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Becker ML, Hurkmans HL, Verhaar JAN, Bussmann JBJ. Monitoring postures and motions of hospitalized patients using sensor technology: a scoping review. Ann Med 2024; 56:2399963. [PMID: 39239877 PMCID: PMC11382703 DOI: 10.1080/07853890.2024.2399963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Sensor technology could provide solutions to monitor postures and motions and to help hospital patients reach their rehabilitation goals with minimal supervision. Synthesized information on device applications and methodology is lacking. OBJECTIVES The purpose of this scoping review was to provide an overview of device applications and methodological approaches to monitor postures and motions in hospitalized patients using sensor technology. METHODS A systematic search of Embase, Medline, Web of Science and Google Scholar was completed in February 2023 and updated in March 2024. Included studies described populations of hospitalized adults with short admission periods and interventions that use sensor technology to objectively monitor postures and motions. Study selection was performed by two authors independently of each other. Data extraction and narrative analysis focused on the applications and methodological approaches of included articles using a personalized standard form to extract information on device, measurement and analysis characteristics of included studies and analyse frequencies and usage. RESULTS A total of 15.032 articles were found and 49 articles met the inclusion criteria. Devices were most often applied in older adults (n = 14), patients awaiting or after surgery (n = 14), and stroke (n = 6). The main goals were gaining insight into patient physical behavioural patterns (n = 19) and investigating physical behaviour in relation to other parameters such as muscle strength or hospital length of stay (n = 18). The studies had heterogeneous study designs and lacked completeness in reporting on device settings, data analysis, and algorithms. Information on device settings, data analysis, and algorithms was poorly reported. CONCLUSIONS Studies on monitoring postures and motions are heterogeneous in their population, applications and methodological approaches. More uniformity and transparency in methodology and study reporting would improve reproducibility, interpretation and generalization of results. Clear guidelines for reporting and the collection and sharing of raw data would benefit the field by enabling study comparison and reproduction.
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Affiliation(s)
- Marlissa L Becker
- Department of Orthopaedics and Sports Medicine - Physical Therapy, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henri L Hurkmans
- Department of Orthopaedics and Sports Medicine - Physical Therapy, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Karapınar M, Kırdı N, Fırat T. Effectiveness of supervised and functional level-based exercise program in elderly inpatients: Randomised controlled trial. Clin Rehabil 2022; 36:1623-1634. [PMID: 35880264 DOI: 10.1177/02692155221116818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of supervised and unsupervised functional level-based exercises program for elderly inpatients on physical activity, mobility, health-related quality of life and depression status. DESIGN A single-blinded randomised controlled trial. SETTING Internal medicine service. SUBJECTS Patients aged 65 years or older. INTERVENTIONS A supervised functional level-based exercise program was applied to the intervention group by a physiotherapist, for 40 min 5 times a week during their hospitalisation. Patients in the control group were asked to perform an unsupervised functional level-based exercise program which was described by the physiotherapist during the first visit. MAIN MEASURES Mobility, physical activity level and health-related quality of life were assessed at admission and discharge in both groups. Depression status was evaluated at admission and 3 months after discharge. RESULTS Sociodemographic features between intervention group (n = 62) and control group (n = 62) were similar. The intervention group showed a higher increment in mobility, physical activity level and quality of life scores than the control group (d = 0.62, p < 0.05; d = 0.57, p < 0.05; d = 1.12, p < 0.05 respectively). Inpatients in the intervention group, depression scores were lower 3 months after discharge (d = 0.42, p < 0.05). The length of stay in the hospital was not different between the groups. CONCLUSIONS A supervised functional level-based exercise program is more effective than an unsupervised functional level-based exercise program for mobility, physical activity, depression and quality of life in elderly inpatients. These positive contributions are seen within a short period like a 5 to 10 days stay in hospital. TRIAL REGISTRATION ClinicalTrials.gov(NCT03516032).
