1
|
Arens CH, Johnsen NM, Milanesi M, Weli A, Linnebjerg C, Christensen H, Kristensen MT. Inter-tester reliability and agreement of the Cumulated Ambulation Score in acute stroke: The InTRO-CAS-stroke study. J Stroke Cerebrovasc Dis 2024; 33:107630. [PMID: 38325673 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/23/2024] [Accepted: 02/04/2024] [Indexed: 02/09/2024] Open
Abstract
TITLE Inter-Tester Reliability and Agreement of the Cumulated Ambulation Score in Stroke patients: The InTRO-CAS-stroke study OBJECTIVE: To examine the inter-tester reliability of the total Cumulated Ambulation Score (CAS) and the three activities of the CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with stroke. METHODS An intertester reliability study. SETTING Participants: 60 participants from a specialized stroke unit with a mean age of 69.10 ± 13.23 years. The CAS describes a patient's independency in three activities - (1) getting in and out of bed, (2) sit to stand from a chair, and (3) walking ability and was assessed by two independent physiotherapists at median day 3 poststroke. Each activity was assessed on a three-point ordinal scale from 0 (not able to) to 2 (independent). The cumulated score for each activity provides a total CAS from 0 to 6, with 6 indicating independent basic mobility. Relative and absolute reliability was evaluated using weighted kappa, the standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS The weighted kappa for the total CAS score was 0.816 and ranged from 0.733 to 0.904 for the 3 CAS activities. The SEM and the MDC of the total CAS was 0.37 and 1.03 respectively. CONCLUSIONS The intertester reliability of the CAS is almost perfect, and a change of 1 CAS point for the total CAS indicates a real change in basic mobility, at group level and for an individual patient with stroke CLINICALTRIALS. GOV IDENTIFIER NCT05601089.
Collapse
Affiliation(s)
- Christian Hedelund Arens
- Department of Physio- and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Nicole Milwertz Johnsen
- Department of Physio- and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Manuela Milanesi
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Sigurdsgade 26, DK-2200 Copenhagen N, Denmark
| | - Ali Weli
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Sigurdsgade 26, DK-2200 Copenhagen N, Denmark
| | - Connie Linnebjerg
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Sigurdsgade 26, DK-2200 Copenhagen N, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Department of Physio- and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| |
Collapse
|
2
|
D'Souza AN, Granger CL, Leggett NE, Tomkins MS, Kay JE, Said CM. Predicting Discharge Destination in Older People From Acute General Medical Wards: A Systematic Review of the Psychometric Properties of 23 Assessment Tools. J Geriatr Phys Ther 2024; 47:E109-E123. [PMID: 38194629 DOI: 10.1519/jpt.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Predicting discharge in older people from general medicine wards is challenging. It requires consideration of function, mobility, and cognitive levels, which vary within the cohort and may fluctuate over a short period. A previous systematic review identified 23 assessment tools associated with discharge destination in this cohort; however, the psychometric properties of these tools have not been explored. PURPOSE To evaluate, synthesize, and compare the psychometric properties of 23 assessment tools used to predict discharge destination from acute general medical wards. METHODS Four databases were systematically searched: Medline (Ovid), Embase (Ovid), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Evidence-Based Medicine Review databases. Studies were included if participants were from general medicine or acute geriatric wards and investigated at least one psychometric property (reliability, internal consistency, measurement error, responsiveness, hypothesis testing, and structural or criterion validity) in 23 previously identified assessment tools. Data were extracted and methodological quality were assessed independently by 2 assessors using the COnsensus-based Standards for selection of health Measure INstruments (COSMIN) checklist. As per the COSMIN checklist, results were rated against "sufficient," "insufficient," or "indeterminate." RESULTS Forty-one studies were included. The de Morton Mobility Index (DEMMI) was the most rigorously evaluated assessment tool; it scored "sufficient" psychometric properties in 5 of 7 psychometric categories. The Alpha Functional Independence Measure (AlphaFIM), Barthel Index, and Mini-Mental State Examination (MMSE) demonstrated "sufficient" psychometric properties in at least 3 psychometric categories. The remainder of the tools (n = 19, 83%) had "sufficient" psychometric properties in 2 or fewer psychometric categories. DISCUSSION AND CONCLUSION Based on current evidence, out of 23 assessment tools associated with discharge destination in acute general medicine, the DEMMI has the strongest psychometric properties. Other tools with substantial evidence in this cohort include the AlphaFIM, MMSE, and Barthel Index. Research is required to thoroughly evaluate the psychometric properties of the remaining tools, which have been insufficiently researched to date. Results can be used by physical therapists to guide selection of appropriate tools to assess mobility and predict discharge destination. TRIAL REGISTRATION A priori, PROSPERO (CRD 42017064209).
Collapse
Affiliation(s)
- Aruska N D'Souza
- Department of Physiotherapy, University of Melbourne, Carlton, Victoria, Australia
- Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Catherine L Granger
- Department of Physiotherapy, University of Melbourne, Carlton, Victoria, Australia
- Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nina E Leggett
- Department of Physiotherapy, Sunshine Hospital, Western Health, St Albans, Victoria, Australia
| | - Melanie S Tomkins
- Department of Physiotherapy, Sunshine Hospital, Western Health, St Albans, Victoria, Australia
| | - Jacqueline E Kay
- Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Catherine M Said
- Department of Physiotherapy, University of Melbourne, Carlton, Victoria, Australia
- Department of Physiotherapy, Sunshine Hospital, Western Health, St Albans, Victoria, Australia
- Australian Institute of Musculoskeletal Science, St Albans, Victoria, Australia
| |
Collapse
|
3
|
Feldbusch H, Schmidt M, Steeb EM, Paschek N, Nemesch M, Sartory Y, Brenner R, Nöst S. Theoretical concepts and instruments for measuring hospital discharge readiness: A scoping review. Heliyon 2024; 10:e26554. [PMID: 38439820 PMCID: PMC10909674 DOI: 10.1016/j.heliyon.2024.e26554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
Background The Discharge Readiness of adult patients in a hospital setting is a multidimensional concept which is becoming increasingly important internationally as part of discharge planning. To date, there has been a lack of reviews of existing measurement instruments as well as theoretical concepts of discharge readiness. Objective To provide an overview of existing measurement instruments and theoretical concepts regarding readiness for hospital discharge in adult patients. Design and methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodological manual and PRISMA ScR reporting principles. A literature search was conducted using the CINAHL and LIVIVO databases (including MEDLINE and PSYINDEX) in October 2021. After test screening, all identified articles were screened by two independent reviewers using predefined inclusion and exclusion criteria before the content was extracted and mapped. Results Of the 1823 records identified, 107 were included in this review. Of these, 30 studies were included as development or validation studies of measurement instruments assessing discharge readiness, 68 were included as empirical studies with readiness for hospital discharge as the primary outcome or key concept, and nine publications were included as theoretical papers or reviews. Five dimensions of readiness for hospital discharge were extracted:1) Physical, 2) Psychological, 3) Education and Knowledge, 4) Adequate Individual Support, and 5) Social and Organisational Determinants. Of the 47 instruments identified for measuring discharge readiness, 33 were validated. The Readiness for Hospital Discharge Scale (RHDS) was the most frequently used instrument. Conclusions The systematic measurement of readiness for hospital discharge, particularly from the patient's perspective combined with the nurse's perspective, might be useful in reducing negative outcomes such as readmissions. This review provides an overview of existing and validated instruments for the systematic assessment of discharge readiness in acute inpatient care, as well as an overview of the theoretical concepts of readiness for hospital discharge. Further research is needed on the relationship between organisational determinants and readiness for discharge.
Collapse
Affiliation(s)
- Hanna Feldbusch
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
- Robert Bosch Hospital, Stuttgart, Germany
| | - Marita Schmidt
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
| | | | | | | | | | | | - Stefan Nöst
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
| |
Collapse
|
4
|
Bargiotas I, Wang D, Mantilla J, Quijoux F, Moreau A, Vidal C, Barrois R, Nicolai A, Audiffren J, Labourdette C, Bertin-Hugaul F, Oudre L, Buffat S, Yelnik A, Ricard D, Vayatis N, Vidal PP. Preventing falls: the use of machine learning for the prediction of future falls in individuals without history of fall. J Neurol 2023; 270:618-631. [PMID: 35817988 PMCID: PMC9886639 DOI: 10.1007/s00415-022-11251-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/03/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
Nowadays, it becomes of paramount societal importance to support many frail-prone groups in our society (elderly, patients with neurodegenerative diseases, etc.) to remain socially and physically active, maintain their quality of life, and avoid their loss of autonomy. Once older people enter the prefrail stage, they are already likely to experience falls whose consequences may accelerate the deterioration of their quality of life (injuries, fear of falling, reduction of physical activity). In that context, detecting frailty and high risk of fall at an early stage is the first line of defense against the detrimental consequences of fall. The second line of defense would be to develop original protocols to detect future fallers before any fall occur. This paper briefly summarizes the current advancements and perspectives that may arise from the combination of affordable and easy-to-use non-wearable systems (force platforms, 3D tracking motion systems), wearable systems (accelerometers, gyroscopes, inertial measurement units-IMUs) with appropriate machine learning analytics, as well as the efforts to address these challenges.
Collapse
Affiliation(s)
- Ioannis Bargiotas
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France. .,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.
