An investigation into activity levels of older people on a rehabilitation ward: an observational study

Activity levels of inpatients admitted to two rehabilitation units in regional hospitals: An observational study

OBJECTIVE

The objective of this study is to measure the activity levels of patients admitted to adult general inpatient rehabilitation units in regional areas. These included physical, social, cognitive and self-care activities. A secondary aim was to explore differences in activity levels across different diagnostic groups.

DESIGN

An observational study using behavioural mapping. Patient activity was mapped every 15 minutes, over a 12-hour period (07:00-19:00), on two, non-consecutive days.

SETTING

2 inpatient rehabilitation units, inner regional NSW.

PARTICIPANTS

All patients were admitted for rehabilitation in an adult general rehabilitation unit. Patients presented with diverse diagnoses (eg neurological, musculoskeletal, orthopaedic, pulmonary and cardiovascular diseases). The sample had a mean age of 74.4 years with a range of 33-96 years.

MAIN OUTCOME MEASURES

The percentage of the day spent in physical, cognitive or social activities was recorded. In addition, the patients' location and interacting personnel were recorded.

RESULTS

Fifty-six participants across 8 diagnosis groups were observed. A total of 2285 observations were made. Patients were observed being active physically for 10% of their day, socially active for 23%, and cognitively for 6%. Patients engaged in other activities such as watching TV or eating 21% of their time, and completing self-care activities 7% of their time. Patients were inactive for 27% of their day. There was no statistically significant difference between the diagnostic groups and activity categories.

CONCLUSION

Patients spent a large proportion of their time inactive and alone in rehabilitation. In order to maximise outcome, rehabilitation units can look at new opportunities to maximise activity and promote engagement.

Optimization and Validation of a Classification Algorithm for Assessment of Physical Activity in Hospitalized Patients

Low amounts of physical activity (PA) and prolonged periods of sedentary activity are common in hospitalized patients. Objective PA monitoring is needed to prevent the negative effects of inactivity, but a suitable algorithm is lacking. The aim of this study is to optimize and validate a classification algorithm that discriminates between sedentary, standing, and dynamic activities, and records postural transitions in hospitalized patients under free-living conditions. Optimization and validation in comparison to video analysis were performed in orthopedic and acutely hospitalized elderly patients with an accelerometer worn on the upper leg. Data segmentation window size (WS), amount of PA threshold (PA Th) and sensor orientation threshold (SO Th) were optimized in 25 patients, validation was performed in another 25. Sensitivity, specificity, accuracy, and (absolute) percentage error were used to assess the algorithm’s performance. Optimization resulted in the best performance with parameter settings: WS 4 s, PA Th 4.3 counts per second, SO Th 0.8 g. Validation showed that all activities were classified within acceptable limits (>80% sensitivity, specificity and accuracy, ±10% error), except for the classification of standing activity. As patients need to increase their PA and interrupt sedentary behavior, the algorithm is suitable for classifying PA in hospitalized patients.

App-based supplemental exercise in rehabilitation, adherence, and effect on outcomes: a randomized controlled trial

QUESTION

To determine the uptake of an app-based supplemental exercise programme in a rehabilitation setting and the effect of such a programme on length of stay and function compared to usual care physiotherapy.

DESIGN

Randomized controlled trial with random allocation and assessor blinding.

PARTICIPANTS

A total of 144 individuals with mixed diagnoses (orthopaedic, neurological, reconditioning) admitted for inpatient sub-acute rehabilitation.

INTERVENTIONS

Participants were randomly allocated to usual care physiotherapy (control group) or usual care physiotherapy with the addition of an app-based supplemental exercise programme (intervention group).

OUTCOME MEASURES

The primary measure of interest was total supplementary exercise dosage completed by the intervention group. The primary between-group outcome measure was length of stay with secondary measures including walking endurance (Six-Minute Walk Test), walking speed (10-Metre Walk Test), functional mobility (Timed Up and Go Test) and level of disability (Functional Independence Measure).

RESULTS

Participants in the intervention group performed 7 minutes (SD: 9) or 49 repetitions (SD: 48) of supplementary exercise using the app each day. There were no differences between the groups for length of stay (mean difference (MD): -0.5 days, 95% confidence interval (CI): -3.2 to 2.2) or change in any secondary functional outcome measures, including walking speed (MD: -0.1 m/s, 95% CI: -0.2 to 0.0) and disability (MD: -0.9, 95% CI: -3.6 to 1.8).