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Affiliation(s)
- Merve Karapınar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, 52994Suleyman Demirel University, Isparta, Turkey
| | - Nuray Kırdı
- Faculty of Physical Therapy and Rehabilitation, 37515Hacettepe University, Ankara, Turkey
| | - Tüzün Fırat
- Faculty of Physical Therapy and Rehabilitation, 37515Hacettepe University, Ankara, Turkey
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Liechti FD, Heinzmann J, Schmidt Leuenberger JM, Limacher A, Wertli MM, Verra ML. Effect of goal-directed mobilisation intervention compared with standard care on physical activity among medical inpatients: protocol for the GoMob-in randomised controlled trial. BMJ Open 2022; 12:e058509. [PMID: 35551091 PMCID: PMC9109085 DOI: 10.1136/bmjopen-2021-058509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite the fact that immobilisation is a major contributor to morbidity and mortality, patients hospitalised in general internal medicine (GIM) wards spend up to 50% of time in bed. Previous studies in selected patient populations showed increased mobility after implementation of goal-directed mobilisation (GDM). Due to the study design used so far, the degree of evidence is generally low. The effect of GDM on clinical outcomes and economically relevant indicators in patients hospitalised in GIM wards is currently unknown. This study aims to evaluate a GDM intervention compared to standard care on physical activity (de Morton Mobility Index, DEMMI) in medical inpatients. METHODS AND ANALYSIS GoMob-in is a randomised, controlled, open-label study with blinded outcome assessment. We plan to enrol 160 inpatients with indication for physiotherapy on GIM wards of a tertiary hospital in Bern, Switzerland. Adult patients newly hospitalised on GIM wards will be included in the study. The primary outcome will be the change in the DEMMI score between baseline and 5 days. Secondary outcomes are change of DEMMI (inclusion to hospital discharge), mobilisation time (inclusion to day 5, inclusion to discharge), in-hospital delirium episodes, number of in-hospital falls, length of stay, number of falls within 3 months, number of re-hospitalisations and all-cause mortality within 3 months, change in independence during activities of daily living, concerns of falling, and quality of life within 3 months and destination after 3 months. Patients in the intervention group will be attributed a regularly updated individual mobility goal level made visible for all stakeholders and get a short educational intervention on GDM. ETHICS AND DISSEMINATION This study has been approved by the responsible Ethics Board (Ethikkommission Bern/2020-02305). Written informed consent will be obtained from participants before study inclusion. Results will be published in open access policy peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04760392.
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Affiliation(s)
- Fabian D Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jeannelle Heinzmann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Maria M Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Kantonsspital Baden, Baden, Switzerland
| | - Martin L Verra
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
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Kavanagh AY, O'Brien LJ, Maloney SR, Osadnik CR. The Effectiveness of Multicomponent Functional Maintenance Initiatives for Acutely Hospitalized Older Adults: A Systematic Review and Meta-analysis. J Geriatr Phys Ther 2022; 45:50-61. [PMID: 33734158 DOI: 10.1519/jpt.0000000000000305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the effectiveness of multicomponent functional maintenance initiatives (MFMIs) on functional outcomes and adverse events associated with functional decline among acutely hospitalized older adults. DATA SOURCES Studies were sourced from OVID Medline, PubMed, Embase, CINAHL, the Cochrane Library, and PEDro databases from inception to April 15, 2020, and their bibliographies. STUDY SELECTION Randomized controlled trials were included if they investigated multicomponent interventions comprising more than one nonpharmacological intervention targeting physical functional decline and another shared risk factor for geriatric syndromes in acutely hospitalized medical or nonelective surgical patients 65 years and older. DATA EXTRACTION Two reviewers independently assessed for eligibility, extracted data, and conducted risk of bias assessments. DATA SYNTHESIS Eight studies involving 5534 patients were included. Multicomponent functional maintenance initiatives did not appear to confer significant effects on functional status, length of stay, or 30-day hospital readmissions; however, clinical heterogeneity limited meta-analysis for some specific functional outcomes. Patients who did not receive MFMIs were more likely to be discharged to a nursing staff facility (odds ratio = 1.53; 95% confidence interval, 1.23 to 1.90). No effect of MFMI on all-cause mortality was observed, and adverse events were rare and unlikely attributed to nonpharmacological interventions. CONCLUSIONS Data from a small number of studies suggest MFMIs reduce the likelihood of discharge to a nursing staff facility in acutely hospitalized older adults; however, this effect may not be driven via improvements in physical function. Standardized evaluation methods to determine MFMI effectiveness appear indicated to assist decision-making regarding their implementation in clinical practice.