| | - Danping Wang
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Juan Mantilla
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Flavien Quijoux
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,ORPEA Group, Puteaux, France
| | - Albane Moreau
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Catherine Vidal
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,Service of Otorhinolaryngology (ENT), AP-HP, Hôpital Universitaire Pitié Salpêtrière, Paris, 75013, France
| | - Remi Barrois
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Alice Nicolai
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Julien Audiffren
- Department of Neuroscience, University of Fribourg, Fribourg, Switzerland
| | - Christophe Labourdette
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | | | - Laurent Oudre
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Stephane Buffat
- Laboratoire d'accidentologie de biomécanique et du comportement des conducteurs, GIE Psa Renault Groupes, Nanterre, France
| | - Alain Yelnik
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,Service of Physical and Rehabilitation Medicine (PRM), AP- HP, GH St Louis, Lariboisière, F. Widal, Paris, 75010, France
| | - Damien Ricard
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,Service of Neurology, AP-HP, Hôpital d'Instruction des Armées de Percy, Service de Santé des Armées, Clamart, 92140, France.,École d'application du Val-de-Grâce, Service de Santé des Armée, Paris, France
| | - Nicolas Vayatis
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Pierre-Paul Vidal
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,Institute of Information and Control, Hangzhou Dianzi University, Zhejiang, China
| |
Collapse
|
5
|
Fairhall NJ, Dyer SM, Mak JC, Diong J, Kwok WS, Sherrington C. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2022; 9:CD001704. [PMID: 36070134 PMCID: PMC9451000 DOI: 10.1002/14651858.cd001704.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Improving mobility outcomes after hip fracture is key to recovery. Possible strategies include gait training, exercise and muscle stimulation. This is an update of a Cochrane Review last published in 2011. OBJECTIVES To evaluate the effects (benefits and harms) of interventions aimed at improving mobility and physical functioning after hip fracture surgery in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, trial registers and reference lists, to March 2021. SELECTION CRITERIA All randomised or quasi-randomised trials assessing mobility strategies after hip fracture surgery. Eligible strategies aimed to improve mobility and included care programmes, exercise (gait, balance and functional training, resistance/strength training, endurance, flexibility, three-dimensional (3D) exercise and general physical activity) or muscle stimulation. Intervention was compared with usual care (in-hospital) or with usual care, no intervention, sham exercise or social visit (post-hospital). DATA COLLECTION AND ANALYSIS Members of the review author team independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We used the assessment time point closest to four months for in-hospital studies, and the time point closest to the end of the intervention for post-hospital studies. Critical outcomes were mobility, walking speed, functioning, health-related quality of life, mortality, adverse effects and return to living at pre-fracture residence. MAIN RESULTS We included 40 randomised controlled trials (RCTs) with 4059 participants from 17 countries. On average, participants were 80 years old and 80% were women. The median number of study participants was 81 and all trials had unclear or high risk of bias for one or more domains. Most trials excluded people with cognitive impairment (70%), immobility and/or medical conditions affecting mobility (72%). In-hospital setting, mobility strategy versus control Eighteen trials (1433 participants) compared mobility strategies with control (usual care) in hospitals. Overall, such strategies may lead to a moderate, clinically-meaningful increase in mobility (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.10 to 0.96; 7 studies, 507 participants; low-certainty evidence) and a small, clinically meaningful improvement in walking speed (CI crosses zero so does not rule out a lack of effect (SMD 0.16, 95% CI -0.05 to 0.37; 6 studies, 360 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to short-term (risk ratio (RR) 1.06, 95% CI 0.48 to 2.30; 6 studies, 489 participants; low-certainty evidence) or long-term mortality (RR 1.22, 95% CI 0.48 to 3.12; 2 studies, 133 participants; low-certainty evidence), adverse events measured by hospital re-admission (RR 0.70, 95% CI 0.44 to 1.11; 4 studies, 322 participants; low-certainty evidence), or return to pre-fracture residence (RR 1.07, 95% CI 0.73 to 1.56; 2 studies, 240 participants; low-certainty evidence). We are uncertain whether mobility strategies improve functioning or health-related quality of life as the certainty of evidence was very low. Gait, balance and functional training probably causes a moderate improvement in mobility (SMD 0.57, 95% CI 0.07 to 1.06; 6 studies, 463 participants; moderate-certainty evidence). There was little or no difference in effects on mobility for resistance training. No studies of other types of exercise or electrical stimulation reported mobility outcomes. Post-hospital setting, mobility strategy versus control Twenty-two trials (2626 participants) compared mobility strategies with control (usual care, no intervention, sham exercise or social visit) in the post-hospital setting. Mobility strategies lead to a small, clinically meaningful increase in mobility (SMD 0.32, 95% CI 0.11 to 0.54; 7 studies, 761 participants; high-certainty evidence) and a small, clinically meaningful improvement in walking speed compared to control (SMD 0.16, 95% CI 0.04 to 0.29; 14 studies, 1067 participants; high-certainty evidence). Mobility strategies lead to a small, non-clinically meaningful increase in functioning (SMD 0.23, 95% CI 0.10 to 0.36; 9 studies, 936 participants; high-certainty evidence), and probably lead to a slight increase in quality of life that may not be clinically meaningful (SMD 0.14, 95% CI -0.00 to 0.29; 10 studies, 785 participants; moderate-certainty evidence). Mobility strategies probably make little or no difference to short-term mortality (RR 1.01, 95% CI 0.49 to 2.06; 8 studies, 737 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to long-term mortality (RR 0.73, 95% CI 0.39 to 1.37; 4 studies, 588 participants; low-certainty evidence) or adverse events measured by hospital re-admission (95% CI includes a large reduction and large increase, RR 0.86, 95% CI 0.52 to 1.42; 2 studies, 206 participants; low-certainty evidence). Training involving gait, balance and functional exercise leads to a small, clinically meaningful increase in mobility (SMD 0.20, 95% CI 0.05 to 0.36; 5 studies, 621 participants; high-certainty evidence), while training classified as being primarily resistance or strength exercise may lead to a clinically meaningful increase in mobility measured using distance walked in six minutes (mean difference (MD) 55.65, 95% CI 28.58 to 82.72; 3 studies, 198 participants; low-certainty evidence). Training involving multiple intervention components probably leads to a substantial, clinically meaningful increase in mobility (SMD 0.94, 95% CI 0.53 to 1.34; 2 studies, 104 participants; moderate-certainty evidence). We are uncertain of the effect of aerobic training on mobility (very low-certainty evidence). No studies of other types of exercise or electrical stimulation reported mobility outcomes. AUTHORS' CONCLUSIONS Interventions targeting improvement in mobility after hip fracture may cause clinically meaningful improvement in mobility and walking speed in hospital and post-hospital settings, compared with conventional care. Interventions that include training of gait, balance and functional tasks are particularly effective. There was little or no between-group difference in the number of adverse events reported. Future trials should include long-term follow-up and economic outcomes, determine the relative impact of different types of exercise and establish effectiveness in emerging economies.
Collapse
Affiliation(s)
- Nicola J Fairhall
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Jenson Cs Mak
- Healthy Ageing, Mind & Body Institute, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wing S Kwok
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
6
|
van Dijk-Huisman HC, Welters MHP, Bijnens W, van Kuijk SMJ, Magdelijns FJH, de Bie RA, Lenssen AF. Development and internal validation of a prediction model to identify older adults at risk of low physical activity levels during hospitalisation: a prospective cohort study. BMC Geriatr 2022; 22:479. [PMID: 35659569 PMCID: PMC9164480 DOI: 10.1186/s12877-022-03146-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Inactive behaviour is common in older adults during hospitalisation and associated with poor health outcomes. If patients at high risk of spending little time standing/walking could be identified early after admission, they could be given interventions aimed at increasing their time spent standing/walking. This study aims to identify older adults at high risk of low physical activity (PA) levels during hospitalisation. Methods Prospective cohort study of 165 older adults (≥ 70 years) admitted to the department of Internal Medicine of Maastricht University Medical Centre for acute medical illness. Two prediction models were developed to predict the probability of low PA levels during hospitalisation. Time spent standing/walking per day was measured with an accelerometer until discharge (≤ 12 days). The average time standing/walking per day between inclusion and discharge was dichotomized into low/high PA levels by dividing the cohort at the median (50.0%) in model 1, and lowest tertile (33.3%) in model 2. Potential predictors—Short Physical Performance Battery (SPPB), Activity Measure for Post-Acute Care (AM-PAC), age, sex, walking aid use, and disabilities in activities of daily living—were selected based on literature and analysed using logistic regression analysis. Models were internally validated using bootstrapping. Model performance was quantified using measures of discrimination (area under the receiver operating characteristic curve (AUC)) and calibration (Hosmer and Lemeshow (H–L) goodness-of-fit test and calibration plots). Results Model 1 predicts a probability of spending ≤ 64.4 min standing/walking and holds the predictors SPPB, AM-PAC and sex. Model 2 predicts a probability of spending ≤ 47.2 min standing/walking and holds the predictors SPPB, AM-PAC, age and walking aid use. AUCs of models 1 and 2 were .80 (95% confidence interval (CI) = .73—.87) and .86 (95%CI = .79—.92), respectively, indicating good discriminative ability. Both models demonstrate near perfect calibration of the predicted probabilities and good overall performance, with model 2 performing slightly better. Conclusions The developed and internally validated prediction models may enable clinicians to identify older adults at high risk of low PA levels during hospitalisation. External validation and determining the clinical impact are needed before applying the models in clinical practise. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03146-9.
Collapse
|
7
|
van Dijk - Huisman HC, Raeven-Eijkenboom PH, Magdelijns FJH, Sieben JM, de Bie RA, Lenssen AF. Barriers and enablers to physical activity behaviour in older adults during hospital stay: a qualitative study guided by the theoretical domains framework. BMC Geriatr 2022; 22:314. [PMID: 35399054 PMCID: PMC8994876 DOI: 10.1186/s12877-022-02887-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Older adults admitted with an acute medical illness spent little time active during hospitalisation and this has been associated with negative health outcomes. Understanding which barriers and enablers influence the physical activity behaviour of hospitalised older adults is a first step towards identifying potentially modifiable factors and developing, evaluating and implementing targeted interventions aimed at increasing their physical activity behaviour. Using a theoretical framework has been found to be more successful in changing behaviour than using a non-theory driven approach. This study aimed to explore barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness, as perceived by patients and healthcare professionals, and to categorise them using the Theoretical Domains Framework (TDF).
Methods
A qualitative study was conducted at a combined university and regional hospital in the Netherlands between January 2019 and February 2020. Older adults (≥70 years) admitted with an acute medical illness, and healthcare professionals (nurses, physicians, physiotherapists) were recruited using purposive sampling. Semi-structured interviews were audiotaped, transcribed and analysed using directed qualitative content analysis. Barriers and enablers to physical activity behaviour during hospitalisation were identified and coded using the TDF.
Results
Meaning saturation was determined after interviews with 12 patients and 16 healthcare professionals. A large number of barriers and enablers were identified and each categorised to 11 of the 14 domains of the TDF. The ‘Environmental Context and Resources’ domain in particular yielded many examples, and revealed that the hospital environment exerts an inactivating influence on patients.
Conclusions
The large number of identified barriers and enablers highlights the complexity of influencing older adults’ physical activity behaviour during hospitalisation. This overview of barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness represents an initial step towards developing, evaluating and implementing theory-informed behaviour change interventions to improve hospitalised older adults’ physical activity levels. It can assist clinicians and researchers in selecting modifiable factors that can be targeted in future interventions.
Collapse
|
8
|
Boerrigter JL, Geelen SJG, van Berge Henegouwen MI, Bemelman WA, van Dieren S, de Man-van Ginkel JM, van der Schaaf M, Eskes AM, Besselink MG. Extended mobility scale (AMEXO) for assessing mobilization and setting goals after gastrointestinal and oncological surgery: a before-after study. BMC Surg 2022; 22:38. [PMID: 35109840 PMCID: PMC8812167 DOI: 10.1186/s12893-021-01445-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/10/2021] [Indexed: 01/31/2023] Open
Abstract
Background Early structured mobilization has become a key element of Enhanced Recovery After Surgery programs to improve patient outcomes and decrease length of hospital stay. With the intention to assess and improve early mobilization levels, the 8-point ordinal John Hopkins Highest Level of Mobility (JH-HLM) scale was implemented at two gastrointestinal and oncological surgery wards in the Netherlands. After the implementation, however, healthcare professionals perceived a ceiling effect in assessing mobilization after gastrointestinal and oncological surgery. This study aimed to quantify this perceived ceiling effect, and aimed to determine if extending the JH-HLM scale with four additional response categories into the AMsterdam UMC EXtension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale reduced this ceiling effect. Methods All patients who underwent gastrointestinal and oncological surgery and had a mobility score on the first postoperative day before (July–December 2018) or after (July–December 2019) extending the JH-HLM into the AMEXO scale were included. The primary outcome was the before-after difference in the percentage of ceiling effects on the first three postoperative days. Furthermore, the before-after changes and distributions in mobility scores were evaluated. Univariable and multivariable logistic regression analysis were used to assess these differences. Results Overall, 373 patients were included (JH-HLM n = 135; AMEXO n = 238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score before extending the JH-HLM into the AMEXO as compared to 4 (1.7%) patients after (OR = 0.021, CI = 0.007–0.059, p < 0.001). During the first three postoperative days, 118 (87.4%) patients scored the highest possible mobility score before compared to 40 (16.8%) patients after (OR = 0.028, CI = 0.013–0.060, p < 0.001). A change in mobility was observed in 88 (65.2%) patients before as compared to 225 (94.5%) patients after (OR = 9.101, CI = 4.046–20.476, p < 0.001). Of these 225 patients, the four additional response categories were used in 165 (73.3%) patients. Conclusions A substantial ceiling effect was present in assessing early mobilization in patients after gastrointestinal and oncological surgery using the JH-HLM. Extending the JH-HLM into the AMEXO scale decreased the ceiling effect significantly, making the tool more appropriate to assess early mobilization and set daily mobilization goals after gastrointestinal and oncological surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01445-3.
