Abstract
BackgroundInterventions that enhance mobility in frail older people are needed to maintain health and independence, yet definitive evidence of effective interventions is lacking. Our objective was to assess the impact of a multifactorial intervention on mobility-related disability in frail older people.MethodsWe conducted a randomised, controlled trial with 241 frail community-dwelling older people in Sydney, Australia. Participants were classified as frail using the Cardiovascular Health Study definition, did not have severe cognitive impairment and were recently discharged from an aged care and rehabilitation service. The experimental group received a 12 month multifactorial, interdisciplinary intervention targeting identified frailty components. Two physiotherapists delivered a home exercise program targeting mobility, and coordinated management of psychological and medical conditions with other health professionals. The control group received usual care. Disability in the mobility domain was measured at baseline and at 3 and 12 months using the International Classification of Functioning, Disability and Health framework. Participation (involvement in life situations) was assessed using the Life Space Assessment and the Goal Attainment Scale. Activity (execution of mobility tasks) was measured using the 4-metre walk and self-report measures.ResultsThe mean age of participants was 83.3 years (SD: 5.9 years). Of the participants recruited, 216 (90%) were followed-up at 12 months. At this time point, the intervention group had significantly better scores than the control group on the Goal Attainment Scale (odds ratio 2.1; 95% confidence interval (CI) 1.3 to 3.3, P = 0.004) and Life Space Assessment (4.68 points, 95% CI 1.4 to 9.9, P = 0.005). There was no difference between groups on the global measure of participation or satisfaction with ability to get out of the house. At the activity level, the intervention group walked 0.05 m/s faster over 4 m (95% CI 0.0004 to 0.1, P = 0.048) than the control group, and scored higher on the Activity Measure for Post Acute Care (P < 0.001).ConclusionsThe intervention reduced mobility-related disability in frail older people. The benefit was evident at both the participation and activity levels of mobility-related disability.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ANZCTRN12608000507381.
Highlights
Interventions that enhance mobility in frail older people are needed to maintain health and independence, yet definitive evidence of effective interventions is lacking
The ability to mobilise is important in this vulnerable population, as gait speed is associated with mortality [8] and dependence in older people, yet the majority of frail older people walk more slowly than average [9] and report restricted mobility in the community [7]
Statistical significance was set at P < 0.05 and we reported the differences in percentage or mean (95% confidence interval (CI)) between the two groups at the 3-month and 12-month follow-ups
Summary
Interventions that enhance mobility in frail older people are needed to maintain health and independence, yet definitive evidence of effective interventions is lacking. As the proportion of older people rises globally, the ability to each of these levels; sarcopenia and muscle weakness are prevalent [1], limitations in performing activities (for example, walking, basic activities of daily living) are common [5,6], and 80% of frail older people experience restricted participation in life roles [7]. There is little evidence to guide interventions to prevent or reduce mobility-related disability in frail older people, in terms of participation in life roles. Mobility outcomes are predominantly evaluated at the activity level (for example, speed of gait and stair climbing, basic activities of daily living) and the few studies that have measured participation in life roles used global measures that show participation across multiple domains of life [10], so the effect of intervention on participation in the mobility domain is unknown. The optimal intervention to improve mobility-related participation in life situations remains unclear with few controlled trials
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