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Affiliation(s)
- Alethea Y Kavanagh
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Lisa J O'Brien
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Stephen R Maloney
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Christian R Osadnik
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
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Karlsen A, Cullum CK, Norheim KL, Scheel FU, Zinglersen AH, Vahlgren J, Schjerling P, Kjaer M, Mackey AL. Neuromuscular Electrical Stimulation Preserves Leg Lean Mass in Geriatric Patients. Med Sci Sports Exerc 2020; 52:773-784. [PMID: 31688649 DOI: 10.1249/mss.0000000000002191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM This study aimed to examine changes in lean mass during hospitalization in geriatric patients and the effect of muscle activation by neuromuscular electrical stimulation. METHODS Thirteen patients (69-94 yr) at a geriatric ward completed tests at hospital admission (days 2-3) and discharge (days 8-10). One leg received daily stimulation of the knee extensors, whereas the other leg served as a control leg. Lean mass was evaluated by dual-energy x-ray absorptiometry scans and muscle thickness by ultrasound scans. Muscle biopsies were collected from both legs at admission and discharge in nine patients and analyzed for fiber size, satellite cell number, and activation and expression of genes associated with muscle protein synthesis and breakdown, connective tissue, and cellular stress. RESULTS The relative decline in leg lean mass and midthigh region lean mass was larger in the control (-2.8% ± 1.5%) versus the stimulated leg (-0.5% ± 1.4%, P < 0.05). Although there were no changes in fiber size or satellite cell number, the mRNA data revealed that, compared with control, the stimulation resulted in a downregulation of myostatin (P < 0.05) and a similar trend for MAFbx (P = 0.099), together with an upregulation of Collagen I (P < 0.001), TenascinC (P < 0.001), CD68 (P < 0.01), and Ki67 (P < 0.05) mRNA. CONCLUSION These findings demonstrate a moderate decline in leg lean mass during a hospital stay in geriatric patients, whereas leg lean mass was preserved with daily neuromuscular electrical muscle activation. At the cellular level, the stimulation had a clear influence on suppression of atrophy signaling pathways in parallel with a stimulation of connective tissue and cellular remodeling processes.
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Patients performing lower limb exercises in an orthopedic ward: a best practice implementation project. JBI Evid Implement 2020; 19:257-267. [PMID: 33038111 DOI: 10.1097/xeb.0000000000000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The evidence-based project sought to educate patients on doing lower limb exercises within 24 h of their admissions to the ward. Patients spend most of their time in bed during their hospital stays, which imposes negative outcomes due to inactivity, such as risks of reduced muscle mass and deconditioning, which may further implicate patients' conditions. METHODS The project occurred in three phases over a period of 18 months. The project was undertaken in an orthopedic ward of an acute tertiary hospital. A preimplementation and postimplementation audit strategy using the Joanna Briggs Institute's Practical Application of Clinical Evidence System was conducted on a sample of 20 adult patients. The Getting Research into Practice framework was utilized to analyze the barriers and gaps encountered in the clinical ground. RESULTS The baseline audit result revealed that only 35% of the patients received education on the exercise program and that there was poor compliance on nursing documentation of the intervention in daily note-free texts. Following the implementation, there was an improvement in nurses' documentation compliance. In follow-up audits one and two, the nurses achieved compliance rates of 60 and 90% in nursing documentation, respectively. CONCLUSION Overall, there were improvements in provision of lower limb exercise education to patients. This project has demonstrated that patients were willing to exercise during hospitalization. Nurses play a significant role in providing early education to patients to do simple exercises. The implementation of the evidence-based project may increase the awareness of the importance of exercises to minimize hospital-acquired deconditioning and functional declines among ward nurses and patients.
