通过个体化运动方案恢复住院后日常生活活动能力下降：一项随机临床试验的二次分析。

Recovery of the Decline in Activities of Daily Living After Hospitalization Through an Individualized Exercise Program: Secondary Analysis of a Randomized Clinical Trial.

机构信息

Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.

CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.

出版信息

J Gerontol A Biol Sci Med Sci. 2021 Jul 13;76(8):1519-1523. doi: 10.1093/gerona/glab032.

DOI:10.1093/gerona/glab032

PMID:33522565

Abstract

BACKGROUND

During the period of hospitalization, patients can develop functional decline. The main aim of our study was to assess the natural trajectory of each activity of daily living (ADL) and to assess how in-hospital exercise could influence short-term trajectory of ADLs.

METHOD

Acutely hospitalized patients (n = 297, 56.5% women) were randomly assigned to the intervention or control (usual care) group within the first 48 hours of admission. An exercise training program was prescribed in 2 daily sessions (morning and evening) of 20 minutes duration during 5-7 consecutive days for the intervention group. The primary endpoint was the change in every ADL (assessed with the Barthel Index) from 2 weeks before admission to hospital discharge.

RESULTS

Acute hospitalization per se led to significant in-patient's functional ability impairment in ADLs during hospitalization, whereas the exercise intervention reversed this trend (3.7 points; 95% CI: 0.5-6.8 points). After analyzing the trajectory of each one of the ADLs, patients in the control group significantly worsened all activities, but with a different degree of loss. For the between-group analysis, significant differences were obtained in many ADLs including bathing, dressing, grooming, bladder control, toilet use, transfers, mobility, and climbing stairs (p < .05). The control group had the greatest impairment in all domains analyzed (ie, feeding, bathing, dressing, grooming, bowel control, bladder control, toilet use, transfers, mobility, and climbing stairs; p < .05).

CONCLUSIONS

An individualized multicomponent exercise training program in older adults is effective to reverse the loss of specific ADLs that frequently occurs during hospitalization. Each patient profile should receive an individualized prescription of exercise during hospitalizations.

CLINICAL TRIALS REGISTRATION NUMBER

NCT02300896.

摘要

背景

在住院期间，患者可能会出现功能下降。我们的主要目的是评估日常生活活动（ADL）的自然轨迹，并评估住院期间的运动如何影响 ADL 的短期轨迹。

方法

急性住院患者（n=297，56.5%为女性）在入院后 48 小时内被随机分配到干预组或对照组（常规护理）。干预组每天进行 2 次 20 分钟的运动训练，共 5-7 天。主要终点是从入院前 2 周到出院时 ADL（采用巴氏指数评估）的变化。

结果

急性住院本身导致住院期间患者的日常生活能力显著受损，而运动干预则扭转了这一趋势（3.7 分；95%CI：0.5-6.8 分）。分析每个 ADL 的轨迹后，对照组患者所有活动均明显恶化，但丧失程度不同。对于组间分析，在许多 ADL 中均获得了显著差异，包括洗澡、穿衣、修饰、膀胱控制、如厕、转移、活动、上下楼梯（p<0.05）。对照组在所有分析领域的损害最大（即进食、洗澡、穿衣、修饰、排便控制、膀胱控制、如厕、转移、活动和上下楼梯；p<0.05）。