De Morton Mobility Index Research Articles

Effect of goal-directed mobilisation versus standard care on physical functioning among medical inpatients: the GoMob-in randomised, controlled trial

ObjectiveTo assess the effect of goal-directed mobilisation (GDM) on physical functioning in medical inpatients.DesignRandomised, controlled, single-centre, parallel, superiority trial with a 3-month follow-up and blinded outcome assessment.SettingGeneral internal medicine wards...

Increased knee-extension strength and steps per day after a novel post-hospitalization rehabilitative program in older adults (65+): Secondary analyses of a randomized controlled single-blinded trial using an expanded sample size

IntroductionOlder adults are at risk of developing new or worsened disability when hospitalized for acute medical illness. This study is a secondary analysis of the STAND-Cph trial on the effect of a simple strength training intervention initiated during hospitalization and continued after discharge. We investigated the between-group difference in change in functional performance outcomes, the characteristics of patients who experienced a relevant effect of the intervention, and the characteristics of those who were compliant with the intervention, using an expanded sample size as protocolized. MethodsThe STAND-Cph was a randomized controlled trial conducted at a major Danish university hospital. Acutely admitted older adult patients (65+) from the Emergency Department were randomized to the intervention group receiving progressive strength training and a protein supplement during and after hospitalization (12 sessions over 4 weeks) or control group receiving usual care. The primary outcome was the de Morton Mobility Index assessed at baseline and 4 weeks after discharge. The secondary outcomes were 24-h mobility (assessed by ActivPAL accelerometers), isometric knee-extension strength, 30 s. sit-to-stand performance, and habitual gait speed. ResultsBetween September 2013 and September 2018, a total of 158 patients were included and randomized to either the intervention group (N = 80; mean age 79.9 ± 7.6 years) or the control group (N = 78; mean age 80.8 ± 7.4 years). We found no significant between-group difference in change in our primary outcome (p > 0.05). Both the intention-to-treat (difference in change 0.14 Nm/kg (95 % CI 0.03;0.24), p = 0.01) and the per protocol (difference in change 0.16 Nm/kg (95 % CI 0.04;0.29), p = 0.008) analyses showed that between baseline and 4 weeks, knee-extension strength increased significantly more in the intervention group than in the control group. Also, the per protocol analysis showed that the intervention group increased their daily number of steps significantly more than the control group (difference in change 1088 steps (95 % CI 44; 2132); p = 0.04). When examining subgroups of patients, we found no significant differences neither between those who experienced a clinically relevant improvement in the de Morton Mobility Index and those who did not, nor between those who were compliant and those who were not. ConclusionThis exploratory analysis indicates that while simple progressive strength training and protein supplementation does not improve functional performance assessed by the de Morton Mobility Index, it can benefit specific facets of physical activity and muscle strength among geriatric patients.

Applications of de Morton Mobility Index on the Middle-Aged Population—Post Cholecystectomy: A Preliminary Report

Applications of de Morton Mobility Index on the Middle-Aged Population—Post Cholecystectomy: A Preliminary Report

Feasibility of prehabilitation for patients awaiting total knee arthroplasty; a pilot study

ObjectiveTo examine the feasibility of conducting a preoperative home-based prehabilitation program for total knee arthroplasty patients at risk for delayed in-hospital recovery, and to explore the pre- and postoperative impact of this program. DesignA retrospective cohort study with matched controls, enabling subgroup analyses. SettingHome-based. SubjectsPatients awaiting primary unilateral total knee arthroplasty between 2019 and 2020, were compared with matched historic cases from 2016 to 2017. Matching criteria were scoring ≤17 points on the De Morton Mobility Index and >12.5 s on the timed-up-and-go test. InterventionSupervised home-based prehabilitation program versus no prehabilitation. OutcomesFeasibility, determined by recruitment rate, adherence, and safety of the program. Preoperative impact, assessed for the intervention group by differences in mean values for aerobic capacity, muscle strength and functional mobility between the first and last sessions. Postoperative impact was defined as the time needed to achieve in-hospital independence of physical function and was measured by the differences in mean values between the intervention and control groups. ResultsRecruitment rate was 71 %; adherence and drop-out rates were 88 % and 12 % respectively. No adverse events were reported. Preoperatively, the intervention group showed significant improvements in aerobic capacity on the 2-min walking test (84.29 m–98.06 m; p = 0.007) and 2-min step test (40.35 steps to 52.95 steps; p = 0.014), muscle strength on the 30 s chair stand test (7.3 stands to 10.1 stands; p = 0.002), and functional mobility as seen in the timed-up-and-go-test (19.52 s–15.85 s; p = 0.031). Postoperatively, the intervention group achieved in-hospital independence of physical function earlier (mean rank 16.11) than the control group (mean rank 24.89; p=<0.01). ConclusionsIt is feasible to conduct a prehabilitation program 4–6 weeks preoperatively, for high-risk patients awaiting total knee arthroplasty. Additionally, the program appears to have a positive impact on physical fitness both pre- and postoperatively.