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Baldwin CE, Phillips AC, Edney SM, Lewis LK. Recommendations for older adults' physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study. Int J Behav Nutr Phys Act 2020; 17:69. [PMID: 32450879 PMCID: PMC7249667 DOI: 10.1186/s12966-020-00970-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/11/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Immobility is major contributor to poor outcomes for older people during hospitalisation with an acute medical illness. Yet currently there is no specific mobility guidance for this population, to facilitate sustainable changes in practice. This study aimed to generate draft physical activity (PA) and sedentary behaviour (SB) recommendations for older adults' during hospitalisation for an acute medical illness. METHODS A 4-Round online Delphi consensus survey was conducted. International researchers, medical/nursing/physiotherapy clinicians, academics from national PA/SB guideline development teams, and patients were invited to participate. Round 1 sought responses to open-ended questions. In Rounds 2-3, participants rated the importance of items using a Likert scale (1-9); consensus was defined a priori as: ≥70% of respondents rating an item as "critical" (score ≥ 7) and ≤ 15% of respondents rating an item as "not important" (score ≤ 3). Round 4 invited participants to comment on draft statements derived from responses to Rounds 1-3; Round 4 responses subsequently informed final drafting of recommendations. RESULTS Forty-nine people from nine countries were invited to each Round; response rates were 94, 90, 85 and 81% from Rounds 1-4 respectively. 43 concepts (items) from Rounds 2 and 3 were incorporated into 29 statements under themes of PA, SB, people and organisational factors in Round 4. Examples of the final draft recommendations (being the revised version of statements with highest participant endorsement under each theme) were: "some PA is better than none", "older adults should aim to minimise long periods of uninterrupted SB during waking hours while hospitalised", "when encouraging PA and minimising SB, people should be culturally responsive and mindful of older adults' physical and mental capabilities" and "opportunities for PA and minimising SB should be incorporated into the daily care of older adults with a focus on function, independence and activities of daily living". CONCLUSIONS These world-first consensus-based statements from expert and stakeholder consultation provide the starting point for recommendations to address PA and SB for older adults hospitalised with an acute medical illness. Further consultation and evidence review will enable validation of these draft recommendations with examples to improve their specificity and translation to clinical practice.
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Affiliation(s)
- Claire E Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia.
| | - Anna C Phillips
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Sarah M Edney
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia.,Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Adelaide, Australia
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Bertelsen AS, Storm A, Minet L, Ryg J. Use of robot technology in passive mobilization of acute hospitalized geriatric medicine patients: a pilot test and feasibility study. Pilot Feasibility Stud 2020; 6:1. [PMID: 31921434 PMCID: PMC6943926 DOI: 10.1186/s40814-019-0545-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/20/2019] [Indexed: 11/21/2022] Open
Abstract
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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Affiliation(s)
- A S Bertelsen
- 1Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløwsvej 4, 5000 Odense, Denmark
| | - A Storm
- 2Department of Rehabilitation, Odense University Hospital, Odense, Denmark
| | - L Minet
- 2Department of Rehabilitation, Odense University Hospital, Odense, Denmark.,3Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,4Department of Health Sciences, UCL University College, Odense, Denmark
| | - J Ryg
- 1Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløwsvej 4, 5000 Odense, Denmark.,3Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Pedersen MM, Petersen J, Beyer N, Larsen HGJ, Jensen PS, Andersen O, Bandholm T. 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. Trials 2019; 20:655. [PMID: 31779693 PMCID: PMC6883554 DOI: 10.1186/s13063-019-3720-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/13/2019] [Indexed: 01/03/2023] Open
Abstract
Background During hospitalization, older adults (+ 65 years) 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 in 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 the effect on change in mobility in older medical patients. Methods Older medical patients (≥ 65 years) 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-h 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 daily number of steps taken increased significantly more in the intervention group 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 in the effect 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 greater 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 ClinicalTrials.gov, NCT01964482. Registered on 14 October 2013. Trial protocol PubMed ID (PMID), 27039381.
