The baseline speed of 10-m gait predicts ambulatory discharge for hospitalized frail elderly after DOPPO rehabilitation

Abstract

The discharge of elderly patients from hospital on the basis of their independent gait program (DOPPO) is a new rehabilitation strategy for physically frail hospitalized elderly that aims to recover independent gait and to achieve ambulatory discharge. We retrospectively investigated baseline determinants of physical measures associated closely with the 6-min walking distance (6MWD) after DOPPO. Participants were 137 consecutive elderly inpatients, irrespective of the causative disease (mean age: 82±7 years; 76 women), who had a Short Physical Performance Battery (SPPB) score of less than 12 and low independent walking capacity. The rehabilitation comprised muscle stretching, muscle strengthening, balance training, and endurance exercise, including walking. The exercises were gradually increased until the goal of ambulatory discharge was attained. The SPPB, isometric knee-extension muscle strength (IKEMS), functional reach test (FRT), one-leg stance time (OLST), and the 10-m gait speed (TMGS) were measured, before and after the DOPPO intervention, and their association with the 6MWD was evaluated. All participants achieved ambulatory discharge, requiring on average 35±19 hospital days and 32±18 h of rehabilitation. The SPPB, IKEMS, FRT, OLST, and TMGS improved. The SPPB scores increased from 7.1 at baseline to 9.2 at discharge. Eighty-eight patients completed the 6MWD. The SPPB, IKEMS, FRT, OLST, and TMGS were strongly associated with the 6MWD. Only the baseline TMGS and SPPB predicted the 6MWD, with a cut-off TMGS value of 0.84 m/s providing the best prediction of achieving a distance of more than 300 m on the 6MWD. Thus, the baseline TMGS is the best prediction of the ambulatory outcome after the present DOPPO rehabilitation.

Characteristics of Elderly Patients with Heart Failure and Impact on Activities of Daily Living: A Registry Report from Super-Aged Society

“…ADL scores on admission were particularly low in the very elderly patients, with 67.9% unable to walk unaided and 77.2% unable to use the toilet independently; self-care was highly infeasible. These facts suggest that the elderly patients with HF essentially require disease management and personalized care support, possibly achieved by comprehensive rehabilitation [16].…”

Effects of Phase II Cardiac Rehabilitation on Physical Function and Anxiety Levels in Frail Patients

“…To date, exercise therapy has been shown to improve physical function, 6MWD, and the Short Physical Performance Battery in frail patients. [19][20][21] Furthermore, recent studies in Japan have suggested that a 3-month CR program for frail older adults with cardiovascular disease may significantly improve walking speed, grip strength, and lower limb muscle strength. 22 In the present study, a significant improvement in 6MWD at the end of CR was also observed, suggesting that a CR program that includes exercise therapy improves exercise tolerance in frail patients.…”

JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease

“…addition, in older patients with heart disease, usual gait speed and 6MWD show a strong positive correlation, 159,160 and the prognostic value is also reported to be similar. 159 ▋ 3.2.2 Significance and Effectiveness (Table30)…”