EFFECTIVENESS OF THE LEBED METHOD THERAPEUTIC INTERVENTION ON PHYSICAL STABILITY AMONG ELDERLY INDIVIDUALS IN KAKAMEGA COUNTY

Background. In Kenya, falls among individuals over 60 years of age are a major concern. Despite physical activity being known to reduce fall risks, existing studies face challenges like high drop-out rates and limited exercise types. The Lebed Method, a dance program originally developed for breast cancer survivors by Sherry Lebed Davis, has shown potential to improve physical and emotional well-being. This study aimed to explore its effectiveness in improving physical stability among the elderly in Kakamega County. Methods. The study involved a community-based randomized control trial with 30 participants aged 60 and older, selected based on low social support scores. They were divided into intervention and control groups, meeting specific inclusion criteria. Baseline functional stability (mobility and balance) was assessed by Timed Up and Go (TUG), Berg Balance Scale (BBS) scores, gait speed time, and de Morton Mobility Index (DEMMI) score. To ensure the reliability of the study, biases such as selection, performance, detection, attrition, and reporting biases were addressed. Changes in physical stability between the groups were analyzed using the Analysis of Covariance, accounting for baseline differences, while within-group changes were evaluated using the dependent sample t-test. The threshold for statistical significance was set at p &lt; 0.05. Results. The findings showed that the intervention group improved significantly in physical stability compared to the control group. Specifically, notable enhancements were observed on TUG times (p &lt; .001, ηp2 = 0.53, d = 3.38), BBS scores (p &lt; .001, ηp2 = 0.64, d = 1.97), gait speed (p &lt; .001, ηp2 = 0.65, d = 1.99) and DEMMI score (p &lt; .001, ηp2 = 0.38, d = 1.94). Conclusions. The intervention significantly improved mobility and balance among participants, demonstrating the effectiveness of the Lebed method for elderly individuals. Future research could explore specific components of dance-based therapy that contribute to functional mobility and balance improvements

Validation of the de Morton mobility index (DEMMI) among acute stroke patients aged ≥65 years: a register study

Purpose To validate the de Morton Mobility Index (DEMMI) in older (≥65 years) patients with acute stroke in a hospital setting within the first week after stroke onset. Materials and methods In the Danish National Database of Geriatrics, we identified 4,176 patients with acute stroke (≥65 years). Floor and ceiling effects of DEMMI were investigated. Furthermore, convergent validity was investigated by correlations between DEMMI and the Barthel Index using Spearman’s rho. Known-groups validity was tested by comparing DEMMI scores for different groups (with/without dementia, depression, comorbidity, and walking aids), and unidimensionality of DEMMI was evaluated by Mokken scale analysis. Results A floor effect was identified with 22.1% of the patients scoring 0 on DEMMI on admission. Both convergent and known-groups validity were confirmed for DEMMI. Patients who were bedbound had a lower DEMMI score (median [IQR]: 0 [0;0]) than patients without any walking aid (median [IQR]: 62 [33;74]). Furthermore, Mokken scale analysis identified unidimensionality with overall fit to the model (Loevinger H 0.88 (p < 0.0001)). Conclusion DEMMI is a valid instrument for use in patients with acute stroke (≥65 years) in a hospital setting within the first week after stroke onset.

The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report

BackgroundTotal pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear.Case presentationA 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis.ConclusionStandardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.