Collapse
Affiliation(s)
- José L Boerrigter
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Nursing Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Janneke M de Man-van Ginkel
- Nursing Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Anne M Eskes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
9
|
Morgan A, Bégin D, Heisz J, Tang A, Thabane L, Richardson J. Measurement properties of remotely or self-administered physical performance measures to assess mobility: a systematic review protocol. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1978779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ashley Morgan
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Diane Bégin
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Heisz
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
10
|
Moulton E, Wilson R, Silva AR, Kircher C, Petry S, Goldie C, Medves J, Deluzio K, Ross-White A. Measures of movement and mobility used in clinical practice and research: a scoping review. JBI Evid Synth 2021; 19:341-403. [PMID: 33323776 DOI: 10.11124/jbisrir-d-19-00366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The first objective of this scoping review was to identify all the tools designed to measure movement or mobility in adults. The second objective was to compare the tools to the conceptual definitions of movement and mobility by mapping them to the International Classification of Functioning, Disability and Health (ICF). INTRODUCTION The concepts of movement and mobility are distinct concepts that are often conflated, and the differences are important to patient care. Movement is a change in the place or position of a part of the body or of the whole body. Mobility is derived from movement and is defined as the ability to move with ease. Researchers and clinicians, including nurses, physiotherapists, and occupational therapists who work with adults and in rehabilitation, need to be confident that they are measuring the outcome of interest. INCLUSION CRITERIA This scoping review considered studies that included participants who are adults, aged 19 and older, with any level of ability or disability. The concepts of interest were tools that measured movement or mobility relative to the human body. Studies were considered regardless of country of origin, health care setting, or sociocultural setting. METHODS CINAHL, Health and Psychosocial Instruments, MEDLINE, and Embase were searched in June 2018 and OpenGrey, Dissertation Abstracts International, and Google Scholar were searched in November 2018. The searches were limited to articles in English, and the date range was from the inception of the database to the current date. Data were extracted from the studies using a custom data extraction tool. Once tools were identified for analysis, they were coded using the table format developed by Cieza and colleagues. RESULTS There were 702 unique tools identified, with 651 of them available to be coded for the ICF. There were 385 ICF codes used when coding the tools. From these codes, the percentage of codes of the defining attributes of movement and mobility that were covered could be calculated, as well as the percentage of tool items that were linked to the antecedents, consequences, or defining attributes of movement or mobility. CONCLUSIONS Although there are many tools that measure only movement or mobility, there are many that measure a mixture of the defining attributes as well as the antecedents and consequences. The tool name alone should not be considered a guarantee of the concept measured, and tool selection should be done with a critical eye. This study provides a starting point from which clinicians and researchers can find tools that measure the concepts of movement and mobility of interest and importance to their patient population.
Collapse
Affiliation(s)
- Elizabeth Moulton
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Queen's Collaboration for Healthcare Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Rosemary Wilson
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Queen's Collaboration for Healthcare Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Amina Regina Silva
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Colleen Kircher
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Stéfany Petry
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Catherine Goldie
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Queen's Collaboration for Healthcare Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Jennifer Medves
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Queen's Collaboration for Healthcare Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Kevin Deluzio
- Department of Mechanical and Materials Engineering, Faculty of Engineering and Applied Science, Queen's University, Kingston, ON, Canada
| | - Amanda Ross-White
- Queen's Collaboration for Healthcare Quality: A JBI Centre of Excellence, Kingston, ON, Canada.,Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| |
Collapse
|
11
|
Responsiveness and interpretability of commonly used outcome assessments of mobility capacity in older hospital patients with cognitive spectrum disorders. Health Qual Life Outcomes 2021; 19:68. [PMID: 33648508 PMCID: PMC7923341 DOI: 10.1186/s12955-021-01690-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background In older hospital patients with cognitive spectrum disorders (CSD), mobility should be monitored frequently with standardised and psychometrically sound measurement instruments. This study aimed to examine the responsiveness, minimal important change (MIC), floor effects and ceiling effects of commonly used outcome assessments of mobility capacity in older patients with dementia, delirium or other cognitive impairment. Methods In a cross-sectional study that included acute older hospital patients with CSD (study period: 02/2015–12/2015), the following mobility assessments were applied: de Morton Mobility Index (DEMMI), Hierarchical Assessment of Balance and Mobility (HABAM), Performance Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed test, 5-times chair rise test, 2-min walk test, Timed Up and Go test, Barthel Index mobility subscale, and Functional Ambulation Categories. These assessments were administered shorty after hospital admission (baseline) and repeated prior to discharge (follow-up). Global rating of mobility change scales and a clinical anchor of functional ambulation were used as external criteria to determine the area under the curve (AUC). Construct- and anchor-based approaches determined responsiveness. MIC values for each instrument were established from different anchor- and distribution-based approaches. Results Of the 63 participants (age range: 69–94 years) completing follow-up assessments with mild (Mini Mental State Examination: 19–24 points; 67%) and moderate (10–18 points; 33%) cognitive impairment, 25% were diagnosed with dementia alone, 13% with delirium alone, 11% with delirium superimposed on dementia and 51% with another cognitive impairment. The follow-up assessment was performed 10.8 ± 2.5 (range: 7–17) days on average after the baseline assessment. The DEMMI was the most responsive mobility assessment (all AUC > 0.7). For the other instruments, the data provided conflicting evidence of responsiveness, or evidence of no responsiveness. MIC values for each instrument varied depending on the method used for calculation. The DEMMI and HABAM were the only instruments without floor or ceiling effects. Conclusions Most outcome assessments of mobility capacity seem insufficiently responsive to change in older hospital patients with CSD. The significant floor effects of most instruments further limit the monitoring of mobility alterations over time in this population. The DEMMI was the only instrument that was able to distinguish clinically important changes from measurement error. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015.
Collapse
|
12
|
Optimization and Validation of a Classification Algorithm for Assessment of Physical Activity in Hospitalized Patients. SENSORS 2021; 21:s21051652. [PMID: 33673447 PMCID: PMC7956397 DOI: 10.3390/s21051652] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
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.
Collapse
|
13
|
Viberg B, Kold S, Brink O, Larsen MS, Hare KB, Palm H. Is arthropla Sty b Etter than inter Nal fixation for undi Splaced femoral n Eck fracture? A national pragmatic RCT: the SENSE trial. BMJ Open 2020; 10:e038442. [PMID: 33040011 PMCID: PMC7552868 DOI: 10.1136/bmjopen-2020-038442] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Undisplaced femoral neck fractures (FNFs) are usually treated by internal fixation (IF) but two randomised controlled trials (RCTs) have demonstrated advantages of treatment with arthroplasty. The complication rate was lowered but there were no clinically improved patient-reported outcome measures (PROM), which could be due to underpowering or choice of selected PROM as the studies do appear to report a better functional outcome. We will conduct an RCT comparing IF with arthroplasties in patients aged over 65 years with an undisplaced FNF. METHODS AND ANALYSIS All hospitals in Denmark treating patients with hip fracture can provide patients for this study; therefore, the study can be considered a national RCT. Patients over 65 years old with an undisplaced FNF will be screened for eligibility and patients will only be excluded if they are unable to understand the study information (due to dementia or language), if they have a posterior tilt >20°, a pathological fracture or they cannot walk. Participants will be electronically randomised (in alternating blocks of 4 or 6) into either IF or arthroplasty. Postoperative care will follow the department standards.Primary and secondary outcomes and measuring points have been established in collaboration with patients with hip fracture by focus group interviews. The primary outcome measure is the New Mobility Score assessed after 1 year. Secondary outcomes are the Oxford Hip Score, EuroQol 5 domain (EQ-5D-5L), degree of posterior tilt, pain Verbal Rating Scale, reoperation and mortality. ETHICS AND DISSEMINATION The study is approved by the Danish Data Protection Agency (19/7429) and the scientific ethics committee (S-20180036). All participants will sign an informed consent before entering the trial. Because this is a national trial, all relevant healthcare professionals in Denmark will automatically receive the trial results that will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04075461).
Collapse
Affiliation(s)
- Bjarke Viberg
- Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Søren Kold
- Orthopaedic Surgery and Traumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Brink
- Orthopaedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kristoffer Borbjerg Hare
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedics, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Henrik Palm
- Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, Kobenhavn, Denmark
| |
Collapse
|
14
|
Aagesen M, Kristensen MT, Vinther A. The cumulated ambulation score is superior to the new mobility score and the de Morton Mobility Index in predicting discharge destination of patients admitted to an acute geriatric ward; a 1-year cohort study of 491 patients. Disabil Rehabil 2020; 44:1481-1488. [PMID: 32757865 DOI: 10.1080/09638288.2020.1802522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the predictive value of New Mobility Score, de Morton Mobility Index, and Cumulated Ambulation Score regarding discharge destination, and to determine the feasibility of the tests in an acute geriatric ward. MATERIALS AND METHODS Observational 1-year cohort study of 491 geriatric patients admitted consecutively from own home. New Mobility Score (pre-hospital functional level), de Morton Mobility Index, and Cumulated Ambulation Score were recorded at the first physiotherapy contact. RESULTS Univariable logistic regression showed that the odds for not being discharged home were 7 times higher (odds ratio = 7.6, 95%CI; 4.5-12.7) for patients with a non-independent mobility level (Cumulated Ambulation Score ≤ 5) compared to independent (Cumulated Ambulation Score = 6). Corresponding ratios were 6.2 (3.8-10.0) for de Morton Mobility Index ≤ 41 points and 2.8 (1.8-4.5) for New Mobility Score ≤5 points. Adjustment for gender, age, cause of admission, and marital status improved the predictive value of the Cumulated Ambulation Score. Upon admission, 99% of the patients were assessed with New Mobility Score, 100% with Cumulated Ambulation Score, and 81% with de Morton Mobility Index. CONCLUSION Cumulated Ambulation Score is more feasible and superior in predicting discharge destination than de Morton Mobility Index and New Mobility Score in an acute geriatric ward.Implications for rehabilitationEasy, quick, and accurate measurement of mobility is essential for discharge planning and effective targeting of physiotherapy in an acute geriatric ward.The objectively assessed Cumulated Ambulation Score is superior to the de Morton Mobility Index and the pre-hospital New Mobility Score in predicting discharge destination in geriatric patients admitted from their own home.The Cumulated Ambulation Score and the New Mobility Score are more feasible and less time consuming to complete in an acute geriatric ward compared to the de Morton Mobility Index.