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Affiliation(s)
- Mette Merete Pedersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5 Entrance B, 2nd floor, 1014, Copenhagen K, Denmark.,Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen N, Denmark
| | - Nina Beyer
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen N, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Helle Gybel-Juul Larsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Pia Søe Jensen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,The Emergency Department, Copenhagen University Hospital, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Thomas Bandholm
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Physical- and Occupational Therapy, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark
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Braun T, Grüneberg C, Süßmilch K, Wiessmeier M, Schwenk I, Eggert S, Machleit-Ebner A, Harras I, Thiel C. An augmented prescribed exercise program (APEP) to improve mobility of older acute medical patients - a randomized, controlled pilot and feasibility trial. BMC Geriatr 2019; 19:240. [PMID: 31470815 PMCID: PMC6716827 DOI: 10.1186/s12877-019-1246-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/12/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is inconclusive evidence for the effectiveness of additional exercise in older hospital patients. The aims of this study were (1) to assess the feasibility of an augmented prescribed exercise program (APEP) in older acute medical patients and (2) to measure the potential effects of APEP on mobility capacity in order to assess the feasibility of a large full-scale study. METHODS We conducted a single-center, prospective, parallel-group, single-blinded, randomized (1:1) controlled pilot and feasibility trial. Participants were recruited from acute geriatric wards of a general hospital. Key inclusion criteria were: age ≥ 65 years and walking ability. Key exclusion criteria were severe cognitive impairment and medical restriction for physical exercise interventions. Both groups received usual care, including physiotherapy. Intervention group participants were scheduled for additional exercise sessions (20-30 min, 4-5x/week). Feasibility of the trial design was assessed along pre-defined criteria for process, resources and management. Feasibility of the APEP intervention was analyzed by means of adherence, compliance and safety. Outcomes were measured at baseline and prior to hospital discharge. The primary outcome was mobility capacity (de Morton Mobility Index; DEMMI). Secondary outcomes were walking ability, physical endurance, fear of falling, frailty and length of stay. RESULTS Thirty-five participants were recruited (recruitment rate 20.3%). We lost 7 participants to follow-up (retention rate: 80%). Intervention group participants (n = 17) each participated in 5.3 ± 2.2 additional exercise sessions (mean duration: 23.2 ± 4.0 min; mean adherence rate 78% ± 26%). No severe adverse events occurred during study assessments or APEP sessions. There were no statistically significant differences in mean change scores in any outcome measure. A sample of 124 participants would be required to detect a difference of 4 DEMMI points (ES = 0.45) with a power of 80%. CONCLUSIONS This small feasibility RCT indicates that an APEP intervention may be safe and feasible in older acute medical patients. APEP may possibly induce small to moderate effects on mobility, but the clinical relevance of these effects may be limited. These results inform the planning of a larger-scale phase III study. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00011262 ). Registered 27 October 2016.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Kirsten Süßmilch
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- Evangelische Krankenhausgemeinschaft Herne/Castrop-Rauxel gGmbH, Division of Physiotherapy, Castrop-Rauxel, Germany
| | - Max Wiessmeier
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Isabel Schwenk
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Sarah Eggert
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Annika Machleit-Ebner
- Evangelische Krankenhausgemeinschaft Herne/Castrop-Rauxel gGmbH, Clinical Trials Center, Wiescherstraße 24, 44623 Herne, Germany
| | - Irene Harras
- Evangelische Krankenhausgemeinschaft Herne/Castrop-Rauxel gGmbH, Therapeutic management, Wiescherstraße 24, 44623 Herne, Germany
| | - Christian Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- Ruhr-University Bochum, Faculty of Sports Science, Training and Exercise Science, Bochum, Germany
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Vahlgren J, Karlsen A, Scheel FU, Loeb MR, Perez A, Beyer N, Kjær M, Magnusson SP. Using ultrasonography to detect loss of muscle mass in the hospitalized geriatric population. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Julie Vahlgren
- Department of Geriatrics Bispebjerg Hospital Copenhagen University Hospital Copenhagen Denmark
- Institute of Sports Medicine Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen Copenhagen Denmark
| | - Anders Karlsen
- Department of Geriatrics Bispebjerg Hospital Copenhagen University Hospital Copenhagen Denmark
- Institute of Sports Medicine Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen Copenhagen Denmark
- Department of Biomedical Sciences University of Copenhagen Copenhagen Denmark
| | - Frederik U. Scheel
- Department of Geriatrics Bispebjerg Hospital Copenhagen University Hospital Copenhagen Denmark
- Institute of Sports Medicine Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen Copenhagen Denmark
| | - Mads R. Loeb
- Department of Geriatrics Bispebjerg Hospital Copenhagen University Hospital Copenhagen Denmark
- Institute of Sports Medicine Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen Copenhagen Denmark
| | - Alberto Perez
- Department of Geriatrics Bispebjerg Hospital Copenhagen University Hospital Copenhagen Denmark
| | - Nina Beyer
- Department of Physical and Occupational Therapy Bispebjerg Hospital Copenhagen University Hospital Copenhagen Denmark
| | - Michael Kjær
- Institute of Sports Medicine Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen Copenhagen Denmark
| | - S. Peter Magnusson
- Institute of Sports Medicine Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Copenhagen University Hospital Copenhagen Denmark
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