Abstract
BackgroundOlder adults who have received inpatient rehabilitation often have significant mobility disability at discharge. Physical activity levels in rehabilitation are also low. It is hypothesized that providing increased physical activity to older people receiving hospital-based rehabilitation will lead to better mobility outcomes at discharge.Methods/DesignA single blind, parallel-group, multisite randomized controlled trial with blinded assessment of outcome and intention-to-treat analysis. The cost effectiveness of the intervention will also be examined. Older people (age >60 years) undergoing inpatient rehabilitation to improve mobility will be recruited from geriatric rehabilitation units at two Australian hospitals. A computer-generated blocked stratified randomization sequence will be used to assign 198 participants in a 1:1 ratio to either an ‘enhanced physical activity’ (intervention) group or a ‘usual care plus’ (control) group for the duration of their inpatient stay. Participants will receive usual care and either spend time each week performing additional physical activities such as standing or walking (intervention group) or performing an equal amount of social activities that have minimal impact on mobility such as card and board games (control group). Self-selected gait speed will be measured using a 6-meter walk test at discharge (primary outcome) and 6 months follow-up (secondary outcome). The study is powered to detect a 0.1 m/sec increase in self-selected gait speed in the intervention group at discharge. Additional measures of mobility (Timed Up and Go, De Morton Mobility Index), function (Functional Independence Measure) and quality of life will be obtained as secondary outcomes at discharge and tertiary outcomes at 6 months follow-up. The trial commenced recruitment on 28 January 2014.DiscussionThis study will evaluate the efficacy and cost effectiveness of increasing physical activity in older people during inpatient rehabilitation. These results will assist in the development of evidenced-based rehabilitation programs for this population.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000884707 (Date of registration 08 August 2013); ClinicalTrials.gov Identifier NCT01910740 (Date of registration 22 July 2013).
Highlights
Older adults who have received inpatient rehabilitation often have significant mobility disability at discharge
This study will evaluate the efficacy and cost effectiveness of increasing physical activity in older people during inpatient rehabilitation. These results will assist in the development of evidenced-based rehabilitation programs for this population
Loss of mobility is a major determinant of the need for inpatient rehabilitation for older adults [57]
Summary
Loss of mobility is a major determinant of the need for inpatient rehabilitation for older adults [57]. There is currently little evidence to guide clinicians in the management for older people admitted to rehabilitation. This study will assess both the shorter and longer term (6 months following discharge) functional outcomes and healthcare utilization of participants who undergo a program to increase their physical activity in addition to usual rehabilitation compared to those who only receive usual rehabilitation plus social interaction. The results of this study will inform current rehabilitation practice in Australia and worldwide, and will contribute to the development of clinical practice guidelines. Authors’ contributions The protocol was developed by CMS, MM, JMcG, CSz, JB, KH, DL, MW, and BW. All authors reviewed the final manuscript prior to submission. All authors read and approved the final manuscript
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