Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia.
Physiotherapy Department, Western Health, St Albans, Australia.
BMC Geriatr. 2021 Jan 31;21(1):90. doi: 10.1186/s12877-021-02016-0.
Older people are often admitted for rehabilitation to improve walking, yet not everyone improves. The aim of this study was to determine key factors associated with a positive response to hospital-based rehabilitation in older people.
This was a secondary data analysis from a multisite randomized controlled trial. Older people (n= 198, median age 80.9 years, IQR 76.6- 87.2) who were admitted to geriatric rehabilitation wards with a goal to improve walking were recruited. Participants were randomized to receive additional daily physical therapy focused on mobility (n = 99), or additional social activities (n = 99). Self-selected gait speed was measured on admission and discharge. Four participants withdrew. People who changed gait speed ≥0.1 m/s were classified as 'responders' (n = 130); those that changed <0.1m/s were classified as 'non-responders' (n = 64). Multivariable logistic regression explored the association of six pre-selected participant factors (age, baseline ambulation status, frailty, co-morbidities, cognition, depression) and two therapy factors (daily supervised upright activity time, rehabilitation days) and response.
Responding to rehabilitation was associated with the number of days in rehabilitation (OR 1.04; 95% CI 1.00 to 1.08; p = .039) and higher Mini Mental State Examination scores (OR 1.07, 95% CI 1.00 - 1.14; p = .048). No other factors were found to have association with responding to rehabilitation.
In older people with complex health problems or multi-morbidities, better cognition and a longer stay in rehabilitation were associated with a positive improvement in walking speed. Further research to explore who best responds to hospital-based rehabilitation and what interventions improve rehabilitation outcomes is warranted.
Australian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740 .
老年人常因康复而入院，以改善行走能力，但并非所有人都能改善。本研究旨在确定与老年人住院康复后积极反应相关的关键因素。
这是一项多地点随机对照试验的二次数据分析。招募了 198 名（中位年龄 80.9 岁，IQR 76.6-87.2）因改善行走能力而入住老年康复病房的老年人。参与者被随机分配接受额外的每日物理治疗（99 人）或额外的社会活动（99 人）。入院和出院时测量自我选择的步速。有 4 名参与者退出。步速变化≥0.1m/s 的人被归类为“应答者”（n=130）；步速变化<0.1m/s 的人被归类为“非应答者”（n=64）。多变量逻辑回归探讨了六个预先选择的参与者因素（年龄、基线活动状态、衰弱、合并症、认知、抑郁）和两个治疗因素（每日监督直立活动时间、康复天数）与反应的关系。
对康复的反应与康复天数（OR 1.04；95%CI 1.00-1.08；p=0.039）和较高的简易精神状态检查评分（OR 1.07，95%CI 1.00-1.14；p=0.048）有关。没有其他因素与对康复的反应有关。
在患有复杂健康问题或多种疾病的老年人中，更好的认知和更长的康复时间与行走速度的积极改善相关。需要进一步研究以探索谁最能从基于医院的康复中受益，以及哪些干预措施能改善康复效果。
澳大利亚新西兰临床试验注册中心 ACTRN12613000884707；ClinicalTrials.gov 标识符 NCT01910740。