Collapse
Affiliation(s)
- Maria Aagesen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.,QD-Research Unit, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| |
Collapse
|
15
|
Dokken I, Brovold T, Hesseberg K. Reliability and validity of the Norwegian-language version of the elderly mobility scale in older hospitalised patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1857. [PMID: 32627335 DOI: 10.1002/pri.1857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/14/2020] [Accepted: 05/23/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE Reliable and valid assessment tools are needed to evaluate and predict physical function in older hospitalised patients. The purpose of this study was to determine the reliability and validity of the Norwegian-language version of the Elderly Mobility Scale (EMS-N) for use with geriatric patients. METHODS Fifty patients admitted to a medical ward in a hospital in Norway were included. The inclusion criteria were acute hospital admission because of medical issues, age ≥65 years and referred to a physiotherapist for a physical function review. The original version of the Elderly Mobility Scale (EMS) was translated from English to Norwegian before initiating this study. EMS-N was tested for internal consistency, test-retest reliability and criterion validity by using the short physical performance battery (SPPB) as the gold standard. Internal consistency was measured by Cronbach's alpha. Test-retest reliability was estimated by linear weighted kappa and the intra-class correlation coefficient (ICC). RESULTS The mean age of participants was 82 (range 65-95). The main admission diagnoses were acute functional decline (64%, n = 32) or acute infection (26%, n = 13). Internal consistency was estimated at 0.88. Test-retest reliability: six of the seven EMS-N items showed very good consistency, and the last item showed good consistency, ICC was estimated at 0.99. The standard error of measurement (SEM) reflected the absolute reliability, calculated at 0.52. The minimal detectable change (MDC) was calculated with 95 and 90% confidence intervals at 1.44 and 1.21, respectively. Criterion validity was calculated by a correlation analysis of the EMS-N and the SPPB. The rho value was estimated as 0.75, which corresponds to a high correlation and indicated good criterion validity. DISCUSSION EMS-N exhibited good internal consistency and good to very good test-retest reliability and criterion validity. EMS can safely be used as an assessment tool for hospitalised geriatric patients.
Collapse
Affiliation(s)
| | - Therese Brovold
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | | |
Collapse
|
16
|
Martin J, Barker K. The Hierarchical Assessment of Balance and Mobility (HABAM): a useful tool to estimate length of hospital stay following hip and knee replacement. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The Hierarchical Assessment of Balance and Mobility is a measure of balance and mobility that can detect recovery of physical function, and can be used to identify patients at risk of delayed discharge. The aim of this study was to investigate the use of Hierarchical Assessment of Balance and Mobility scores as a predictor of length of hospital stay in patients following hip and knee replacement. Methods Hierarchical Assessment of Balance and Mobility scores were collected on 191 patients following primary total joint replacement. Regression and receiver operating characteristic curve analyses were conducted to assess the relationship between Hierarchical Assessment of Balance and Mobility and length of stay. Results Hierarchical Assessment of Balance and Mobility scores of <31 on the first post-operative day predicted longer than mean length of stay (4 days) with sensitivity and specificity of 79% and 83%. Receiver operating characteristic curve analyses showed that a Hierarchical Assessment of Balance and Mobility score of 50 was the optimal cut-off point for discharge. Conclusions Hierarchical Assessment of Balance and Mobility offers a practical way to quantify and objectively track patients' physical function, and can help identify patients at risk of an increased length of stay on post-operative day one.
Collapse
Affiliation(s)
- Jack Martin
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
| |
Collapse
|
17
|
Heldmann P, Werner C, Belala N, Bauer JM, Hauer K. Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures. BMC Geriatr 2019; 19:189. [PMID: 31288750 PMCID: PMC6617943 DOI: 10.1186/s12877-019-1201-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/02/2019] [Indexed: 01/11/2023] Open
Abstract
Background Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients. The aim of this review was to describe primary outcome measures that have been used in randomized controlled trials (RCTs) on early rehabilitation in acutely hospitalized older patients, to analyze their matching, and to evaluate the effects of matching on the main findings of these RCTs. Methods A systematic literature search was conducted in PubMed, Cochrane CENTRAL, CINAHL, and PEDro databases. Additional studies were identified through reference and citation tracking. Inclusion criteria were: RCT, patients aged ≥65 years, admission to an acute hospital medical ward (but not to an intensive medical care unit), physical exercise intervention (also as part of multidisciplinary programs), and primary outcome measure during hospitalization. Two independent reviewers extracted the data, assessed the methodological quality, and analyzed the matching of primary outcome measures to the intervention, study sample, and setting. Main study findings were related to the results of the matching procedure. Results Twenty-eight articles reporting on 24 studies were included. A total of 33 different primary outcome measures were identified, which were grouped into six categories: functional status, mobility status, hospital outcomes, adverse clinical events, psychological status, and cognitive functioning. Outcome measures differed considerably within each category and showed a large heterogeneity in their matching to the intervention, study sample, and setting. Outcome measures that specifically matched the intervention contents were more likely to document intervention-induced benefits. Mobility instruments seemed to be the most sensitive outcome measures to reveal such benefits. Conclusions This review highlights that the selection of outcome measures has to be highly specific to the intervention contents as this is a key factor to reveal benefits attributable to early rehabilitation in acutely hospitalized older patients. Inappropriate selection of outcome measures may represent a major cause of inconsistent findings reported on the effectiveness of early rehabilitation in this setting. Trial registration PROSPERO CRD42017063978. Electronic supplementary material The online version of this article (10.1186/s12877-019-1201-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany.
| | - Christian Werner
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany.,Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Nacera Belala
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Jürgen M Bauer
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany.,Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
| |
Collapse
|
18
|
Aarden JJ, van der Schaaf M, van der Esch M, Reichardt LA, van Seben R, Bosch JA, Twisk JWR, Buurman BM, Engelbert RHH. Muscle strength is longitudinally associated with mobility among older adults after acute hospitalization: The Hospital-ADL study. PLoS One 2019; 14:e0219041. [PMID: 31276471 PMCID: PMC6611658 DOI: 10.1371/journal.pone.0219041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background 30 to 60% of the acute hospitalized older adults experience functional decline after hospitalization. The first signs of functional decline after discharge can often be observed in the inability to perform mobility tasks, such as raising from a chair or walking. Information how mobility develops over time is scarce. Insight in the course of mobility is needed to prevent and decrease mobility limitations. Objectives The objectives of this study were to determine (i) the course of mobility of acute hospitalized older adults and (ii) the association between muscle strength and the course of mobility over time controlled for influencing factors. Methods In a multicenter, prospective, observational cohort study, measurements were taken at admission, discharge, one- and three months post-discharge. Mobility was assessed by the De Morton Mobility Index (DEMMI) and muscle strength by the JAMAR. The longitudinal association between muscle strength and mobility was analysed with a Linear Mixed Model and controlled for potential confounders. Results 391 older adults were included in the analytic sample with a mean (SD) age of 79.6 (6.7) years. Mobility improved significantly from admission up to three months post-discharge but did not reach normative levels. Muscle strength was associated with the course of mobility (beta = 0.64; p<0.01), even after controlling for factors as age, cognitive impairment, fear of falling and depressive symptoms (beta = 0.35; p<0.01). Conclusion Muscle strength is longitudinally associated with mobility. Interventions to improve mobility including muscle strength are warranted, in acute hospitalized older adults.
Collapse
Affiliation(s)
- Jesse J. Aarden
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- * E-mail:
| | - Marike van der Schaaf
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, Netherlands
| | - Lucienne A. Reichardt
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Rosanne van Seben
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Jos A. Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jos W. R. Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands
| | - Bianca M. Buurman
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | |
Collapse
|
19
|
A Systematic Review of Thirty-One Assessment Tests to Evaluate Mobility in Older Adults. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1354362. [PMID: 31321227 PMCID: PMC6610744 DOI: 10.1155/2019/1354362] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/28/2019] [Accepted: 05/27/2019] [Indexed: 12/05/2022]
Abstract
Assessments of gait, balance, and transfer in elderly people play a valuable role in maintaining healthy aging and preventing a decline in mobility. Several evaluation tools have been proposed; however, clinicians should select the most accurate ones wisely, based on numerous criteria. This systematic review aims to identify all applicable elderly mobility assessment tests and show their measurement properties with as much detail as possible. Initially, a broad search was performed. Articles were screened based on their titles and abstracts, and only studies published in English were considered. Based on our inclusion and exclusion criteria, 31 assessment tests evaluating the mobility of healthy elderly people were found. Then, further searches were completed to identify the measurement properties of each test. These characteristics include the origin and year of establishment, several practicality factors, and validity. The analysis of our outcomes illustrates the similarities and differences between the identified tests.
Collapse
|
20
|
González-Seguel F, Corner EJ, Merino-Osorio C. International Classification of Functioning, Disability, and Health Domains of 60 Physical Functioning Measurement Instruments Used During the Adult Intensive Care Unit Stay: A Scoping Review. Phys Ther 2019; 99:627-640. [PMID: 30590839 PMCID: PMC6517362 DOI: 10.1093/ptj/pzy158] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/18/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND There has been a recent surge in the creation and adaptation of instruments to measure physical functioning (PF) in the intensive care unit (ICU). Selecting the right measurement instrument depends on understanding the core constructs that it measures in terms of the International Classification of Functioning, Disability and Health (ICF) domains. PURPOSE The purpose of this study was to map systematically the ICF domains and subdomains included in the PF measurement instruments used for adult patients during the ICU stay. DATA SOURCES A systematic search was carried out in Cochrane CENTRAL, PubMed, CINAHL, and LILACS as well as a hand search up to May 17, 2017. STUDY SELECTION Study selection included all types of research articles that used at least 1 PF measurement instrument in adult patients within the ICU. DATA EXTRACTION Study design, year of publication, study population, and the measurement instruments reported were recorded. A consensus of experts analyzed the ICF domains included in each instrument. DATA SYNTHESIS We found 181 articles containing 60 PF measurement instruments used during the ICU stay. Twenty-six ICF domains were identified, 38 instruments included Mobility, and 13 included Muscle function. LIMITATIONS Studies not written in English or Spanish were excluded. CONCLUSIONS There are numerous PF measurement instruments used in adult patients in the ICU. The most frequent ICF domain measured is Mobility. This study highlights the ICF domains contained in the instruments that can be used clinically, providing a complete database of instruments that could facilitate selection of the most appropriate measure based on the patients' needs.
Collapse
Affiliation(s)
- Felipe González-Seguel
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Vitacura 5951, Santiago, Chile,Address all correspondence to Mr González-Seguel at:
| | - Evelyn Jane Corner
- Department of Clinical Sciences, Brunel University London and The Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | |
Collapse
|
21
|
van Dronkelaar C, Tieland M, Aarden JJ, Reichardt LA, van Seben R, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Decreased Appetite is Associated with Sarcopenia-Related Outcomes in Acute Hospitalized Older Adults. Nutrients 2019; 11:nu11040932. [PMID: 31027202 PMCID: PMC6520962 DOI: 10.3390/nu11040932] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Decreased appetite is one of the main risk factors of malnutrition. Little is known on how appetite changes during hospitalization and after discharge and how it relates with sarcopenia-related outcomes. We analyzed data of the Hospital-ADL study, a multicenter prospective cohort study that followed 400 acutely hospitalized older adults (≥70 year). Appetite (SNAQ), handgrip strength (Jamar), muscle mass (BIA), mobility (DEMMI), and physical performance (SPPB) were assessed within 48 h of admission, at discharge, and at one and three months post-discharge. The course of decreased appetite was analysed by Generalised Estimating Equations. Linear Mixed Model was used to analyse the associations between decreased appetite and the sarcopenia-related outcomes. Decreased appetite was reported by 51% at hospital admission, 34% at discharge, 28% one month post-discharge, and 17% three months post-discharge. Overall, decreased appetite was associated with lower muscle strength (β = −1.089, p = 0.001), lower mobility skills (β = −3.893, p < 0.001), and lower physical performance (β = −0.706, p < 0.001) but not with muscle mass (β = −0.023, p = 0.920). In conclusion, decreased appetite was highly prevalent among acute hospitalized older adults and remained prevalent, although less, after discharge. Decreased appetite was significantly associated with negative sarcopenia-related outcomes, which underlines the need for assessment and monitoring of decreased appetite during and post hospitalization.
Collapse
Affiliation(s)
- Carliene van Dronkelaar
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067SM Amsterdam, The Netherlands.
| | - Michael Tieland
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067SM Amsterdam, The Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, 1056 AB Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands.
