Factors associated with improved walking in older people during hospital rehabilitation: secondary analysis of a randomized controlled trial

Catherine M Said; Jennifer L McGinley; Cassandra Szoeke; Barbara Workman; Keith D Hill; Joanne E Wittwer; Michael Woodward; Danny Liew; Leonid Churilov; Julie Bernhardt; Meg E Morris

doi:10.1186/s12877-021-02016-0

Factors associated with improved walking in older people during hospital rehabilitation: secondary analysis of a randomized controlled trial

BMC Geriatr. 2021 Jan 31;21(1):90. doi: 10.1186/s12877-021-02016-0.

Authors

Catherine M Said^{1

2

3

4}, Jennifer L McGinley⁵, Cassandra Szoeke^{6

7

8}, Barbara Workman^{9

10}, Keith D Hill¹¹, Joanne E Wittwer¹², Michael Woodward^{13

14}, Danny Liew¹⁵, Leonid Churilov¹⁶, Julie Bernhardt^{17

18}, Meg E Morris^{12

19}

Affiliations

¹ Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia. csaid@unimelb.edu.au.
² Physiotherapy Department, Western Health, St Albans, Australia. csaid@unimelb.edu.au.
³ Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital, St Albans, Australia. csaid@unimelb.edu.au.
⁴ Physiotherapy Department Austin Health, Heidelberg, Australia. csaid@unimelb.edu.au.
⁵ Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia.
⁶ Healthy Ageing Program, Department of Medicine, The University of Melbourne, Centre for Medical Research, Parkville, Australia.
⁷ The Royal Melbourne Hospital, Parkville, Australia.
⁸ Institute for Health and Ageing, Australian Catholic University, Fitzroy, Australia.
⁹ Rehabilitation and Aged Care Services, Monash Health, Cheltenham, Australia.
¹⁰ Monash Ageing Research Centre (MONARC), Monash University, Cheltenham, Australia.
¹¹ Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia.
¹² La Trobe Centre for Exercise and Sports Medicine Research, School of Allied Health, La Trobe University, Bundoora, Australia.
¹³ Aged Care Services, Austin Health, Heidelberg, Australia.
¹⁴ Department of Medicine, The University of Melbourne, Parkville, Australia.
¹⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹⁶ Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, The University of Melbourne, Heidelberg, Australia.
¹⁷ Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, Australia.
¹⁸ CRE Stroke Rehabilitation and Recovery, Heidelberg, Australia.
¹⁹ Victorian Rehabilitation Centre, Healthscope Australia, Melbourne, Australia.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740 .

Keywords: Aged; Aged, 80 and over; Exercise therapy; Hospitalization; Mobility limitation; Rehabilitation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living*
Aged
Aged, 80 and over
Australia
Humans
Physical Therapy Modalities
Treatment Outcome
Walking*

Associated data

ClinicalTrials.gov/NCT01910740

Grants and funding

1042680/National Health and Medical Research Council