In acutely admitted geriatric patients, offering increased physical activity during hospitalization decreases length of stay and can improve mobility

Oestergaard, Anne Skov; Mathiesen, Margrethe; Karlsen, Anders; Turtumoeygaard, I. F.; Vahlgren, Julie; Kjær, Michael; Beyer, Nina

doi:10.1002/tsm2.2

Cited by 15 publications

(19 citation statements)

References 44 publications

(92 reference statements)

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“…Also, we found no effect on mobility during hospitalization. This is in agreement with previous studies in geriatric patients showing no effect on mobility, assessed by the DEMMI [87], nor on functional outcomes [88] of an in-hospital progressive strength training program. Several reasons for the lack of effect in our primary outcome can be suggested.…”

Section: Discussionsupporting

confidence: 93%

“…In the intervention group, only 43% were highly compliant with the intervention, which may explain the lack of effect seen in this study. This level of compliance, though, is in line with a study in acutely admitted geriatric patients [87] and stresses the challenges in maintaining acutely admitted older adults in training interventions. Also, we experienced a large amount of missing data in our study, among others due to the high number of drop outs.…”

Section: Strengths and Limitationssupporting

confidence: 74%

“…Like our study, Tibaek et al [88] found no effect on mobility or strength of strength training in addition to standard physiotherapy. Also, Oestergaard et al [87] found no effect of an in-hospital chair-based exercise program on mobility and muscle strength.…”

Section: Discussionmentioning

confidence: 98%

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A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial

Pedersen

Petersen

Beyer

et al. 2019

Preprint

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Background: During hospitalization, older adults (+65) are inactive, which puts them at risk of functional decline and loss of independence. Systematic strength training can prevent loss of functional performance and combining strength training with protein supplementation may enhance the response on muscle mass and strength . However, we lack knowledge about the effect of strength training commenced during hospitalization and continued after discharge in older medical patients. This assessor-blinded, randomized study investigated the effect of a simple, supervised strength training program for the lower extremities, combined with post-training protein supplementation during hospitalization and in the home setting for 4 weeks after discharge on change in mobility in older medical patients. Methods: Older medical patients (≥65 yrs) admitted acutely from their home to the Emergency Department were randomized to either standard care or supervised progressive strength training and an oral protein supplement during hospitalization and at home 3 days/week for 4 weeks after discharge. The primary outcome was between-group difference in change in mobility from baseline to 4 weeks after discharge assessed by the De Morton Mobility Index, which assesses bed mobility, chair mobility, static and dynamic balance, and walking. Secondary outcomes were 24-hour mobility, lower extremity strength, gait speed, grip strength and Activities of Daily Living. Results: Eighty-five patients were randomized to an intervention group (N=43) or a control group (N=42). In the intervention group, 43% were highly compliant with the intervention. Our intention to treat analysis revealed no between-group difference in mobility (mean difference in change from baseline to 4 weeks: -4.17 (95 % CI: -11.09;2.74; p=0.24) nor in any of the secondary outcomes. The per protocol analysis showed that the intervention group increased significantly more in the daily number of steps taken compared to the control group (mean difference in change from baseline to 4 weeks: 1033.4 steps (95 % CI: 4.1;2062.7), p=0.049, adjusted for mobility at baseline and length of stay; 1032.8 steps (95% CI: 3.6;2061.9), p=0.049, adjusted for mobility at baseline, length of stay and steps at baseline). Conclusions: Simple supervised strength training for the lower extremities, combined with protein supplementation initiated during hospitalization and continued at home for 4 weeks after discharge was not superior to usual care on change in mobility at 4 weeks in older medical patients. For the secondary outcome, daily number of steps, high compliance with the intervention resulted in a higher daily number of steps. Less than half of the patients were compliant with the intervention indicating that a simpler intervention might be needed. Trial registration: NCT01964482, https://clinicaltrials.gov/ct2/show/NCT01964482 , registration date: October 14, 2013, trial protocol: PubMed ID (PMID): 27039381.

