Walking in hospital is associated with a shorter length of stay in older medical inpatients

McCullagh, Ruth; Dillon, Christina; Dahly, D; Horgan, N Frances; Timmons, Suzanne

doi:10.1016/j.physio.2016.10.057

Cited by 9 publications

(12 citation statements)

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“…Additionally, we defined two supplementary hypotheses (2 and 4) based on the input of the research team and involved physiotherapists. Earlier research, using other mobility tools, showed that both the patient's length of stay and the performance of ADL prior to admission have a moderate to strong relationship with the patient's mobility [35][36][37][38]. These relationships were confirmed in this study using the AM-PAC "6-clicks" Basic Mobility to measure the patient's independent mobility.…”

Section: Discussionsupporting

confidence: 76%

Construct validity and inter-rater reliability of the Dutch activity measure for post-acute care “6-clicks” basic mobility form to assess the mobility of hospitalized patients

Geelen

Valkenet

Veenhof

2018

Disability and Rehabilitation

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To evaluate the construct validity and the inter-rater reliability of the Dutch Activity Measure for Post-Acute Care "6-clicks" Basic Mobility short form measuring the patient's mobility in Dutch hospital care. First, the "6-clicks" was translated by using a forward-backward translation protocol. Next, 64 patients were assessed by the physiotherapist to determine the validity while being admitted to the Internal Medicine wards of a university medical center. Six hypotheses were tested regarding the construct "mobility" which showed that: Better "6-clicks" scores were related to less restrictive pre-admission living situations (p = 0.011), less restrictive discharge locations (p = 0.001), more independence in activities of daily living (p = 0.001) and less physiotherapy visits (p < 0.001). A correlation was found between the "6-clicks" and length of stay (r= -0.408, p = 0.001), but not between the "6-clicks" and age (r= -0.180, p = 0.528). To determine the inter-rater reliability, an additional 50 patients were assessed by pairs of physiotherapists who independently scored the patients. Intraclass Correlation Coefficients of 0.920 (95%CI: 0.828-0.964) were found. The Kappa Coefficients for the individual items ranged from 0.649 (walking stairs) to 0.841 (sit-to-stand). The Dutch "6-clicks" shows a good construct validity and moderate-to-excellent inter-rater reliability when used to assess the mobility of hospitalized patients. Implications for Rehabilitation Even though various measurement tools have been developed, it appears the majority of physiotherapists working in a hospital currently do not use these tools as a standard part of their care. The Activity Measure for Post-Acute Care "6-clicks" Basic Mobility is the only tool which is designed to be short, easy to use within usual care and has been validated in the entire hospital population. This study shows that the Dutch version of the Activity Measure for Post-Acute Care "6-clicks" Basic Mobility form is a valid, easy to use, quick tool to assess the basic mobility of Dutch hospitalized patients.

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Section: Discussionsupporting

confidence: 76%

Construct validity and inter-rater reliability of the Dutch activity measure for post-acute care “6-clicks” basic mobility form to assess the mobility of hospitalized patients

Geelen

Valkenet

Veenhof

2018

Disability and Rehabilitation

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“…Patients walk an average of 600 steps daily [1,2] which equates to twelve minutes of walking [3]; 49% of older patients remain on bedrest or transfer from bed to chair only [4], and less than 19% of patients walk hospital corridors [5]. Our recently conducted observation study suggested that people who walked more had a shorter stay in hospital, where a 50% higher step-count was associated with a 6% shorter hospital stay, and those with poor physical performance on admission were the least active in hospital [1]. These frailer patients are potentially most at risk of functional decline following a hospital admission [6].…”

Section: Introductionmentioning

confidence: 99%

“…Trials which have included both robust and frail inpatients have shown limited effectiveness of exercise alone on length of stay [13,14], with conflicting results on physical and functional performance [13,15]. A meta-analysis of exercise interventions suggested that they were more effective for those patients needing more assistance to walk [16]; potentially as those patients are most at risk of acute sarcopenia [1]. Positive effects on functional and physical capacity were gained in an exercise intervention specifically for very elderly patients in hospital.…”

Section: Introductionmentioning

confidence: 99%

Augmented Exercise in Hospital Improves Physical Performance and Reduces Negative Post Hospitalization Events: A Randomized Controlled Trial

