Abstract
BackgroundOlder people are often admitted for rehabilitation to improve walking, yet not everyone improves. The aim of this study was to determine key factors associated with a positive response to hospital-based rehabilitation in older people.MethodsThis was a secondary data analysis from a multisite randomized controlled trial. Older people (n= 198, median age 80.9 years, IQR 76.6- 87.2) who were admitted to geriatric rehabilitation wards with a goal to improve walking were recruited. Participants were randomized to receive additional daily physical therapy focused on mobility (n = 99), or additional social activities (n = 99). Self-selected gait speed was measured on admission and discharge. Four participants withdrew. People who changed gait speed ≥0.1 m/s were classified as ‘responders’ (n = 130); those that changed <0.1m/s were classified as ‘non-responders’ (n = 64). Multivariable logistic regression explored the association of six pre-selected participant factors (age, baseline ambulation status, frailty, co-morbidities, cognition, depression) and two therapy factors (daily supervised upright activity time, rehabilitation days) and response.ResultsResponding to rehabilitation was associated with the number of days in rehabilitation (OR 1.04; 95% CI 1.00 to 1.08; p = .039) and higher Mini Mental State Examination scores (OR 1.07, 95% CI 1.00 – 1.14; p = .048). No other factors were found to have association with responding to rehabilitation.ConclusionIn older people with complex health problems or multi-morbidities, better cognition and a longer stay in rehabilitation were associated with a positive improvement in walking speed. Further research to explore who best responds to hospital-based rehabilitation and what interventions improve rehabilitation outcomes is warranted.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740.
Highlights
Older people are often admitted for rehabilitation to improve walking, yet not everyone improves
Some studies have shown that comorbidities, cognition and frailty are associated with poor rehabilitation outcomes; [8,9,10] others have found no association with rehabilitation response [11,12,13,14,15,16,17,18]
Of the 194 participants included in analysis, 130 (67 %) participants were classified as responders and 64 (33 %) participants were classified as non-responders
Summary
Older people are often admitted for rehabilitation to improve walking, yet not everyone improves. Older people are more likely to have multiple co-morbidities, cognitive impairment and frailty [4, 5] These factors are associated with less optimal health outcomes, [6, 7] associations with response to rehabilitation is less well understood. Some studies have shown that comorbidities, cognition and frailty are associated with poor rehabilitation outcomes; [8,9,10] others have found no association with rehabilitation response [11,12,13,14,15,16,17,18] Factors such as age, ambulation status on admission to hospital rehabilitation and depression may affect rehabilitation outcomes [10, 19]
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