CONCLUSION

A small supplementary exercise dose was achieved by participants in the intervention group. However, such a programme did not affect length of stay or functional outcomes when compared to usual care.

Staff knowledge, attitudes and behaviours related to mobilisation in a rehabilitation setting: Short report of a multidisciplinary survey

OBJECTIVES

Regular mobilising is important in inpatient rehabilitation, but objective measurements show low patient mobility. We sought to understand multidisciplinary staff perspectives on barriers and enablers to mobility in a rehabilitation setting.

METHODS

A validated barriers survey (standardised score 0-100, higher representing greater barriers) was distributed to 99 clinical staff on two wards at a single rehabilitation facility.

RESULTS

The survey was completed by 83 staff (52 nurses, 25 allied health professionals, 4 therapy assistants and 2 medical officers) and identified barriers in behaviour (mean 39, SD 11), attitudes (mean 34, SD 12) and knowledge (mean 23, SD 18). Prominent perceived barriers were nursing workload, unclear responsibility for mobilising, risk of staff injury, patient motivation and family participation; perceived enablers were good knowledge, positive outcome expectations and team communication.

CONCLUSIONS

These barriers can inform locally tailored strategies to improve rehabilitation patient mobility.

An observational study of physical, cognitive and social activities in rehabilitation inpatients

OBJECTIVES

To describe patient behaviour related to mobility in a rehabilitation inpatient setting and compare intensive and Transition Care Program (TCP, slow-stream rehabilitation) models.

METHODS

Prospective cross-sectional design including weekday and weekend sampling in two rehabilitation wards (one intensive and one TCP) in a publicly funded facility. A single trained observer undertook behavioural mapping, observing patient location, mobility, activity and company on all inpatients 8 am-4 pm using a structured 2-minute observation protocol. Observations were summarised and compared between wards.

RESULTS

We observed 74 inpatients on a Tuesday and 77 on a Sunday. Participants spent 7% (median) of daytime standing or walking. They spent 62%-87% in their room, 22%-40% sleeping or resting and 74%-86% alone. The only significant difference between wards was time spent off ward on Tuesday. Activity was lower on Sunday.

CONCLUSIONS

Time spent in physical, cognitive and social activities is low in inpatient rehabilitation and TCP wards.

'I will walk out of here': Qualitative analysis of older rehabilitation patients' perceptions of mobility

OBJECTIVES

To understand the motivation of older rehabilitation inpatients for mobilisation, and identify barriers and enablers to greater mobilisation.

METHODS

Qualitative semi-structured interviews were conducted with older rehabilitation inpatients. All interviews were audio-taped, transcribed verbatim and analysed using thematic and inductive techniques.

RESULTS

From 23 interviews, we found that older patients strongly value mobilisation during rehabilitation admission, to get better and maintain identity, personhood and meaningful connections. At the patient level, mobilisation was impacted by patient's confidence, family support and symptom management. At the organisational level, barriers to mobilisation included lack of timely staff support, inflexible routines, limited social opportunities, lack of physical resources, and poor communication.

CONCLUSIONS

Recognising and understanding motivators, enablers and barriers to mobilising during subacute hospitalisation of older patients is an essential step towards developing and implementing successful strategies to promote greater mobilisation. Addressing mobilisation barriers requires a multifaceted approach at the patient and organisational level.

In the hands of nurses: A focus group study of how nurses perceive and promote inpatients' needs for physical activity

Aims

To describe how nurses perceive and promote inpatients' needs for physical activity during their stay at the ward.

Design

A qualitative descriptive design was employed providing an exploration of how nurses perceive and promote inpatients' need for physical activity.

Methods

Seven semi-structured focus group discussions were held between November 2016 and February 2017 with 29 nurses in three hospitals in Sweden. Both interaction analysis and content analysis of the data were conducted.

Results

Patients are dependent on nurses' prioritizations and promotions to be sufficiently physically active during their stay at the ward. The external environment and the integration of physical activity affected the promotion of physical activity. The nurses perceived that understanding the patient's expectations was important and that promotion of physical activity was a joint responsibility of patient, relatives and healthcare professionals. The interaction analysis revealed no clear hierarchical pattern as all members in each focus group took initiative to open the discussions. The Registered Nurses contributed with more new ideas.

