaxation exercises. Length of stay was the primary outcome measure. Blindly assessed secondary measures included readmissions within 3 months, and physical performance (Short Physical Performance Battery) and quality of life (EuroQOL-5D-5 L) at discharge and at 3 months. Time-to-event analysis was used to measure differences in length of stay, and regression models were used to measure differences in physical performance, quality of life, adverse events (falls, deaths) and negative events (prolonged hospitalisation, institutionalisation).
Of the 199 patients allocated, 190 patients' (aged 80 ± 7.5 years) data were analysed. Groups were comparable at baseline. In intention-to-treat analysis, length of stay did not differ between groups (HR 1.09 (95% CI, 0.77-1.56) p = 0.6). Physical performance was better in the intervention group at discharge (difference 0.88 (95% CI, 0.20-1.57) p = 0.01), but lost at follow-up (difference 0.45 (95% CI, - 0.43 - 1.33) p = 0.3). An improvement in quality of life was detected at follow-up in the intervention group (difference 0.28 (95% CI, 0.9-0.47) p = 0.004). Overall, fewer negative events occurred in the intervention group (OR 0.46 (95% CI 0.23-0.92) p = 0.03).
Improvements in physical performance, quality of life and fewer negative events suggest that this intervention is of value to frail medical inpatients. Its effect on length of stay remains unclear.
ClinicalTrials.gov Identifier: NCT02463864, registered prospectively 26.05.2015.
在急性环境中，测量强化规定运动方案对身体表现、生活质量和医疗保健利用的影响，对比常规护理，针对虚弱的老年医学患者。
这是一项平行的单盲随机对照试验。在入院后 2 天内，预计住院时间≥3 天、需要辅助/辅助行走的老年内科住院患者被盲法随机分配到干预组或对照组。直到出院，两组均接受每周 5 天、每天 2 次、每次半小时的辅助运动，由一名工作人员物理治疗师协助。干预组完成定制的强化和平衡运动；对照组进行伸展和放松运动。住院时间是主要的观察指标。盲法评估的次要指标包括 3 个月内再入院，以及出院时和 3 个月时的身体表现（简短身体表现电池）和生活质量（EuroQOL-5D-5L）。采用时间事件分析来测量住院时间的差异，回归模型用于测量身体表现、生活质量、不良事件（跌倒、死亡）和负性事件（住院时间延长、住院）的差异。
199 名分配患者中，有 190 名患者（年龄 80±7.5 岁）的数据进行了分析。两组在基线时具有可比性。在意向治疗分析中，两组的住院时间无差异（HR 1.09（95%CI，0.77-1.56）p=0.6）。在出院时，干预组的身体表现更好（差异 0.88（95%CI，0.20-1.57）p=0.01），但在随访时下降（差异 0.45（95%CI，-0.43-1.33）p=0.3）。在干预组中，随访时生活质量有所改善（差异 0.28（95%CI，0.9-0.47）p=0.004）。总体而言，干预组的负性事件较少（OR 0.46（95%CI 0.23-0.92）p=0.03）。
身体表现、生活质量的提高和负性事件的减少表明，这种干预对虚弱的内科住院患者有价值。其对住院时间的影响尚不清楚。
ClinicalTrials.gov 标识符：NCT02463864，前瞻性注册于 2015 年 5 月 26 日。
