Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne; Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne.
Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne; Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne.
Arch Phys Med Rehabil. 2021 Jun;102(6):1134-1139. doi: 10.1016/j.apmr.2020.12.017. Epub 2021 Jan 23.
To examine the relationship between falls efficacy and the change in gait speed and functional status in older patients undergoing postacute rehabilitation.
Prospective cohort study.
Postacute rehabilitation facility.
Patients (N=180) aged 65 years and older (mean age ± SD, 81.3±7.1y).
Not applicable.
Data on demographics; functional, cognitive, and affective status; and falls efficacy using a 10-item version of the Falls Efficacy Scale (FES; range, 0-100) were collected upon admission. Data about gait speed and functional status (Barthel Index and Basic Activities of Daily Living [BADL]) were measured at admission and discharge. In addition, BADL performance was self-reported 1 month after discharge.
Compared with admission, all rehabilitation outcomes improved at discharge: gait speed (0.41±0.15 m/s vs 0.50±0.16 m/s; P<.001), Barthel Index score (68.4±16.3 vs 82.5±13.6; P<.001), and BADL (3.5±1.6 vs 4.7±1.3; P<.001). Adjusting for baseline status and other potential confounders, baseline FES independently predicted gait speed (adjusted coefficient: 0.002; 95% confidence interval [CI], 0.000-0.004; P=.025) and Barthel index (adjusted coefficient: 0.225; 95% CI, 0.014-0.435; P=.037) at discharge, with higher confidence at baseline predicting greater improvement. Baseline FES was also independently associated with self-reported BADL performance at the 1-month follow-up (adjusted coefficient: 0.020; 95% CI, 0.010-0.031; P<.001).
In older patients, higher falls efficacy predicted better gait and functional rehabilitation outcomes, independently of baseline performance. These results suggest that interventions aiming at falls efficacy improvement during rehabilitation might also contribute to enhancing gait speed and functional status in patients admitted to this setting.
探讨老年患者在接受急性后康复治疗时，跌倒效能与步态速度和功能状态变化之间的关系。
前瞻性队列研究。
急性后康复机构。
年龄在 65 岁及以上的患者（平均年龄±标准差，81.3±7.1 岁）。
不适用。
在入院时收集人口统计学数据、功能、认知和情感状态以及使用 10 项跌倒效能量表（FES；范围 0-100）的数据。在入院和出院时测量步态速度和功能状态（巴氏指数和基本日常生活活动[BADL]）。此外，在出院后 1 个月时自我报告 BADL 表现。
与入院时相比，所有康复结果在出院时均有所改善：步态速度（0.41±0.15m/s 比 0.50±0.16m/s；P<.001）、巴氏指数评分（68.4±16.3 比 82.5±13.6；P<.001）和 BADL（3.5±1.6 比 4.7±1.3；P<.001）。在调整基线状态和其他潜在混杂因素后，基线 FES 独立预测出院时的步态速度（调整系数：0.002；95%置信区间[CI]，0.000-0.004；P=.025）和巴氏指数（调整系数：0.225；95%CI，0.014-0.435；P=.037），基线信心越高，预示着改善程度越大。基线 FES 也与 1 个月随访时自我报告的 BADL 表现独立相关（调整系数：0.020；95%CI，0.010-0.031；P<.001）。
在老年患者中，较高的跌倒效能预示着更好的步态和功能康复结局，独立于基线表现。这些结果表明，在康复期间旨在提高跌倒效能的干预措施也可能有助于提高入住该环境的患者的步态速度和功能状态。