App-based supplemental exercise during inpatient orthopaedic rehabilitation increases activity levels: a pilot randomised control trial

Background

There is a known positive relationship between time in therapy and therapy outcomes. Effective rehabilitation should therefore include larger doses of therapy. However, individuals participating in inpatient rehabilitation have low levels of activity throughout the day. This level of inactivity may limit rehabilitation potential. New technologies which deliver personalised exercise programs and track time spent on exercises may lead to greater activity levels and therefore improve functional outcomes in rehabilitation. This pilot randomised control trial aimed to investigate whether an app-based supplemental exercise program in orthopaedic rehabilitation will be feasible and acceptable to participants, increase activity levels and improve functional outcomes.

Methods

Participants were randomised to receive supplemental exercise via an app (PTPal™) on a tablet device additional to usual care or usual care alone. Primary outcome measures were participant satisfaction with app-based supplemental exercise, total repetitions of each activity and time in supplemental exercise programs. Secondary measures were 10-m walk test (10MWT), 6-min walk test (6MWT), Timed Up and Go (TUG), Functional Independence Measure and length of stay assessed by a blinded assessor.

Results

Twenty individuals admitted into an inpatient private general rehabilitation unit for orthopaedic rehabilitation over a 4-week duration were included in this study. High acceptance of the app-based supplemental exercise program was demonstrated. Those using the app completed an additional 549 exercise repetitions during their admission (694 supplemental app-based repetitions vs 146 supplemental paper-based repetitions in the control group, mean difference [MD] 549, 95% CI 95 to 1002, p = 0.02) and an additional 157 min in supplemental exercise throughout their admission (195.3 min vs 38.7 min, MD 157 min, 95% CI 0.9–312.3 min, p = 0.05). There was insufficient power to demonstrate statistical significance in functional outcomes, but a trend towards improved functional outcomes was observed in the intervention group.

Conclusion

An app-based exercise program increases activity levels, is feasible and is a safe intervention with the potential to improve functional outcomes. This pilot study should be followed with a larger study powered to demonstrate functional effects with more participants having greater impairment.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR); trial number ACTRN12617000817347. This study was retrospectively registered (registration date 05/06/2017).

Observations of Activity Levels in a Purpose-Built, Inpatient, Rehabilitation Facility

Background:

Effective rehabilitation should include high levels of physical activity. The impact of the environmental design on activity levels has had minimal consideration.

Purpose:

This study investigates activity levels of inpatients undergoing rehabilitation in a new rehabilitation facility with innovative design and multidisciplinary care, comparing weekday and weekend activity levels, as well as changes over a 12-month period.

Method:

An observational study reporting participants’ location, people present, body position, and activity type on 2 weekdays and 1 weekend day using behavior mapping techniques. Fifteen participants were observed in a mixed rehabilitation unit with neurological, orthopedic, and other health conditions.

Results:

Results were calculated as the proportion of observations participants spent in each location, position, and performing activities (physical, cognitive, social), and time spent alone and inactive. On average, participants were engaged in activity for 86% (standard deviation [ SD] = 9) of the day, with physical activity accounting for 51% ( SD = 11), cognitive activity 28% ( SD = 10), and social activity 42% ( SD = 16). There was more physical activity (mean difference [ MD] 8% absolute, confidence interval [CI] = [4, 12], p < .01) and less social activity ( MD −6% absolute, CI [−11, −1], p = .02) on weekdays compared to weekends. Overall, participants were alone and inactive for 12% ( SD = 9) of the day. Participants observed in 2016 displayed similar results to those observed in 2015.

Conclusion:

High levels of activity were achieved in this facility that underwent environmental redesign, construction of new facilities, and implementation of evidence-based strategies.

Additional structured physical activity does not improve walking in older people (>60years) undergoing inpatient rehabilitation: a randomised trial

QUESTIONS

Among older people receiving inpatient rehabilitation, does additional supervised physical activity lead to faster self-selected gait speed at discharge? Does additional supervised physical activity lead to better mobility, function and quality of life at discharge and 6 months following discharge?

DESIGN

Multi-centre, parallel-group, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

PARTICIPANTS

Older people (age>60years) from two Australian hospitals undergoing rehabilitation to improve mobility.

INTERVENTION

Participants received multidisciplinary care, including physiotherapy. During hospital rehabilitation, the experimental group (n=99) spent additional time daily performing physical activities that emphasised upright mobility tasks; the control group (n=99) spent equal time participating in social activities.