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| |
Collapse
|
22
|
Lyons A, Romero‐Ortuno R, Hartley P. Functional mobility trajectories of hospitalized older adults admitted to acute geriatric wards: A retrospective observational study in an English university hospital. Geriatr Gerontol Int 2019; 19:305-310. [DOI: 10.1111/ggi.13623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/19/2018] [Accepted: 01/01/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Adam Lyons
- School of Clinical MedicineUniversity of Cambridge Cambridge UK
- Department of Medicine for the ElderlyAddenbrooke's Hospital Cambridge UK
| | - Roman Romero‐Ortuno
- Department of Medicine for the ElderlyAddenbrooke's Hospital Cambridge UK
- Clinical Gerontology Unit, Department of Public Health and Primary CareUniversity of Cambridge Cambridge UK
- Discipline of Medical Gerontology, Trinity College Dublin, Mercer's Institute for Successful AgingSt James's Hospital Dublin Ireland
| | - Peter Hartley
- Primary Care Unit, Department of Public Health and Primary CareUniversity of Cambridge Cambridge UK
- Department of PhysiotherapyAddenbrooke's Hospital Cambridge UK
| |
Collapse
|
23
|
Braun T, Thiel C, Schulz RJ, Grüneberg C. Reliability of mobility measures in older medical patients with cognitive impairment. BMC Geriatr 2019; 19:20. [PMID: 30674278 PMCID: PMC6343264 DOI: 10.1186/s12877-019-1036-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/14/2019] [Indexed: 01/06/2023] Open
Abstract
Background Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment. Methods A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of ≤24 points, were assessed twice within 1 day by a trained physiotherapist. The following instruments were applied: de Morton Mobility Index, Hierarchical Assessment of Balance and Mobility, Performance-Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed, 5-times chair rise test, 2-min walk test, timed up and go test, Barthel Index mobility subscale and Functional Ambulation Categories. As appropriate, the intraclass correlation coefficient (ICC), Cohen’s kappa, standard error of measurement, limits of agreement and minimal detectable change (MDC) values were estimated. Results Sixty-five older acute medical patients with cognitive impairment participated in the study (mean age: 82 ± 7 years; mean MMSE: 20 ± 4, range: 10 to 24 points). Some participants were physically or cognitively unable to perform the gait speed (46%), 2-min walk (46%), timed up and go (51%) and chair rise (75%) tests. ICC and kappa values were above 0.9 in all instruments except for the gait speed (ICC = 0.86) and chair rise (ICC = 0.72) measures. Measurement error is reported for each instrument. The absolute limits of agreement ranged from 11% (de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility) to 35% (chair rise test). Conclusions The test-retest reliability is sufficient (> 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose. Trial registration German Clinical Trials Register (DRKS00005591). Registered 2 February 2015. Electronic supplementary material The online version of this article (10.1186/s12877-019-1036-z) contains supplementary material, which is available to authorized users.
Collapse
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 Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.,Faculty of Sports Science, Training and Exercise Science, Ruhr-University Bochum, Bochum, Germany
| | - Ralf-Joachim Schulz
- Department of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| |
Collapse
|
24
|
Moulton E, Wilson R, Edge DS, VanDenKerkhof E, Deluzio K, Ross-White A. Measures of movement and mobility used in clinical practice and research. ACTA ACUST UNITED AC 2018; 16:2279-2287. [DOI: 10.11124/jbisrir-2017-003800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
25
|
Lee IFK, Yau FN, Yim SSH, Lee DTF. Evaluating the impact of a home-based rehabilitation service on older people and their caregivers: a matched-control quasi-experimental study. Clin Interv Aging 2018; 13:1727-1737. [PMID: 30254432 PMCID: PMC6140694 DOI: 10.2147/cia.s172871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Previous studies evaluating home-based rehabilitation service (HBRS) merely focused on the period immediately after the patients’ discharge from hospitals. The present study focuses on HBRS that covers clients who have not been recently hospitalized. HBRS aims to meet older clients’ rehabilitation needs and support their caregivers in the community. This study intended to evaluate the impact of HBRS on the older clients’ health outcomes and hospital services utilization, and caregivers’ strain in providing care for clients. Methods This study used a matched-control quasi-experimental design with a 3-month follow-up to evaluate HBRS. The health outcome measures used for the older clients included Elderly Mobility Scale, Timed Up and Go test, Modified Barthel Index, Lawton’s Instrumental Activities of Daily Living Scale, Mini-Mental State Examination, and World Health Organization Quality of Life Scale, Short Form, Hong Kong version (WHOQOL-BREF [HK]). Meanwhile, the Caregiver Strain Index was used to measure the caregivers’ caregiving strain. Data on clients’ hospital services utilization 3 and 6 months before and after the study were also collected and evaluated. Results The final sample consisted of 122 pairs of older clients and caregivers who live in a community in Hong Kong. In the follow-up after 3 months, the intervention group showed immensely substantial improvements across all the health outcome measures compared with the control group. The intervention group also demonstrated substantial reduction in the clients’ hospital services utilization compared with the control group. However, no significant differences in the clients’ hospital services utilization exist between the two groups in the follow-up after 6 months. Conclusion HBRS of this study is an effective intervention service to improve health outcomes and reduce hospital services utilization among older people living in the community. Moreover, HBRS of this study was effective in reducing the caregivers’ caregiving strain.
Collapse
Affiliation(s)
- Iris Fung-Kam Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region,
| | - Felix Ngok Yau
- Nethersole Outreaching Rehabilitation Mission, Alice Ho Miu Ling Nethersole Charity Foundation, Hong Kong, Special Administrative Region
| | - Sally Suk-Ha Yim
- Nethersole Outreaching Rehabilitation Mission, Alice Ho Miu Ling Nethersole Charity Foundation, Hong Kong, Special Administrative Region
| | - Diana Tze-Fan Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region,
| |
Collapse
|
26
|
Abstract
Rehabilitation assists patients with return to baseline activities of daily living after catastrophic events or long hospitalizations. In an effort to increase mobility episodes in the rehabilitation patient, a nurse-led mobility program was suggested. This allows the rehabilitation nurse to participate in the improvement of mobility for rehabilitation patients by mobilizing the patients safely during hours in which physical therapy is not available. The purpose of this project was twofold: (1) Can additional mobility episodes improve outcomes in the rehabilitation patient? (2) How can safe patient handling principles be applied to the rehabilitation patient?
Collapse
|
27
|
Braun T, Grüneberg C, Thiel C, Schulz RJ. Measuring mobility in older hospital patients with cognitive impairment using the de Morton Mobility Index. BMC Geriatr 2018; 18:100. [PMID: 29685107 PMCID: PMC5913915 DOI: 10.1186/s12877-018-0780-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mobility is a key outcome in older patients with cognitive impairment. The de Morton Mobility Index (DEMMI) is an established measure of older people’s mobility that is promising for use in older patients with cognitive impairment. The aim of this study was to examine the DEMMI’s psychometric properties in older patients with dementia, delirium or other cognitive impairment. Methods This cross-sectional study was performed in a geriatric hospital and includes older acute medical patients with cognitive impairment indicated by a Mini Mental State Examination (MMSE) score ≤ 24 points. A Rasch analysis was performed to check the DEMMI’s unidimensionality. Construct validity was assessed by testing 13 hypotheses about expected correlations between the DEMMI and outcome measures of similar or related constructs, and about expected differences of DEMMI scores between groups differing in mobility related characteristics. Administration times were recorded. Results A sample of 153 patients with mild (MMSE 19–24 points; 63%) and moderate (MMSE: 10–18 points; 37%) cognitive impairment was included (age range: 65–99 years; mean MMSE: 19 ± 4, range: 8–24 points; diagnosis of dementia and delirium: 40% and 18%, respectively). Rasch analysis indicated unidimensionality with an overall fit to the model (P = 0.107). Internal consistency reliability was excellent (Cronbach’s alpha = 0.92). Eleven out of 13 (85%) hypotheses on construct validity were confirmed. The DEMMI showed good feasibility, and no adverse events occurred. The mean administration time of 5 min (range: 1–10) was not influenced by the level of cognitive impairment. In contrast to some other comparator instruments, no floor or ceiling effects were evident for the DEMMI. Conclusions Results indicate sufficient psychometric properties of the DEMMI in older patients with cognitive impairment. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015. Electronic supplementary material The online version of this article (10.1186/s12877-018-0780-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tobias Braun
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany. .,University of Cologne, Medical Faculty, Cologne, Germany. .,St. Marien-Hospital, Department of Geriatric Medicine, Cologne, Germany.
| | - Christian Grüneberg
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | - Christian Thiel
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | | |
Collapse
|
28
|
Ferriero G, Kristensen MT, Invernizzi M, Salgovic L, Bravini E, Sartorio F, Vercelli S. Psychometric properties of the Cumulated Ambulation Score: a systematic review. Eur J Phys Rehabil Med 2018; 54:766-771. [PMID: 29600687 DOI: 10.23736/s1973-9087.18.04822-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In the geriatric population, independent mobility is a key factor in determining readiness for discharge following acute hospitalization. The Cumulated Ambulation Score (CAS) is a potentially valuable score that allows day-to-day measurements of basic mobility. The CAS was developed and validated in older patients with hip fracture as an early postoperative predictor of short-term outcome, but it is also used to assess geriatric in-patients with acute medical illness. Despite the fast-accumulating literature on the CAS, to date no systematic review synthesizing its psychometric properties has been published. Therefore, we aimed to provide a comprehensive review of the psychometric properties of the CAS, summarizing the present evidence on this measure as a basis for further research to investigate its applicability across a wider range of functional abilities and care settings. EVIDENCE ACQUISITION A literature search was conducted on research articles published between 2006 and June 2016 in journals indexed by MEDLINE and Scopus databases using as a search item "Cumulated Ambulation Score"[All Fields], and selecting studies that presented a psychometric analysis of the scale. Of 49 studies identified, 17 examined the psychometric properties of the CAS. EVIDENCE SYNTHESIS Most papers dealt with patients after hip fracture surgery, and only 4 studies assessed the CAS psychometric characteristics also in geriatric in-patients with acute medical illness. Two versions of CAS (CAS1 and the more detailed CAS2 version) and two different methods to calculate the total score (1-day and 3-day CAS) were used in the selected papers. Most of the papers assessed reliability and validity, using different statistics, and only one showed evidence of sensitivity to change of the score. CONCLUSIONS This systematic review shows international interest of researchers in the CAS, despite the short time frame since its first publication in 2006. The results support the reliability, validity, and sensitivity to change of the tool. Since different versions of CAS are available and two scores are commonly used, we suggest that clinicians and researchers in the future choose the more detailed CAS2 version, already used by the large majority of studies, and report whether they used the 1- or 3-day score.