Predicting Delayed In-Hospital Recovery of Physical Function After Total Knee Arthroplasty

ObjectiveTo identify patients at high risk of delayed in-hospital functional recovery after knee replacement surgery by developing and validating a prediction model, including a combination of preoperative physical fitness parameters and patient characteristics. DesignRetrospective cohort study using binary logistic regression. SettingUniversity hospital, orthopedic department. Participants260 adults (N=260) (≥18y) with knee osteoarthritis awaiting primary unilateral total knee arthroplasty and assessed during usual care between 2016 and 2020. InterventionNot applicable. Main Outcome MeasuresTime to reach in-hospital functional independence (in days), measured by the modified Iowa Level of Assistance Scale. A score of 0 means completely independent. Potential predictor variables are a combination of preoperative physical fitness parameters and patient characteristics. ResultsBinary logistic regression modeling was applied to develop the initial model. A low de Morton Mobility Index (DEMMI), walking aid use indoors, and a low handgrip strength (HGS) were the most important predictors of delayed in-hospital recovery. This model was internally validated and had an optimism-corrected R2 of 0.07 and an area under curve of 61.2%. The probability of a high risk of delayed in-hospital recovery is expressed by the following equation:Phighrisk=(1/(1+e(−(2.638−0.193×DEMMI+0.879×indoorwalkingaid−0.007×HGS))))×100%. ConclusionsThe model has a low predictive value and a poor discriminative ability. However, there is a positive association between preoperative physical fitness and postoperative recovery of physical function. The validity of our model to distinguish between high and low risk, based on preoperative fitness values and patient characteristics, is limited.

Association between reduced physical performance measures and short-term consequences after major emergency abdominal surgery: a prospective cohort study

BackgroundMajor emergency abdominal surgery is associated with high morbidity with outcomes worse than for similar elective surgery, including complicated physical recovery, increased need for rehabilitation, and prolonged hospitalisation.PurposeTo investigate whether low physical performance test scores were associated with an increased risk of postoperative complications, and, furthermore, to investigate the feasibility of postoperative performance tests in patients undergoing major emergency abdominal surgery. We hypothesize that patients with low performance test scores suffer more postoperative complications.MethodsThe study is a prospective observational cohort study including all patients who underwent major abdominal surgery at the Department of Surgery at Zealand University Hospital between 1st March 2017 and 31st January 2019. Patients were evaluated with De Morton Mobility Index (DEMMI) score, hand grip strength, and 30-s chair-stand test.ResultsThe study included 488 patients (median age 69, 50.6% male). Physiotherapeutic evaluation including physical performance tests with DEMMI and hand grip strength in the immediate postoperative period were feasible in up to 68% of patients undergoing major emergency abdominal surgery. The 30-s chair-stand test was less viable in this population; only 21% of the patients could complete the 30-s chair-stand test during the postoperative period. In logistic regression models low DEMMI score (< 40) and ASA classification and low hand grip strength (< 20 kg for women, < 30 kg for men were independent risk factors for the development of postoperative severe complications Clavien–Dindo (CD) grade ≥ 3.ConclusionsIn patients undergoing major emergency surgery low performance test scores (DEMMI and hand grip strength), were independently associated with the development of significant postoperative complications CD ≥ 3.

The De Morton Mobility Index (DEMMI) in hospitalized geriatric patients is associated with risk of readmission, mortality, and discharge to a post-acute care facility: A nationwide register-based cohort study

ObjectiveTo examine the association between the de Morton Mobility Index (DEMMI) score on admission in geriatric patients and readmission and mortality within 30, 180, and 365 days after discharge, and discharge to a post-acute care facility. MethodsA nationwide register-based cohort study including 23,941 geriatric in-patients aged ≥65 years admitted to a geriatric ward between 2014 and 2017 and included in the Danish National Database for Geriatrics. The DEMMI score was categorized into four subcategories: very low mobility (DEMMI=0–24), low mobility (DEMMI=27–39), moderately reduced mobility (DEMMI=41–57), and independent mobility (DEMMI=62–100). Patients were followed 30, 180 and 365 days after discharge for readmission and mortality. Their risk of being discharged to a post-acute care facility was examined. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated. ResultsHRs for readmission within 30-days were 1.36 (1.24–1.48) for very low mobility, 1.30 (1.20–1.42) for low mobility and 1.17 (1.08–1.28) for moderately reduced compared with independent mobility. Similar results were seen for readmission within 180- and 365-days. For mortality, HR for 30-day mortality ranged from1.93 and 5.66, 180-day mortality between 1.62 and 3.19, and 365-day mortality between 1.54 and 2.81 compared with patients with independent mobility. OR for discharge to a post-acute care facility was 8.76 (7.29–10.53) for lowest compared with the highest DEMMI mobility subcategory. ConclusionIn geriatric in-patients, lower DEMMI scores on hospital admission are associated with increased rates of discharge to a post-acute care facility, and for readmission, and mortality within one year.