OUTCOME MEASURES

Self-selected gait speed was the primary outcome at discharge and a secondary outcome at the 6-month follow-up. Timed Up and Go, De Morton Mobility Index, Functional Independence Measure and quality of life were secondary outcomes at discharge and tertiary outcomes at the 6-month follow-up.

RESULTS

The experimental group received a median of 20 additional minutes per day (IQR 15.0 to 22.5) of upright activities for a median of 16.5days (IQR 10.0 to 25.0). Gait speed did not differ between groups at discharge. Mean gait speed was 0.51m/s (SD 0.29) in the experimental group and 0.56m/s (SD 0.28) in the control group (effect size -0.06m/s, 95% CI -0.12 to 0.01, p=0.096). No significant differences were detected in other secondary measures.

CONCLUSION

While substantial gains in mobility were achieved by older people receiving inpatient rehabilitation, additional physical activity sessions did not lead to better walking outcomes at discharge or 6 months.

TRIAL REGISTRATION

ACTRN12613000884707. [Said CM, Morris ME, McGinley JL, Szoeke C, Workman B, Liew D, Hill KD, Woodward M, Wittwer JE, Churilov L, Danoudis M, Bernhardt J (2018) Additional structured physical activity does not improve walking in older people (> 60 years) undergoing inpatient rehabilitation: a randomised trial. Journal of Physiotherapy 64: 237-244].

Acceptability of physical activity monitoring in older adults undergoing inpatient rehabilitation

BACKGROUND

There is little research into interventions to increase activity levels of hospitalised older adults.

AIMS

To assess the feasibility of using a physical activity monitor (PAL2) in hospitalized older adults and the effect of group exercise on activity levels.

METHODS

Participants were hospitalized, ambulant adults ≥ 65 years randomized to individual physical therapy alone or combined with a high intensity exercise group and wore the PAL2 for five consecutive days.

RESULTS

Only 33% of eligible participants agreed to participate with 19/30 (63%) complete data sets obtained; physical activity levels were low regardless of intervention.

CONCLUSION

Acceptability of physical activity monitoring in hospitalized older adults was low and physical activity levels of those monitored was low across groups. To improve monitor compliance, future studies may consider excluding patients with specific comorbidities that impact on wear time, or selection of an alternative monitor.

Promoting Activity in Geriatric Rehabilitation: A Randomized Controlled Trial of Accelerometry

Background

Low activity levels in inpatient rehabilitation are associated with adverse outcomes. The study aimed to test whether activity levels can be increased by the provision of monitored activity data to patients and clinicians in the context of explicit goal setting.

Methods

A randomized controlled trial in three sites in Australia included 255 inpatients aged 60 and older who had a rehabilitation goal to become ambulant. The primary outcome was patients’ walking time measured by accelerometers during the rehabilitation admission. Walking times from accelerometry were made available daily to treating therapists and intervention participants to motivate patients to improve incidental activity levels and reach set goals. For the control group, ‘usual care’ was followed, including the setting of mobility goals; however, for this group, neither staff nor patients received data on walking times to aid the setting of daily walking time targets.

Results

The median daily walking time in the intervention group increased from 10.3 minutes at baseline to 32.1 minutes at day 28, compared with an increase from 9.5 to 26.5 minutes per day in the control group. Subjects in the intervention group had significantly higher non-therapy walking time by about 7 minutes [mean (95% CI): 24.6 (21.7, 27.4)] compared to those in the control group [mean(95% CI): 17.3 (14.4, 20.3)] (p = 0.001).

Conclusions

Daily feedback to patients and therapists using an accelerometer increased walking times during rehabilitation admissions. The results of this study suggest objective monitoring of activity levels could provide clinicians with information on clinically important, mobility-related activities to assist goal setting.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12611000034932 http://www.ANZCTR.org.au/

Implementing an inpatient rehabilitation Saturday service is associated with improved patient outcomes and facilitates patient flow across the health care continuum

PURPOSE

To evaluate the effectiveness of the introduction of a Saturday inpatient rehabilitation service in improving patient outcomes and facilitating hospital access and flow.

METHODS

A quasi-experimental study with a historical comparison group is presented. Data were evaluated for the 477 patients admitted and discharged in the 6 months following the implementation (October 2012-March 2013) of the service and 499 patients in the historical control group (April 2012-September 2012).