Collapse
Affiliation(s)
- Giorgio Ferriero
- Department of Physical Medicine and Rehabilitation, Scientific Institute of Lissone, Maugeri Clinical Institutes for Research and Care, Lissone, Monza-Brianza, Italy -
| | - Morten T Kristensen
- Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | | | | | - Francesco Sartorio
- Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Department of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Maugeri Clinical Institutes for Research and Care, Veruno, Novara, Italy
| | - Stefano Vercelli
- Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Department of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Maugeri Clinical Institutes for Research and Care, Veruno, Novara, Italy
| |
Collapse
|
29
|
Soh SE, Stuart L, Raymond M, Kimmel L, Holland AE. The validity, reliability, and responsiveness of the modified Iowa Level of Assistance scale in hospitalized older adults in subacute care. Disabil Rehabil 2017; 40:2931-2937. [DOI: 10.1080/09638288.2017.1359687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Sze-Ee Soh
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Laura Stuart
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Melissa Raymond
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Lara Kimmel
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Anne E. Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Physiotherapy, La Trobe University, Melbourne, Australia
| |
Collapse
|
30
|
Rodrigues P, Hering F, Cieli E, Campagnari JC. Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a nonurological population clinical study of the relationship between lower limbs and bladder function. Int Braz J Urol 2017; 42:1202-1209. [PMID: 27532117 PMCID: PMC5117978 DOI: 10.1590/s1677-5538.ibju.2015.0450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives To understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR) in older patients admitted to hospitals for non-urological causes using clinical parameters. Materials and Methods 56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6) with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME) instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used. Results All patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days). Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03). Prolonged hospital stay impairs mobility in all domains (p<0.05) except step-up and transfer skills (p<0.02) although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02). Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up. Conclusions Recovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments.
Collapse
Affiliation(s)
- Paulo Rodrigues
- Clínica de Urologia do Hospital Beneficência Portuguesa de São Paulo - São Paulo, Brasil.,Departamento de Urologia, Hospital Santa Helena de São Paulo - São Paulo, Brasil
| | - Flávio Hering
- Clínica de Urologia do Hospital Beneficência Portuguesa de São Paulo - São Paulo, Brasil.,Departamento de Urologia, Hospital Santa Helena de São Paulo - São Paulo, Brasil
| | - Eli Cieli
- Clínica de Urologia do Hospital Beneficência Portuguesa de São Paulo - São Paulo, Brasil
| | - João Carlos Campagnari
- Clínica de Urologia do Hospital Beneficência Portuguesa de São Paulo - São Paulo, Brasil
| |
Collapse
|
31
|
Soares Menezes KVR, Auger C, de Souza Menezes WR, Guerra RO. Instruments to evaluate mobility capacity of older adults during hospitalization: A systematic review. Arch Gerontol Geriatr 2017; 72:67-79. [PMID: 28599140 DOI: 10.1016/j.archger.2017.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/05/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
Independent mobility is a key factor in predicting morbidity and determining hospital discharge readiness for older patients. The main objective was identify and appraise relevant instruments for the measurement of mobility of hospitalized geriatric patients. A systematic review was performed in two consecutive steps. Based on the definition of mobility of the International Classification of Functioning (ICF). Step 1 identified mobility measurement instruments used to assess patients 60 years of age and over hospitalized in acute care or intensive geriatric rehabilitation unit. Aim of the instrument, coverage of mobility construct, applicability (format, training required, administration time and use of assistive devices) were extracted. For each included instrument, Step 2 identified and appraised articles reporting about their measurement properties. Consensus-based Standards for the selection of health status Measurement INstruments (COSMIN) was used by two independent reviewers to critically appraise and compare the measurement properties. Step 1 resulted in 6350 articles, of which 28 articles reported about 17 different instruments. Step 2 retained 11 instruments with 70 articles reporting about their measurement properties in various settings. Judgement-based instruments (n=5) covered the ICF mobility construct more broadly than performance-based measures (n=6). Our results showed that 3 instruments (DEMMI, SPPB and Tinetti scale) had the most extensive and robust measurement properties, and from those, SPPB and DEMMI covered the mobility construct more broadly but SPPB had the longest administration (10-15min). Conclusion SPPB presents the best balance between mobility coverage, measurement properties and applicability to acute care or intensive geriatric rehabilitation unit.
Collapse
Affiliation(s)
| | - Claudine Auger
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), CRIR-CRLB du CIUSSS Centre-Sud-de-l'Ile-de-Montréal
- Centre de réadaptation Lucie-Bruneau 2275, avenue Laurier Est Montréal, QC H2H 2N8, Canada.
| | | | - Ricardo Oliveira Guerra
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Av Sen. Salgado Filho, 3000, Campus Universitário, Natal 59078-970, RN, Brazil.
| |
Collapse
|
32
|
Raymond MJM, Jeffs KJ, Winter A, Soh SE, Hunter P, Holland AE. The effects of a high-intensity functional exercise group on clinical outcomes in hospitalised older adults: an assessor-blinded, randomised-controlled trial. Age Ageing 2017; 46:208-213. [PMID: 27932360 DOI: 10.1093/ageing/afw215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Indexed: 01/31/2023] Open
Abstract
Objective to investigate a high-intensity functional exercise (HIFE) group in hospitalised older adults. Design assessor-blinded, randomised-controlled trial. Setting sub-acute wards at a metropolitan rehabilitation hospital. Participants older adults ≥65 years (n = 468) able to stand with minimum assistance or less from a chair and follow instructions. Intervention 'group' participants were offered a standing HIFE group three times a week and individual physiotherapy sessions twice a week. Control participants were offered daily individual physiotherapy sessions. Main outcome measures the primary outcome measure was the Elderly Mobility Scale (EMS). Secondary measures included the Berg Balance Scale, gait speed, Timed Up and Go Test, falls, length of stay and discharge destination. Results participants' mean age was 84.3 (7.1) years and 61% were female. There was no difference between groups for the improvement in EMS from admission to discharge (effect size -0.07, 95% confidence interval: -0.26 to 0.11, P = 0.446) and no difference in discharge destination, P = 0.904. Therapists saved 31-205 min/week treating group participants compared with control participants. Conclusion the results suggest that a HIFE group programme combined with individual physiotherapy may improve mobility to a similar extent to individual physiotherapy alone in hospitalised older adults. Providing physiotherapy in a group setting resulted in increased therapist efficiency. A high-intensity exercise group with individual physiotherapy may be an effective and efficient method to provide care to older inpatients.
Collapse
Affiliation(s)
- Melissa J. M. Raymond
- Physiotherapy Department, Alfred Health, Caulfield Hospital, Melbourne, Victoria, Australia
| | | | - Adele Winter
- Physiotherapy Department, Alfred Health, Caulfield Hospital, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Physiotherapy Department, Alfred Health, Caulfield Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Hunter
- Department of Aged Care, Alfred Health, Caulfield Hospital, Melbourne, Victoria, Australia
| | - Anne E. Holland
- Alfred Health Clinical School, Alfred Health, La Trobe University, Victoria, Australia
- Physiotherapy Department, Alfred Health, The Alfred, Melbourne, Victoria, Australia
| |
Collapse
|
33
|
Moorhouse P, Theou O, Fay S, McMillan M, Moffatt H, Rockwood K. Treatment in a Geriatric Day Hospital improve individualized outcome measures using Goal Attainment Scaling. BMC Geriatr 2017; 17:9. [PMID: 28061887 PMCID: PMC5219800 DOI: 10.1186/s12877-016-0397-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/10/2016] [Indexed: 12/01/2022] Open
Abstract
Background Evidence regarding outcomes in the Geriatric Day Hospital (GDH) model of care has been largely inconclusive, possibly due to measurement issues. This prospective cohort study aims to determine whether treatment in a GDH could improve individualized outcome measures using goal attainment scaling (GAS) and whether improvements are maintained 6-months post-discharge. Methods A total of 469 outpatients admitted to a Canadian Geriatric Day Hospital, between December 2008 and June 2011, were included in the analysis (81.1 ± 6.7 years, 66.3% females); a smaller cohort of 121 patients received a follow-up phone call 6 months following discharge. Baseline, discharge and 6 month post-discharge observer-rated measures of mobility, cognition, and function were completed using GAS. Traditional psychometric measures were also captured. Results The mean number of goals set was 1.6 (SD 0.8) and patients set goals in the following domains: 88% mobility or falls reduction; 18% optimization of home supports; 17% medication optimization;12% cognition; 8% increasing social engagement; and 5% optimization of function. Total GAS was the most responsive measure to change with 86% of patients improving at discharge; mobility goals were the most likely to be achieved. Six-month GAS scores remained significantly higher than GAS scores on admission. Those who had more goals were more likely to improve during GDH admission (OR 1.49, CI 1.02-2.19) but this association was not seen 6 months after discharge. Conclusions This study demonstrated short- and long-term effectiveness of GDH in helping patients achieve individualized outcome measures using GAS.
Collapse
Affiliation(s)
- Paige Moorhouse
- Division of Geriatric Medicine, Dalhousie University, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada. .,Centre for Health Care of the Elderly, Nova Scotia Health Authority, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada.
| | - Olga Theou
- Division of Geriatric Medicine, Dalhousie University, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada
| | - Sherri Fay
- Centre for Health Care of the Elderly, Nova Scotia Health Authority, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada
| | - Miranda McMillan
- Centre for Health Care of the Elderly, Nova Scotia Health Authority, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada
| | - Heather Moffatt
- Centre for Health Care of the Elderly, Nova Scotia Health Authority, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada.,Centre for Health Care of the Elderly, Nova Scotia Health Authority, Veterans' Memorial Building, 5955 Veterans memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada
| |
Collapse
|
34
|
Swank C, Medley A, Thompson M, Trudelle-Jackson E, Barisa M. The effect of aerobic exercise on dual-task gait in individuals with Parkinson's disease. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.11.524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Dual tasking exacerbates gait deficits in people with Parkinson's disease. This pilot study aimed to examine the effect of aerobic exercise on dual-task gait in individuals with Parkinson's disease and begin to identify the impact of volitional pedal rate. Methods: Twenty people with Parkinson's disease were recruited and tested at baseline, post-intervention, and follow-up for motor (Unified Parkinson's Disease Rating Scale) and cognitive function (Repeatable Battery for the Assessment of Neuropsychological Status) and dual-task gait (Time Up and Go) conditions (manual and cognitive). A 12-week aerobic exercise intervention of cycle ergometry was carried out three times a week for 60 minutes each session. To assess our intervention, separate repeated measures of analysis of variance were conducted. As determined a priori, to assess the impact of volitional pedal rate, participants were divided after the intervention into a high-pedal rate group (>60 rpm) and a low-pedal rate group (≤60 rpm) based upon average maximal pedal rate throughout the intervention and analysed with the Mann Whitney U test and Related Samples Wilcoxon Signed Rank Test. Findings: Overall, motor function (P=0.580), cognitive function (P=0.077), and motor-cognitive interplay (P=0.168) did not improve after aerobic exercise. However, pedal rate groups were different for TUGmanual and TUGcognitive, but not on motor or cognitive function. Only low-pedal rate group improved over time (P=0.028 on TUGmanual) and demonstrated reduced dual task cost after the aerobic exercise (>Minimal Detectible Change of 18.1%). Conclusions: Though the low-pedal rate group experienced greater motor-cognitive interference, persons who pedalled at the slower rate demonstrated the most improvement in dual-task activities.
