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, 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

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.

Conflict of interest statement

The authors declare that they have no competing interests.

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