RESULTS

Prior to the introduction of the service median number of patients admitted on a Saturday was 0 (range 0-3), post-implementation the median number of patients admitted on a Saturday increased to 2 (range 0-5), this difference was statistically significant (Z = -3.61, p < 0.001). Median regression modelling demonstrated that, after adjusting for admission Functional Independence (FIM) score, gender, length of stay (LOS) and age, there was a small but significant increase in discharge FIM scores (median increase 2.28, p = 0.027) for those patients admitted in the post-implementation phase. There was no such effect of the service on LOS.

CONCLUSIONS

The implementation of the Saturday inpatient rehabilitation service was associated with improved patient outcomes and supported an increase in patient flow throughout the organization as evidenced by an increased number of Saturday patient admissions.

IMPLICATIONS FOR REHABILITATION

Inpatient rehabilitation services do not operate in isolation; they are a critical link in the healthcare continuum. There is a mounting body of evidence that the introduction of weekend rehabilitation services has a positive impact on patient outcomes. To maximize health outcomes, access to critical services and patient flow, organizations and staff need to move away from the long-standing 5-day/week inpatient rehabilitation model and start transitioning to a model that incorporates weekend therapy services.

Patients receiving inpatient rehabilitation for lower limb orthopaedic conditions do much less physical activity than recommended in guidelines for healthy older adults: an observational study

QUESTION

Are ambulant patients who are admitted for inpatient rehabilitation for a lower limb orthopaedic condition active enough to meet current physical activity guidelines?

DESIGN

Prospective observational study.

PARTICIPANTS

Adults admitted for inpatient rehabilitation for a lower limb orthopaedic condition who were cognitively alert and able to walk independently or with assistance.

OUTCOME MEASURES

Participants wore an activity monitor for three full days. Daily time spent in moderate intensity physical activity was used to determine whether the levels of physical activity recommended in clinical guidelines were achieved.

RESULTS

Fifty-four participants with a mean age of 74 years (SD 11) took a median of 398 (IQR 140 to 993) steps per day and spent a median of 8 (IQR 3 to 16) minutes walking per day. No participant completed a 10-minute bout of moderate intensity physical activity during the monitoring period. One participant accumulated 30 minutes of moderate intensity physical activity and nine participants accumulated 15 minutes of moderate intensity physical activity in a day. Physical activity was associated with shorter length of stay (r=-0.43) and higher functional status on discharge (r=0.39).

CONCLUSIONS

Adults with lower limb orthopaedic conditions in inpatient rehabilitation are relatively inactive and do not meet current physical activity guidelines for older adults. Results of this study indicate that strategies to increase physical activity are required.

Additional Saturday allied health services increase habitual physical activity among patients receiving inpatient rehabilitation for lower limb orthopedic conditions: a randomized controlled trial

OBJECTIVE

To determine whether adults with lower limb orthopedic conditions who received additional weekend physical therapy (PT) and occupational therapy (OT) demonstrated increased habitual physical activity.

DESIGN

Randomized controlled trial.

SETTING

Inpatient rehabilitation center.

PARTICIPANTS

Adults (N=105, 72 women; mean age ± SD, 74±12y) admitted with a lower limb orthopedic condition, cognitively alert and able to walk.

INTERVENTION

The control group received PT and OT Monday to Friday; in addition, the experimental group also received a full Saturday PT and OT service. Participants wore an activity monitor for 7 days.

MAIN OUTCOME MEASURES

Daily steps and daily upright time (hours).

RESULTS

Overall, participants took a mean of 589±640 steps per day and spent a mean of 1.2±0.9 hours upright per day. Experimental group participants took more than twice as many steps (mean difference, 428 steps; 95% confidence interval [CI], 184-673) and spent 50%±20% more time upright (mean difference, 0.5h; 95% CI, 0.1-0.9) than control group participants on Saturdays. In the days after additional therapy, experimental group participants took 63%±28% more steps (mean difference, 283 steps; 95% CI, 34-532) and spent 40%±17% more time upright (mean difference, 0.4h; 95% CI, 0.1-0.8) per day than participants in the control group.

CONCLUSIONS

Providing additional rehabilitation services on the weekend increased habitual activity, but patients with lower limb orthopedic conditions admitted to rehabilitation remained relatively inactive even with additional therapy.

Review of accelerometry for determining daily activity among elderly patients

OBJECTIVES

To review studies that used accelerometers to classify human movements and to appraise their potential to determine the activities of older patients in hospital settings.

DATA SOURCES

MEDLINE, CINAHL, and Web of Science electronic databases. A search constraint of articles published in English language between January 1980 and March 2010 was applied.