McCullagh

O'Connell

O’Meara

et al. 2020

Preprint

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Background: To measure the effects of an augmented prescribed exercise programme versus usual care, on physical performance, quality of life and healthcare utilisation for frail older medical patients in the acute setting. Methods: This was a parallel single-blinded randomised controlled trial. Within two days of admission, older medical inpatients with an anticipated length of stay ≥3 days, needing assistance/aid to walk, were blindly randomly allocated to the intervention or control group. Until discharge, both groups received twice daily, Monday-to-Friday half-hour assisted exercises, assisted by a staff physiotherapist. The intervention group completed tailored strengthening and balance exercises; the control group performed stretching and relaxation exercises. Length of stay was the primary outcome measure. Blindly assessed secondary measures included readmissions within three months, and physical performance (Short Physical Performance Battery) and quality of life (EuroQOL-5D-5L) at discharge and at three months. Time-to-event analysis was used to measure differences in length of stay, and regression models were used to measure differences in physical performance, quality of life, adverse events (falls, deaths) and negative events (prolonged hospitalisation, institutionalisation). Results: Of the 199 patients allocated, 190 patients’ (aged 80 ±7.5 years) data were analysed. Groups were comparable at baseline. In intention-to-treat analysis, length of stay did not differ between groups (HR 1.09 (95% CI, 0.77-1.56) p=0.6). Physical performance was better in the intervention group at discharge (difference 0.88 (95% CI, 0.20-1.57) p=0.01), but lost at follow-up (difference 0.45 (95% CI, -0.43 – 1.33) p=0.3). An improvement in quality of life was detected at follow-up in the intervention group (difference 0.28 (95% CI, 0.9 – 0.47) p=0.004). Overall, fewer negative events occurred in the intervention group (OR 0.46 (95% CI 0.23 – 0.92) p=0.03). Conclusion: Improvements in physical performance, quality of life and fewer negative events suggest that this intervention is of value to frail medical inpatients. Its effect on length of stay remains unclear.

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“…Unnecessarily reduced physical activity during hospitalisation may be part responsible for hospitalassociated functional decline and acute sarcopenia in older patients [1,2]. Higher levels of physical activity whilst in hospital have been shown to correlate negatively with risk of death [3], length of stay [4], and functional decline [5], and positively with likelihood of discharge home [6].…”

Section: Introductionmentioning

confidence: 99%

Predictors of physical activity in older adults early in an emergency hospital admission: a prospective cohort study

Hartley

Dewitt

Forsyth

et al. 2020

Preprint

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Background: Reduced mobility may be responsible for functional decline and acute sarcopenia in older hospitalised patients. The drivers of reduced in-hospital mobility are poorly understood, especially during the early phase of acute hospitalisation. We investigated predictors of in-hospital activity during a 24-hour period in the first 48 hours of hospital admission in older adults.Methods: This was a secondary analysis of a prospective repeated measures cohort study.Participants aged 75 years or older were recruited within the first 24 hours of admission. At recruitment, patients underwent a baseline assessment including measurements of pre-morbid functional mobility, cognition, frailty, falls efficacy, co-morbidity, acute illness severity, knee extension strength and grip strength, and consented to wear accelerometers to measure physical activity during the first 7 days (or until discharge if earlier). In-hospital physical activity was defined as the amount of upright time (standing or walking). To examine the predictors of physical activity, we limited the analysis to the first 24 hours of recording to maximise the sample size as due to discharge from hospital there was daily attrition. We used a best subset analysis including all baseline measures. The optimal model was defined by having the lowest Bayesian information criterion in the best-subset analyses. The model specified a maximum of 5 covariates and used an exhaustive search.Results: Seventy participants were recruited but eight were excluded from the final analysis due to lack of accelerometer data within the first 24 hours after recruitment. Patients spent a median of 0.50 hours (IQR: 0.21; 1.43) standing or walking. The optimal model selected the following covariates: functional mobility as measured by the de Morton Mobility Index and two measures of illness severity, the National Early Warning Score, and serum C-reactive protein. Conclusions:Physical activity, particularly in the acute phase of hospitalisation, is very low in older adults. The association between illness severity and physical activity may be explained by symptoms of acute illness being barriers to activity. Interdisciplinary approaches are required to identify early mobilisation opportunities.

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Walking in hospital is associated with a shorter length of stay in older medical inpatients

Cited by 9 publications

References 0 publications

Construct validity and inter-rater reliability of the Dutch activity measure for post-acute care “6-clicks” basic mobility form to assess the mobility of hospitalized patients

Construct validity and inter-rater reliability of the Dutch activity measure for post-acute care “6-clicks” basic mobility form to assess the mobility of hospitalized patients

Augmented Exercise in Hospital Improves Physical Performance and Reduces Negative Post Hospitalization Events: A Randomized Controlled Trial

Predictors of physical activity in older adults early in an emergency hospital admission: a prospective cohort study

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