Gait Speed Improves During Physical Therapy in General Acute Care, Skilled Nursing, and Inpatient Rehabilitation - a Pilot Study

Abstract

Objective: To describe gait speed and gait speed changes that occurred in patients who received physical therapy in general health care settings of acute care, skilled nursing, and inpatient rehabilitation settings. Design: Pre-post observational cross-sectional study of changes in gait speed. Setting: Acute care, skilled nursing, and inpatient rehabilitation facilities of a regional medical center in the United States. Participants: Individuals (n=110) admitted with physical therapy referrals with full weight bearing status who could ambulate 20 feet and consented to participate. Main Outcome Measure: Change in gait speed from initial visit to therapy discharge. Results: Two-way mixed ANOVA determined that mean gait speed improved significantly between initial and discharge time points (p<.001). An interaction effect between gait speed and health care settings (p<.001), indicated varying levels of speed achieved across different health care settings. Post hoc tests using Bonferroni adjustments showed acute care discharge gait speed was not significantly different from skilled nursing (p=0.352), but inpatient rehabilitation was significantly different from both acute care (p<.001) and skilled nursing (p=0.02) units. Paired t-tests of the individual health care settings revealed that gait speed was significantly improved in acute care [initial vs. discharge; 0.31(0.22) vs. 0.38 (0.21) m/s], skilled nursing [0.36 (0.19) vs. 0.61(0.39) m/s], and inpatient rehabilitation [0.60( 0.70) vs. 0.98 (0.72) m/s]. Minimal detectable change for gait speed was 0.16m/s in acute care, 0.14m/s in skilled nursing, and 0.51m/s inpatient rehabilitation. Conclusions: Self-selected gait speed is an informative measure. Gait speed improved from physical therapy initial evaluation to discharge in 3 different health care settings. In acute care, gait speeds improved over a short course of therapy, but these speeds would still be considered to be slow relative to community requirements. In skilled nursing and inpatient rehabilitation, patients achieve gait speeds required for limited community level ambulation.