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Section: Discussionsupporting

confidence: 93%

Section: Strengths and Limitationssupporting

confidence: 74%

See 1 more Smart Citation

A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial

Pedersen

Petersen

Beyer

et al. 2019

Preprint

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“…Acute hospitalization is often accompanied by a reduced level of physical activity, and studies show that older patients spend most of their time lying passively in bed [3][4][5]. Reduced mobility during hospitalization is an important risk factor for adverse in-hospital outcomes and an independent predictor of poor hospital outcomes at discharge, specifically decline in activities of daily living, institutionalization, and increased mortality [3].…”

Section: Introductionmentioning

confidence: 99%

Use of robot technology in passive mobilization of acute hospitalized geriatric medicine patients: a pilot test and feasibility study

Bertelsen

Storm

Minet

et al. 2020

Pilot Feasibility Stud

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Background: Along with an aging population, the field of robot technology in rehabilitation is expanding. As new technologies develop, it is important to test these clinically before implementation. To assess the possibilities of undertaking a future randomized controlled trial (RCT), the aim of this study was to pilot test and investigate the feasibility of a newly developed passive mobilization robot device in geriatric medicine patients. Methods: We used a robot to perform passive mobilization for all recruited patients while they were lying in bed. Inclusion criteria include the following: ≥ 65 years of age, able to walk before hospitalization, and not capable of walking > 2 m at the first day of hospitalization. Exclusion criteria include the following: known moderate/severe dementia, unstable fractures (back, pelvis, or legs), high intracranial pressure, pressure ulcers/risk of developing pressure ulcers due to fragile skin, positive Confusion and Assessment Method (CAM) score, not able to understand Danish, and medical instability. A mixed-methods approach, including structured interviews for patients and relatives, questionnaires and semi-structured interviews for the staff, and observations in the clinic were used as data collection methods. A 6-week pilot test preceded the feasibility study to test study design, safety, interview guide, and setting, and to become familiar with the robot. Results: The pilot test included 13 patients, made the staff confident in the use of the robot, and led to the correction of the interview guide. In the feasibility study, 177 patients were screened, 14 patients (four men, nine women) included, and 13 completed the intervention (median [IQR] age 86 [82-92] years). Overall, the robot was easy to use during passive mobilization and fully accepted by patients and relatives. Staff, however, found the robot difficult to maneuver. No adverse events were reported. Conclusions: Use of robot technology in passive mobilization of older patients was feasible and well accepted by patients, relatives, and staff. Technical and workflow-related issues, as well as the robot not performing active mobilization, affects the launch of a RCT and thereby its implementation in geriatric medicine patients.

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“…Hospitalization is typically accompanied by a low level of activity; however, whether the level of physical activity during hospitalization has an impact on loss of muscle mass in geriatric patients has yet to be explored. Due to recovery from their medical illness, geriatric patients may actually maintain or even improve functional performance and/or muscle function during hospitalization, which could mask a simultaneous loss of muscle mass. Therefore, it is important not only to monitor the general functional level, but also to monitor the loss of muscle mass in this population during hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Using ultrasonography to detect loss of muscle mass in the hospitalized geriatric population

et al. 2019

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Background and purpose Hospital admission for older patients has been linked to loss of muscle mass and function, and the former can be measured with ultrasonography during hospitalization. Methods Two studies were carried out. In Study 1, 69 patients' (85 ± 8 years) activity level was measured with ActivPal and quadriceps thickness measured twice with ultrasonography during hospitalization. In Study 2, 10 older patients (85 ± 8 years) and 10 healthy young subjects (23 ± 2 years) had their quadriceps thickness measured on two consecutive days with ultrasonography that included a pressure calibrator. Results In Study 1, the results revealed that the older patients had a reduction in thigh muscle thickness together with very low levels of activity level during hospitalization. Patients with a <95% inactivity level show a 1.8% reduction in muscle thickness, and those with a >95% inactivity level had a 7.0% reduction. In Study 2, ultrasonographic measurements were performed using a pressure calibrator, and these results yielded very good reproducibility. Typical error was 1.7% for the young and 7.2% for the old persons. This high reproducibility and low error improve the ability to detect significant changes over time. Conclusion Improving the ultrasonography method including use of a pressure calibrator can result in greater reproducibility.

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In acutely admitted geriatric patients, offering increased physical activity during hospitalization decreases length of stay and can improve mobility

Cited by 15 publications

References 44 publications

A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial

A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial

Use of robot technology in passive mobilization of acute hospitalized geriatric medicine patients: a pilot test and feasibility study

Using ultrasonography to detect loss of muscle mass in the hospitalized geriatric population

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