81 Does premorbid frailty status affect rehabilitation outcome?

Abstract Background Frailty is associated with poorer rehabilitation outcome in functional gains, Length of Stay (LoS) and discharge destination. The aim of the study is to determine if pre-morbid frailty status affect functional gains, LoS, and discharge destination of patients undergoing rehabilitation. Methods 188 men and 241 women were (age 81+/− 10 years) admitted for rehabilitation with median LoS of 36 days. All data were collected as part of routine physiotherapy. Age, Clinical Frailty Score (CFS), functional gains [change in Berg Balance Score (BBS) and de Morton Mobility Index (DEMMI)], LoS and discharge destination (home or non-home) were recorded. 392 (91%) had CFS, 331 (77%) BBS, DEMMI 325 (75%) recorded. Patient with CFS category 1–4 were defined as Non-frail, Category 5–7 as Frail. Results are presented as mean (SD). Statistical tests included unpaired t-test, paired t-test and chi-square test. Significance is set at p &amp;lt; 0.05. Results Of the patients, 76% were living with frailty and were older (83.6 [7.9] years vs 78.4 [8.1] years) than the non-frail group (p &amp;lt; 0.0001), had longer LoS (49.1 [34.2] days vs 41.0 [31.8] days, p = 0.044) but just as likely to return home (71% vs 78%, p = 0.14). Patients living with frailty had lower pre and post-BBS and DEMMI score, both groups had significant functional gains (p &amp;lt; 0.0001). Pre and post-BBS in Frail group and Non- frail groups were (19 [13] vs 26 [15]) and (30[15] vs 42[13]) respectively. DEMMI in Frail and Non-frail group pre vs post were 32(15) vs 45(16) and 43(17) vs 60(18) respectively. While there was no difference in functional gains in BBS between groups (p = 0.17), the difference in DEMMI score were lower in frail group (p = 0.018). Conclusion Our study showed that both frail and Non-frail patients made functional gains with rehabilitation and patients living with frailty are just as likely to return home.

Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study.

After hip fracture surgery, patients often experience complications and a decline in mobility, leading to physical disability and increased dependency on caregivers. This may result in reduced independence, institutionalization, and higher mortality rates. However, there is limited research on mobility and its influencing factors in patients undergoing hip fracture surgery in Thailand. This study aimed to determine the factors influencing mobility in patients with fractured hips within one year after surgery. A cross-sectional study was conducted involving 143 randomly selected participants who had undergone hip fracture surgery between August 2022 to February 2023. Mobility and its influencing factors were measured using standardized questionnaires, including the De Morton Mobility Index, Parker Mobility Scale, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pain Rating Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics and multiple regression were utilized for data analysis. The mean mobility score for the patients was 48.86 out of 100 (SD = 17.89). The study found that comorbidity (β = -0.156, p = 0.009), cognitive function (β = 0.310, p <0.001), social support (β = 0.145, p = 0.010), pain (β = -0.176, p = 0.004), fatigue (β = -0.249, p <0.001), and sleep (β = -0.169, p = 0.009) collectively influenced mobility in patients after hip fracture surgery, explaining 61.8% of the variance (R2 = 0.618; F = 36.598; p <0.001). The study's results provide valuable insights for nurses to target these modifiable factors to enhance patients' mobility. However, it is essential to note that patients with comorbidity and poor cognitive function may face difficulty maintaining mobility. Nurses should be attentive to these patients and provide appropriate management. Additionally, early rehabilitation should be initiated promptly to optimize outcomes.