Collapse
Affiliation(s)
- Chad Swank
- Assistant professor, School of Physical Therapy, Texas Women's University, Dallas, TX, USA
| | - Ann Medley
- Associate professor, director, School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Mary Thompson
- Professor, School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | | | - Mark Barisa
- Director of Neuropsychology, Baylor Institute for Rehabilitation, Dallas, TX, USA
| |
Collapse
|
35
|
Haas R, Bowles KA, O'Brien L, Haines T. Patient and Therapist Agreement on Performance-Rated Ability Using the de Morton Mobility Index. Arch Phys Med Rehabil 2016; 97:2157-2165. [PMID: 27485364 DOI: 10.1016/j.apmr.2016.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the level of agreement between patient self-report and therapist-assessed performance of mobility using the de Morton Mobility Index (DEMMI). DESIGN Interrater agreement study. SETTING Outpatient hospital clinic. PARTICIPANTS Consecutive sample of patients (N=128) undergoing preoperative assessment for elective lower limb (LL) arthroplasty. INTERVENTIONS Participants completed a therapist-directed assessment of the DEMMI followed by self-report of performance. A random subsample (n=62, 48%) also completed a self-report of anticipated performance before the therapist-directed assessment. Both raters (participant and therapist) were blinded to the scores obtained from the other rater. MAIN OUTCOME MEASURES Interrater agreement between patient self-report and therapist-directed assessment of the total DEMMI scores was assessed using the intraclass correlation coefficient model 2,1 (ICC2,1) with a 95% confidence interval. The Bland-Altman plots were also used to illustrate the agreement between the 2 raters. RESULTS The intraclass correlation coefficient (ICC) between patient self-report after performance and therapist-directed assessment of the total DEMMI score was .967 (95% confidence interval, .952-.977). The ICC between patient self-report of anticipated performance and therapist-directed assessment of the total DEMMI score was .830 (95% confidence interval, .730-.894). The Bland-Altman plots depicted higher levels of agreement among participants with impaired levels of mobility (≤74 out of 100) than did those with near-maximum DEMMI scores. CONCLUSIONS Patient self-report of anticipated performance is an acceptable proxy for DEMMI scores derived from the therapist rating of performance. Caution should be exercised when interpreting self-report scores of patients with near-maximum levels of mobility. Further research is required to establish whether these results can be generalized across a range of patient populations and to clinicians with differing backgrounds and expertise.
Collapse
Affiliation(s)
- Romi Haas
- Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia; Monash Health Allied Health Research Unit, Cheltenham, Victoria, Australia.
| | - Kelly-Ann Bowles
- Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia; Monash Health Allied Health Research Unit, Cheltenham, Victoria, Australia
| | - Lisa O'Brien
- Monash Health Allied Health Research Unit, Cheltenham, Victoria, Australia; Department of Occupational Therapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia
| | - Terry Haines
- Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia; Monash Health Allied Health Research Unit, Cheltenham, Victoria, Australia
| |
Collapse
|
36
|
Functional training and timed nutrition intervention in infectious medical patients. Eur J Clin Nutr 2016; 70:1039-45. [DOI: 10.1038/ejcn.2016.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/25/2016] [Accepted: 03/14/2016] [Indexed: 12/22/2022]
|
37
|
Dasenbrock L, Berg T, Lurz S, Beimforde E, Diekmann R, Sobotka F, Bauer JM. [The De Morton Mobility Index for evaluation of early geriatric rehabilitation]. Z Gerontol Geriatr 2016; 49:398-404. [PMID: 27259707 DOI: 10.1007/s00391-016-1061-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 02/16/2016] [Accepted: 03/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The timed up and go (TUG) test and the Tinetti test are most frequently used in Germany to document the success of rehabilitation in early geriatric rehabilitation. However, there has been some uncertainty whether these instruments can describe the entire spectrum of mobility with adequate precision and whether they can be successfully applied for repeated assessments during rehabilitation. Against this background the De Morton Mobility Index (DEMMI) has been developed and validated. OBJECTIVE The aim of this study was to evaluate the suitability of the DEMMI compared to the TUG and Tinetti tests in early geriatric rehabilitation. MATERIAL AND METHODS Ceiling and floor effects of the DEMMI, the TUG test, the Tinetti test and the Barthel Index (BI) were determined. Correlations were calculated using the Spearman correlation coefficient. Effects on the DEMMI were estimated through multiple linear regression. RESULTS A total of 144 patients with an average age of 84.91 years (SD ±5.77) and 65.97 % females participated in this study. The mean value for the DEMMI was 33.45 (SD ±15.37) points at admission and 43.90 (SD ±15.55) at discharge (n = 144). Floor effects were observed in the TUG test in 84.72 % (n = 122) of patients at admission and in 60.42 % (n = 87) at discharge. The DEMMI, Tinetti test and BI showed no floor or ceiling effects. The correlation between the DEMMI and the TUG test was -0.48 at admission and -0.49 at discharge, between the DEMMI and the Tinetti test 0.75 and 0.82, respectively and between the DEMMI and the BI 0.54 and 0.66, respectively (p < 0,01). CONCLUSION Significant correlations with the TUG test, the Tinetti test and the BI, together with the lack of floor and ceiling effects provide evidence that the DEMMI is an appropriate tool to assess mobility in early geriatric rehabilitation. The lack of floor and ceiling effects appears to make the DEMMI a superior tool compared to the TUG test.
Collapse
Affiliation(s)
- L Dasenbrock
- Universitätsklinik für Geriatrie am Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.
| | - T Berg
- Universitätsklinik für Geriatrie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - S Lurz
- Universitätsklinik für Geriatrie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - E Beimforde
- Universitätsklinik für Geriatrie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - R Diekmann
- Universitätsklinik für Geriatrie am Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - F Sobotka
- Abteilung Epidemiologie und Biometrie im Department Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - J M Bauer
- Universitätsklinik für Geriatrie am Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.,Universitätsklinik für Geriatrie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| |
Collapse
|
38
|
Pinto-Carral A, Fernández-Villa T, Molina de la Torre AJ. Patient-Reported Mobility: A Systematic Review. Arch Phys Med Rehabil 2016; 97:1182-94. [PMID: 26898389 DOI: 10.1016/j.apmr.2016.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify the self-administered instruments to assess mobility in adults with disability, to link the mobility assessed by these instruments to the International Classification of Functioning, Disability and Health (ICF), and to evaluate their methodological quality. DATA SOURCES Scopus, Science Direct, and Web of Science were systematically searched up to July 2015. STUDY SELECTION Studies on the development and validation of self-administered questionnaires in which at least half of the items were related to movement or mobility were included. DATA EXTRACTION The mobility assessed by the instruments was classified according to the ICF categories. The methodological quality was assessed according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. DATA SYNTHESIS Of 5791 articles, 34 studies were eligible for inclusion. Only 10 of the instruments contained items that exclusively assessed mobility. The most frequently linked ICF categories were "changing basic body position" (19.4%), "walking" (14.8%), and "moving around" (13.5%). Measurement properties evaluated included internal consistency (5 studies), reliability (5 studies), measurement error (1 study), content validity (9 studies), structural validity (4 studies), hypotheses testing (6 studies), and responsiveness (1 study). Only content validity obtained the highest quality, probably because the studies included in the review reported the development and initial validation of the instruments. CONCLUSIONS Self-administered mobility questionnaires published in the scientific literature assess mobility activities rather than functions related to movement, and do so from the perspective of disability, frequently including self-care and domestic life as domains for assessment. The instruments that presented the highest methodological quality were the Outpatient Physical Therapy Improvement in Movement Assessment Log, the Movement Ability Measure, and the Mobility Activities Measure for Inpatient Rehabilitation Settings.
Collapse
Affiliation(s)
- Arrate Pinto-Carral
- School of Health Science, SALBIS Research Group, University of León, León, Spain.
| | - Tania Fernández-Villa
- Research Group on Gene-Environment Interactions and Health (GIIGAS), University of León, León, Spain
| | | |
Collapse
|
39
|
[Hierarchical assessment of balance and mobility : German translation and cross-cultural adaptation]. Z Gerontol Geriatr 2016; 49:386-97. [PMID: 26861790 DOI: 10.1007/s00391-016-1026-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/21/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The hierarchical assessment of balance and mobility (HABAM) is an internationally established clinical mobility test which has good psychometric properties, allows an easy assessment of mobility and the graphical illustration of change over time in geriatric patients. The aims of this study were the translation and cross-cultural adaptation of the English original HABAM into the German language as well as a preliminary analysis of the practicability and construct validity of the HABAM. MATERIAL AND METHODS The HABAM was translated into German following international guidelines. A prefinal version was clinically tested by physiotherapists in two geriatric hospitals over a period of 5 weeks. In order to make a final revision of the German HABAM version, structured in-depth feedback was obtained from the seven therapists who had used the HABAM most often. RESULTS A total of 18 physiotherapists used the HABAM for 47 elderly inpatients for the initial assessment. The translated items and instructions seemed comprehensible but problems occurred concerning the conducting and documentation of the HABAM. Modifications led to the final German HABAM version and 85 % of the HABAM assessments were performed within ≤ 10 min. There was a correlation of rs= 0.71 with the Tinetti test and of rs = 0.68 with the Barthel index. CONCLUSION A German HABAM version is now accessible for use in clinical practice. The results of a preliminary psychometric analysis indicate a potentially good practicability and sufficient construct validity. A comprehensive analysis of psychometric properties is pending.
Collapse
|
40
|
[German version of the de Morton mobility index. First clinical results from the process of the cross-cultural adaptation]. Z Gerontol Geriatr 2015; 48:154-63. [PMID: 25388543 DOI: 10.1007/s00391-014-0648-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The English version of the de Morton Mobility Index (DEMMI) enables allied health professions in an inpatient setting to assess the mobility of geriatric patients in a reliable, valid, easy and fast way, without showing any floor or ceiling effects. The aim of this study was the DEMMI's cross-cultural adaption into German language with further analysis of some of its psychometric properties based on this process. MATERIAL AND METHODS Translation was done in a multistage procedure following international recommendations. Within clinical pilot testing the DEMMI was routinely applied over a period of 3 weeks in a geriatric hospital. User experiences were evaluated in a qualitative way and DEMMI test results were analyzed with the focus on practicability and responsiveness. RESULTS A German DEMMI version has been translated and performed with 133 patients. The test takes approximately 10 min to administer, is save and easy to use and does not show any floor or ceiling effects. The DEMMI is valid for the whole mobility spectrum, that is why mobility changes can be realized sufficiently in contrast to the Timed Up And Go Test. CONCLUSION The DEMMI is already applicable in the German-speaking world. However, further research on its validity and reproducibility are desirable.
Collapse
|
41
|
Pieber K, Herceg M, Paternostro-Sluga T, Pablik E, Quittan M, Nicolakis P, Fialka-Moser V, Crevenna R. Reliability, validity, sensitivity and internal consistency of the ICF based Basic Mobility Scale for measuring the mobility of patients with musculoskeletal problems in the acute hospital setting: a prospective study. BMC Musculoskelet Disord 2015; 16:187. [PMID: 26242302 PMCID: PMC4525726 DOI: 10.1186/s12891-015-0638-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/16/2015] [Indexed: 01/01/2023] Open
Abstract
Background The assessment of mobility is important in the acute care setting. Existing tests suffer from limitations. The aim of the study was to examine the inter-rater reliability, the validity, the sensitivity to change, and the internal consistency of an ICF based scale. Methods In a prospective study inpatients in the acute care setting with restricted mobility aged above 50 years assigned to rehabilitative treatment were included. Assessment of subscales of the Functional Independence Measure (FIM) and the ICF based Basic Mobility Scale (BMS) were performed at admission and before discharge. Furthermore pain, length of stay in hospital, and post-discharge residential status were recorded. Inter-rater reliability, criterion-concurrent validity, sensitivity to change, and internal consistency were calculated. Furthermore, floor and ceiling effects were determined. Results One hundred twenty-five patients (79 women/46 men) were included. The BMS showed an excellent inter-rater reliability for the total BMS (ICC BMS: 0.85 (95 % CI: 0.81–0.88). The criterion-concurrent validity was high to excellent (Spearman correlation coefficient: −0.91 in correlation to FIM) and the internal consistency was good (Cronbach’s alpha 0.88). The BMS proved to be sensitive to improvements in mobility (Wilcoxon’s signed rank test: p < 0.0001; The effect size for the BMS was 1.075 and the standardized response mean 1.10. At admission, the BMS was less vulnerable to floor effects. Conclusions The BMS may be used as a reliable and valid tool for the assessment of mobility in the acute care setting. It is easy to apply, sensitive to change during the hospital stay and not vulnerable to floor and ceiling effects. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0638-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Karin Pieber
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna General Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Malvina Herceg
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna General Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Tatjana Paternostro-Sluga
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna General Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Eleonore Pablik
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
| | - Michael Quittan
- Institute of Physical Medicine and Rehabilitation and Karl Landsteiner Institute of Remobilization and Functional Health, Kaiser Franz-Joseph Hospital, Vienna, Austria.