STUDY SELECTION

All studies that validated the use of accelerometers to classify human postural movements and mobility were included. Studies included participants from any age group. All types of accelerometers were included. Outcome measures criteria explored within the studies were comparisons of derived classifications of postural movements and mobility against those made by using observations. Based on these criteria, 54 studies were selected for detailed review from 526 initially identified studies.

DATA EXTRACTION

Data were extracted by the first author and included characteristics of study participants, accelerometers used, body positions of device attachment, study setting, duration, methods, results, and limitations of the validation studies.

DATA SYNTHESIS

The accelerometer-based monitoring technique was investigated predominantly on a small sample of healthy adult participants in a laboratory setting. Most studies applied multiple accelerometers on the sternum, wrists, thighs, and shanks of participants. Most studies collected validation data while participants performed a predefined standardized activity protocol.

CONCLUSIONS

Accelerometer devices have the potential to monitor human movements continuously to determine postural movements and mobility for the assessment of functional ability. Future studies should focus on long-term monitoring of free daily activity of a large sample of mobility-impaired or older hospitalized patients, who are at risk for functional decline. Use of a single waist-mounted triaxial accelerometer would be the most practical and useful option.

Effect of accelerometry on the functional mobility of older rehabilitation inpatients as measured by functional independence measure--locomotion (FIM) gain: a retrospective matched cohort study

OBJECTIVES

To examine the effect of wearing an accelerometer (without provision of feedback) on the mobility of older rehabilitation inpatients, using the locomotion component of the FIM at admission and discharge.

DESIGN

A retrospective matched cohort study of patients aged >60 years admitted to a rehabilitation unit between 1 January 2008 and 1 January 2009.

PARTICIPANTS

The exposed group was 17 patients who had worn an accelerometer daily during their rehabilitation stay. These patients were matched with 17 controls (the unexposed group) identified from the unit database using the following variables: age (within 5 years), sex, admission Functional Independence Measure (locomotion) score and reason for admission to rehabilitation.

DATA ANALYSIS

The median length of stay, median FIM (locomotion) gain and median FIM (locomotion) efficiency for the two groups were compared using the Wilcoxon Signed Ranks Test.

RESULTS

There were no statistically significant differences between the two groups at baseline. There was a trend towards a greater FIM-locomotion gain in the accelerometer group (mean 2.88+/- 2.12, median 3.00) compared with the no-accelerometer group (mean 2.53+/- 2.07, median 3.00), but this did not reach statistical significance (p=0.08). There was no significant difference in the FIM -locomotion efficiency for the accelerometer group (mean 0.08 +/- 0.07, median 0.05) compared with the no accelerometer group(mean 0.01 +/- 0.09, median 0.06) (p= 0.33).

CONCLUSION

In the absence of feedback and goal setting, wearing a monitoring device does not significantly increase physical activity.

Promoting walking amongst older patients in rehabilitation: are accelerometers the answer?

The role of physical activity amongst older people in inpatient rehabilitation settings has been little studied. Walking has a number of potential benefits for older people in rehabilitation but it is not known whether increased walking improves outcomes in this population. Until now mobility monitoring has not been possible in routine practice. Recently tri-axial accelerometers have been validated for ambulatory activity monitoring in older adults. Accelerometry has the potential to explore the role of walking in older patients in rehabilitation. Providing data regarding activity levels may improve patient motivation and assist clinicians with activity prescription. Future research could determine the relationship between activity levels and patient outcomes.

Analyzing Free-Living Physical Activity of Older Adults in Different Environments Using Body-Worn Activity Monitors

This study measured objectively the postural physical activity of 4 groups of older adults (≥65 yr). The participants (N= 70) comprised 3 patient groups—2 from rehabilitation wards (cityn= 20, 81.8 ± 6.7 yr; ruraln= 10, 79.4 ± 4.7 yr) and the third from a city day hospital (n= 20, 74.7 ± 7.9 yr)—and a healthy group to provide context (n= 20, 73.7 ± 5.5 yr). The participants wore an activity monitor (activPAL) for a week. A restricted maximum-likelihood-estimation analysis of hourly upright time (standing and walking) revealed significant differences between day, hour, and location and the interaction between location and hour (p< .001). Differences in the manner in which groups accumulated upright and sedentary time (sitting and lying) were found, with the ward-based groups sedentary for prolonged periods and upright for short episodes. This information may be used by clinicians to design appropriate rehabilitation interventions and monitor patient progress.