The Lübeck Scale of Basic Mobility : Assessment of geriatric patients with severely impaired mobility

In the geriatric assessment of mobility, the timed up and go (TUG) test is often used; however, many inpatients are unable to master this test. The Lübeck Scale of Basic Mobility (LSBM) was developed as aperformance test for this target group. The study investigated the properties of the 7‑task LSBM, which has ascaling at item level based on the 5‑level assessment of impairments according to the ICF. In 77patients who had not mastered the TUG test at acute geriatric hospital admission, the LSBM was completed at intervals of 7-18days (t0, t1), including one rating by 2investigators. For convergent validity, the De Morton Mobility Index (DEMMI) was used. The LSBM score and DEMMI score were highly correlated (-0.880, p < 0.001).A floor effect did not occur with LSBM and occurred with DEMMI in 5patients (6.5%). The predictive validity for predicting coping with TUG test at discharge based on the sum score at t0 was -0.577 for the LSBM, and 0.542 for the DEMMI (Spearman's correlation, p = 0.001). The interrater reliability of the LSBM was 0.983 (p < 0.001), the correlation between test and retest was 0.836 (p < 0.001) and the internal consistency via Cronbach'sα was 0.876. The effect size as ameasure of change sensitivity was Cohen'sd 0.711. The LSBM facilitates treatment goal setting and allows standardized documentation of even small improvements and deteriorations in patients with reduced basic mobility.

Fall Risk and Coping of Older Adults After Hospitalization: A Mixed Methods Study.

Coping is defined as cognitive and behavioral effort to manage specific external and/or internal demands, such as managing one's own fall risk. Little is known about the relationship between the risk of falling in older adults and their coping strategies. The purpose of this study is to examine the fall risk after hospitalization, the adequacy of self-perceived fall risk and coping strategies of older adults. In this mixed-methods study, the adequacy of perceived fall risk was determined using the de Morton Mobility Index and the ABC Scale in 98 geriatric patients recruited in a geriatric hospital. Semi-structured interviews were conducted with a subsample of 16 participants 6 months after discharge to identify coping strategies. The six interviewees who adequately assessed their fall risk reported active/positive coping. In contrast, participants who assessed their fall risk inadequately (10 out of 16) reported passive/negative coping. Older adults who inadequately assessed their fall risk need special accompaniment in geriatric wards to develop active/positive coping strategies.

Health-related quality-of-life during rehabilitation in patients with critical illness neuropathy/myopathy after severe coronavirus disease 2019.

Our aim was to evaluate health-related quality-of-life (HRQoL) of the patients with critical illness neuropathy and/or myopathy after severe COVID-19 during their rehabilitation. The prospective cohort study included 157 patients (median age 64 years) admitted to rehabilitation. HRQoL was assessed the using European Quality 5-Dimensions questionnaire [EQ-5D index , range 0(or exceptionally less) to 1, and Visual Analogue Scale (VAS), range 0-100], which was completed by the patients at admission and discharge. Additionally, they were assessed with the de Morton Mobility Index (DEMMI), the 6-Minute Walk Test (6MWT), and the Functional Independence Measure (FIM). Median EQ-5D index was 0.32 and median EQ VAS was 48 at admission, and median EQ-5D index was 0.61 and median EQ VAS 80 at discharge. Some or extreme problems were reported by 154 (98%) patients regarding the mobility dimension, 151 (96%) regarding usual activities, 136 (87%) regarding self-care, 84 (54%) regarding pain or discomfort dimension, and 52 patients (34%) regarding anxiety or depression at admission. At discharge, some or extreme problems were still reported by 96 patients (61%) regarding mobility, 95 (61%) regarding usual activities, 70 patients (45%) regarding pain or discomfort, 46 (29%) regarding self-care, and 19 patients (12%) regarding anxiety or depression. At the same time, the patients exhibited significant improvements in the DEMMI (median increased from 41 to 67 points), 6MWT (from 60 to 293 m) and motor FIM (from 56 to 84 points). The improvement of the self-reported HRQoL was, thus, paralleled by the improvements in clinician-assessed mobility, walking endurance and functional independence.