| | - Peter Nicolakis
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna General Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Veronika Fialka-Moser
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna General Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna General Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| |
Collapse
|
42
|
Braun T, Schulz RJ, Reinke J, van Meeteren NL, de Morton NA, Davidson M, Thiel C, Grüneberg C. Reliability and validity of the German translation of the de Morton Mobility Index (DEMMI) performed by physiotherapists in patients admitted to a sub-acute inpatient geriatric rehabilitation hospital. BMC Geriatr 2015; 15:58. [PMID: 25935559 PMCID: PMC4424447 DOI: 10.1186/s12877-015-0035-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobility is a key outcome in geriatric rehabilitation. The de Morton Mobility Index (DEMMI) is an internationally well-established, unidimensional measure of mobility with good psychometric properties. The aim of this study was to examine the reliability and construct validity of the German translation of the DEMMI in geriatric inpatients. METHODS This cross-sectional study included patients admitted to a sub-acute inpatient geriatric rehabilitation hospital (reliability sample: N = 33; validity sample: N = 107). Reliability, validity, and unidimensionality were investigated. RESULTS Inter-rater reliability between two graduate physiotherapists was excellent, with intra-class correlation coefficient of 0.94 (95% confidence interval: 0.88-0.97). The minimal detectable change with 90% confidence was 9 points. Construct validity for the DEMMI was evidenced by significant moderate to strong correlations with other measures of mobility and related constructs (Performance Oriented Mobility Assessment: rho = 0.89; Functional Ambulation Categories: rho = 0.70; six-minute walk test: rho = 0.73; gait speed: rho = 0.67; Falls Efficacy Scale International: rho = -0.68). Known-groups validity was indicated by significant DEMMI mean group differences between independent versus dependent walkers and walking aid users versus non-users. Unidimensionality of the German DEMMI translation was confirmed by Rasch analysis. CONCLUSIONS The German translation of the DEMMI is a unidimensional instrument producing valid and reproducible measurement of mobility in an inpatient geriatric rehabilitation setting.
Collapse
Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, Universitätsstr. 105, 44789, Bochum, Germany. .,University of Cologne, Medical Faculty, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Ralf-Joachim Schulz
- Department of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany.
| | - Julia Reinke
- Catholic Clinic Bochum, Ruhr-University Bochum, Marien-Hospital Wattenscheid, Parkstr. 15, 44866, Bochum, Germany.
| | - Nico L van Meeteren
- Health~Holland, Topsector Life Sciences and Health, 2509, The Hague, The Netherlands. .,CAPHRI, Maastricht University, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands.
| | - Natalie A de Morton
- Donvale Rehabilitation Hospital, Ramsay Health, 1119 Doncaster Road, Donvale, VIC, 3111, Australia.
| | - Megan Davidson
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Christian Thiel
- Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, Universitätsstr. 105, 44789, Bochum, Germany.
| | - Christian Grüneberg
- Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, Universitätsstr. 105, 44789, Bochum, Germany.
| |
Collapse
|
43
|
Lund K, Oestergaard LG, Maribo T. Reliability and internal consistency of the Danish version of Loewenstein Occupational Therapy Cognitive Assessment 2nd Edition (LOTCA-II/D). Scand J Occup Ther 2014; 21:473-8. [DOI: 10.3109/11038128.2014.925504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
44
|
Kwok TMK, Tong CY. Effects on centre-based training and home-based training on physical function, quality of life and fall incidence in community dwelling older adults. Physiother Theory Pract 2013; 30:243-8. [DOI: 10.3109/09593985.2013.867387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
Tibaek S, Andersen CW, Pedersen SF, Rudolf KS. Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients? A single-blinded randomized controlled trial. Clin Rehabil 2013; 28:319-28. [PMID: 24057894 DOI: 10.1177/0269215513501524] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients. DESIGN A single-blinded randomized controlled trial. SETTING Department of Geriatric Rehabilitation in university hospital. PARTICIPANTS A sample of 71 patients were successively included and randomized either to the treatment group (TG) (n = 36) or the control group (CG) (n = 35). Fifteen participants dropped out (TG n = 7; CG n = 8), leaving 56 participants with a mean age of 79 (SD 7). INTERVENTION Participants in the treatment group were treated in groups with progressive resistance strength training in addition to standard care. Progressive resistance strength training of the lower extremities was performed in three sets of 12-15 repetitions, intensity 60-70% of one repetition maximum, in four 50-minute sessions per week. MAIN MEASURES The effect was evaluated by timed up & go test, 30-second chair-stand test, 10-m walk test, three tasks (transfer, walking, stairs) of the Barthel Index, and use of walking aids. RESULTS Significant improvements in the 10-m walk test (P < 0.01) and Barthel Index (walking) (P = 0.01) were demonstrated within the treatment group but not in the control group. Both groups had significant improvements in timed up & go, 30-second chair-stand (modified) and Barthel Index (transfer and walking). No significant difference was found between groups except for the Barthel Index (stairs) (P = 0.05). Analysis by the mixed-effects model showed that the treatment group improved more than the control group in all outcome variables. CONCLUSION The results indicate that for older hospitalized patients progressive resistance strength training as additional training may have an effect compared to standard care, but no statistically significant effects were demonstrated when measured by functional outcomes.
Collapse
Affiliation(s)
- Sigrid Tibaek
- 1Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | | | | |
Collapse
|
46
|
Maribo T, Iversen E, Andersen NT, Stengaard-Pedersen K, Schiøttz-Christensen B. Intra-observer and interobserver reliability of One Leg Stand Test as a measure of postural balance in low back pain patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/175361409x12472218841040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
47
|
Chin RPH, Ho CH, Cheung LPC. Scheduled analgesic regimen improves rehabilitation after hip fracture surgery. Clin Orthop Relat Res 2013; 471:2349-60. [PMID: 23543417 PMCID: PMC3676603 DOI: 10.1007/s11999-013-2927-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/08/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative pain often is the limiting factor in the rehabilitation of patients after hip fracture surgery. QUESTIONS/PURPOSES We compared an approach using scheduled analgesic dosing with as-needed analgesic dosing in patients after hip fracture surgery, to compare these approaches in terms of (1) resting and dynamic pain intensity, (2) postoperative patient mobility, and (3) functional end points. METHODS We conducted a prospective cohort study of 400 patients who underwent surgical treatment of hip fractures at our hospital. The groups were formed sequentially, such that the first 200 patients formed the intervention group (treated with scheduled analgesic intake for the first 3 weeks after surgery), and the next 200 patients were the control group (treated using a protocol of analgesic administration on request). Resting and dynamic pain intensity, mobility, and functional performance were compared between the two analgesic protocols. RESULTS As expected, analgesic consumption was lower in the control group (tramadol doses, 27 versus 63; paracetamol doses, 29 versus 63). Despite the large difference in the amounts of analgesics consumed, resting and dynamic pain intensity showed improvement in each group and there was no difference between groups in terms of postoperative pain. However, there was a positive correlation between functional outcomes and analgesic consumption in the control group. The intervention group achieved higher functional performance on discharge (elderly mobility scale, 11 versus 8; functional independence measure, 88 versus 79). On discharge, fewer patients in the intervention group were wheelchair ambulators (3 versus 32), meaning more patients in the intervention group were able to walk. CONCLUSIONS The study showed that a scheduled analgesic intake can improve the functional outcomes of patients with geriatric hip fractures after surgery. LEVEL OF EVIDENCE Level II, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Raymond Ping-Hong Chin
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hospital Authority, 3/Floor, M Block, 30 Gascoigne Road, Jordon, Kowloon, Hong Kong, China ,Orthopaedic Rehabilitation Centre, Kowloon Hospital, Hospital Authority, Hong Kong, China
| | - Chin-Hung Ho
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hospital Authority, 3/Floor, M Block, 30 Gascoigne Road, Jordon, Kowloon, Hong Kong, China ,Orthopaedic Rehabilitation Centre, Kowloon Hospital, Hospital Authority, Hong Kong, China
| | - Lydia Po-Chee Cheung
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hospital Authority, 3/Floor, M Block, 30 Gascoigne Road, Jordon, Kowloon, Hong Kong, China ,Orthopaedic Rehabilitation Centre, Kowloon Hospital, Hospital Authority, Hong Kong, China
| |
Collapse
|
48
|
Lowe SA, Rodríguez-Molinero A, Glynn L, Breen PP, Baker PM, Sanford J, Jones BD, ÓLaighin G. New technology–based functional assessment tools should avoid the weaknesses and proliferation of manual functional assessments. J Clin Epidemiol 2013; 66:619-32. [DOI: 10.1016/j.jclinepi.2012.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/21/2012] [Accepted: 12/04/2012] [Indexed: 11/28/2022]
|
49
|
The need to standardize functional outcome in randomized trials of hip fracture: a review using the ICF framework. J Orthop Trauma 2013; 27:e1-8. [PMID: 22534689 DOI: 10.1097/bot.0b013e318252d3c4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The choice of ideal outcome assessment is complex with the ever-growing number of possible instruments found in the orthopaedic literature. It is critical to reach a worldwide consensus approach in identifying the specific measures to be used in study designs for evaluating treatment of patients with hip fracture. In this article, we present results from a systematic review of the measures being used currently to assess functional outcome in randomized trials. We used the International Classification of Functioning Disability and Health (ICF) framework for conceptualizing outcome after hip fracture trauma from a body, individual, and societal perspective. DATA SOURCES Relevant articles from 1980 to 2008 (week 52) were found using PubMed, Ovid MEDLINE, Cochrane, Ovid Healthstar, EMBASE, and CINAHL. STUDY SELECTION Studies were included if (1) patients were older than 65 years and managed postoperatively after a hip fracture and (2) the studies were randomized and in the English language. DATA EXTRACTION The intervention, sample size, follow-up, intention-to-treat analysis, mode of administration, and functional outcome domains and concepts using the ICF were recorded for each study. DATA SYNTHESIS Ninety-seven studies containing 82 different instruments for assessing functional outcome were included. Those trials with a low risk of bias relied upon standardized patient-reported outcomes when compared with those trials with a high risk of bias that adopted more investigator-developed instruments. Nineteen percent of the trials used the Harris hip score, 14% used the Katz activities of daily living index, and 10% used the new mobility score. CONCLUSIONS We believe that standardized patient-reported outcomes should be used to assess functional outcome after hip fracture and more rigor is needed when conducting surgical trials in this area. Variation in outcome measures across trials leads to several problems. Clinicians may not be able to interpret their findings when different measures are used. Researchers will not be able to calculate summary treatment effects. Our findings are based on a process for delineating the categories from within the ICF framework that may serve, in the future, as a comprehensive foundation of content for outcomes in the area of hip fractures.
Collapse
|
50
|
Taylor LM, Maddison R, Pfaeffli LA, Rawstorn JC, Gant N, Kerse NM. Activity and Energy Expenditure in Older People Playing Active Video Games. Arch Phys Med Rehabil 2012; 93:2281-6. [DOI: 10.1016/j.apmr.2012.03.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 03/05/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
|