Clinimetric properties of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit survivors – a cross-sectional observational study

Purpose To investigate the intra-rater reliability and the construct validity of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit (ICU) survivors. Methods Construct validity of the DEMMI was measured by correlating it with physical functioning scales. Known group comparison was made according to the Medical Research Council Sum Score (MRC-SS). Internal consistency was determined by measuring Cronbach α coefficient. Test-retest reliability was assessed by performing the DEMMI by the same researcher after 24 h and calculating the intraclass correlation coefficient (ICC). The minimal detectable change (MDC) value was calculated. Results One hundred and two patients discharged from the ICU were included. The ICC for intra-reliability was 0.972. The internal consistency was excellent (Cronbach = 0.991). The DEMMI total score was correlated with the Barthel Index (r = 0.791), Katz Index of Independence in Activities of Daily Living (r = 0.722), MRC-SS (0.614), ICU length of stay (r = –0.515), and total mechanical ventilation duration (r = –0.488). The DEMMI was able to differentiate between MRC-SS subgroups (p < 0.001), whereby higher strength was associated with higher DEMMI scores. The MDC was determined to be 6.82 out of 100 points. Conclusion The Turkish version of the DEMMI is reliable and valid for measuring mobility in ICU survivors. Trial registration number NCT05196997 Implications for Rehabilitation The Turkish version of the de-Morton Mobility Index (DEMMI) is a reliable and valid outcome measure for the assessment of functional mobility in intensive care unit survivors. The Turkish version of the DEMMI could guide clinicians working in the field of intensive care in the planning of rehabilitation programs after discharge.

Physical recovery across care pathways up to 12 months after hospitalization for COVID-19: A multicenter prospective cohort study (CO-FLOW).

SummaryBackgroudThe sudden COVID-19 pandemic forced quick development of care pathways for patients with different needs. Trajectories of physical recovery in hospitalized patients for COVID-19 following different care pathways are unknown. We aimed to assess trajectories of physical recovery and levels of physical function reached within the different care pathways. Additionally, we assessed differences in physical function across care pathways at follow-up visits.MethodsThis multicenter prospective cohort study of adults who had been hospitalized for COVID-19 was performed in 10 centers, including 7 hospitals (1 academic and 6 regional hospitals) and 3 rehabilitation centers (1 medical rehabilitation center and 2 skilled nursing facilities), located in the Netherlands. Study visits were performed at 3, 6, and 12 months post-hospital discharge and included assessment of cardiorespiratory fitness (6 min walk test [6MWT], 1 min sit-to-stand test [1MSTST]), muscle strength (maximum handgrip strength [HGS]) and mobility (de Morton Mobility Index [DEMMI]).FindingsWe report findings for 582 patients who had been discharged from hospital between March 24, 2020 and June 17, 2021. Patients had a median age of 60·0 years, 68·9% (401/582) were male, 94·6% (561/582) had received oxygen therapy, and 35·2% (205/582) mechanical ventilation. We followed patients across four different rehabilitation settings: no rehabilitation (No-rehab, 19·6% [114/582]), community-based rehabilitation (Com-rehab, 54·1% [315/582]), medical rehabilitation (Med-rehab, 13·7% [80/582]), and rehabilitation in a skilled nursing facility (SNF-rehab, 12·5% [73/582]). Overall, outcomes in 6MWT (14·9 meters [95% CI 7·4 to 22·4]), 1MSTST (2·2 repetitions [1·5 to 2·8]), and HGS (3·5 kg [2·9 to 4·0]) improved significantly (p<0·001) from 3 to 6 months and only HGS from 6 to 12 months (2·5 kg [1·8 to 3·1]; p<0·001). DEMMI scores did not significantly improve over time. At 3 months, percentage of normative values reached in 1MSTST differed significantly (p<0.001) across care pathways, with largest impairments in Med- and SNF-rehab groups. At 12 months these differences were no longer significant, reaching, overall, 90·5% on 6MWD, 75·4% on 1MSTST, and 106·9% on HGS.InterpretationOverall, physical function improved after hospitalization for COVID-19, with largest improvement within 6 months post-discharge. Patients with rehabilitation after hospital discharge improved in more than one component of physical function, whereas patients without rehabilitation improved solely in muscle strength. Patients who received rehabilitation, and particularly patients with Med- and SNF-rehab, had more severe impairment in physical function at 3 months, but reached equal levels at 12 months compared to patients without follow-up treatment. Our findings indicate the importance of rehabilitation.FundingZonMw, Rijndam Rehabilitation, Laurens (The Netherlands).

Using comprehensive geriatric assessment for older adults undertaking a facility-based transition care program to evaluate functional outcomes: a feasibility study

BackgroundThe study aimed to evaluate the feasibility of using a comprehensive geriatric assessment (CGA) in a residential transition care setting to measure older adults’ functional outcomes.MethodsA convenience sample of older adults (n = 10) and staff (n = 4) was recruited. The feasibility of using assessment tools that comprise a CGA to comprehensively measure function in physical, cognitive, social and emotional domains was evaluated pre- and post-rehabilitation.Results10 older adults (mean ± SD age = 78.9 ± 9.1, n = 6 male) completed a CGA performed using assessments across physical, cognitive, social and emotional domains. The CGA took 55.9 ± 7.3 min to complete. Staff found CGA using the selected assessment tools to be acceptable and suitable for the transition care population. Older adults found the procedure to be timely and 60% found the assessments easy to comprehend. Participating in CGA also assisted older adults in understanding their present state of health. The older adults demonstrated improvements across all assessed domains including functional mobility (de Morton Mobility Index; baseline 41.5 ± 23.0, discharge 55.0 ± 24.0, p = 0.01) and quality of life (EQ-5D-5L; baseline 59.0 ± 21.7, discharge 78.0 ± 16.0, p < 0.01).ConclusionsIncorporating CGA to evaluate functional outcomes in transition care using a suite of assessment tools was feasible and enabled a holistic assessment.

FUNCTIONAL ABILITY INDEXES IN PARKINSON’S DISEASE AFTER COVID-19 INFECTION

The aim – to investigate the clinical course, progression of motor and mental disorders inpatients with Parkinson’s disease who relapsed with COVID-19.Materials and methods. 36 people with Parkinson’s disease in early postinfective (30 days)period were surveyed. Mobility was assessed using the de Morton Mobility Index (DEMMI),the Hierarchical Assessment of Equilibrium and Mobility (HABAM), and the Bartel MobilityIndex. Movement ability was assessed by functional mobility categories (FAC).Results. After suff ering from coronavirus disease, patients showed signifi cant deteriorationin mobility on the DEMMI, HABAM and Barthel index scales. The DEMMI scale showeda deterioration in mobility 17% (p &lt;0.05) compared to baseline. The HABAM balanceand mobility index showed a 50.0% decrease in patients’ functional capacity for the&#x0D; disease (p&lt;0.05), followed by an incredible increase in the HABAM index after long-term rehabilitation. There was a decrease in the mobility of patients with Parkinsonism&#x0D; according to the Barthel index 37.5%.Conclusions. After coronavirus disease, patients with Parkinson’s disease havea signifi cant deterioration in functional capacity, mobility indices, mobility and balanceon the DEMMI, HABAM and Barthel scales.

The immediate impact of physical function and quality of life after hematopoietic stem cell transplantation.

Although hematopoietic stem cell transplantation (HSCT) is a curative treatment for hematologic malignancies, HSCT survivors often experience declined physical function and quality of life (QoL). However, the physical function and QoL changes in acute post-transplant patients remain unclear. This study aimed to investigate the impact of HSCT on physical function. This retrospective control study included 107 HSCT patients. Physical function was evaluated weekly from admission to discharge using the de Morton Mobility Index (DEMMI). Impaired physical function was defined as a baseline raw ordinal DEMMI score of < 17 and a decrease of ≥ 2 points. We collected the Visual Analog Scale (VAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Zung Self-rating Depression Scale (SDS) at enrollment and discharge. Based on the DEMMI scores, 41 patients (38.3%) showed impaired physical function. A notable decrease in the DEMMI score was found in the first week after HSCT. In the EORTC QLQ-C30, physical function differed between the groups at admission and discharge. The good physical function group showed better cognitive function and social function. For the SDS, the impaired physical function group showed significantly higher depression at discharge. A third of the patients showed physical impairment during the acute transplant period. Patients with low physical function suffered more from depression and lower QoL. Evaluating patients' pre-transplant physical function and early detection is needed as impaired physical function mainly occurs at 1week post-transplant.