Clinical impact of walking capacity on the risk of disability and hospitalizations among elderly patients with advanced lung cancer

The value of walking: a systematic review on mobility and healthcare costs

“…Detailed information on the individual studies is shown in Table 2 . Six studies were observational cohort studies [ 21 – 23 , 28 , 29 ], two were cross-sectional studies [ 25 , 27 ], one was a decision analysis using a Markov Model [ 24 ], and one was a microsimulation [ 26 ]. All studies ( n = 10) examined the economic impact of mobility in middle-aged to aged populations.…”

“…Patients divided at baseline into two groups characterized by low and high WS (based on the average WS maintained during a moderate 1-km treadmill-walking test) All-cause hospitalization and related costs Hospitalization related costs (Process of transformation of hospitalization rates to costs is not described.) Okayama et al 2021 [ 29 ] Clinical impact of walking capacity on the risk of disability and hospitalizations among elderly patients with advanced lung cancer Japan n = 60 Shizuoka Cancer Center Prospective cohort study Patients aged ≥ 70 years with advanced non-small-cell lung cancer (NSCLC) Recurrent event analysis comparing (not adjusted for socioeconomic confounders) comparing Mobile group vs less mobile group Length of hospital stay, inpatient medical costs Inpatient medical costs. Electronic health records of hospitals, actual revenue that the hospital was paid from the health insurance funds for a given inpatient stay Number of Steps Kato et al 2013 [ 24 ] Effects of walking on medical cost: A quantitative evaluation by simulation focusing on diabetes Japan n = 1,000 hypothetical subjects 10 year- Markov model Hypothetical subjects representing middle aged Japanese people Markov Model (rates of events were determined on papers and statistical data published in Japan) Patients after 10 years with 0 steps, + 3,000 steps, and + 5,000 steps Total number of events during 10 years, Medical costs during 10 years Medical costs for diabetes (inpatient and outpatient costs) associated with each health status events estimated from public statistical data in Japan Karl et al 2018 [ 27 ] Direct healthcare costs associated with Device-based assessment, and self-reported physical activity: results from a cross-sectional population-based study Germany n = 477 KORA FF4 study Retrospective cross-sectional study Patients aged between 48 and 68 years Two-part gamma regression model adjusted for potential socioeconomic confounders comparing inactive participants to active subjects (very low moderate-vigorous physical activity (MVPA) vs. very high MVPA) Total healthcare costs Direct medical costs (based o...…”

“…Costs that should be included in an analysis depend on the study perspective (refers to the point of view one takes when assessing costs), so failing to state the perspective meant that some of these studies lacked a clear rationale for the types of cost included. Five studies [ 24 , 26 , 28 , 29 ] did not adjust costs that occurred at different points in time, and two studies [ 23 , 26 ] conducted a sensitivity analysis to address a certain variety of their assumptions.…”

“…The cost reduction associated with a daily increase of 3,000 steps walked was calculated as 0,000,014 $ for each step Turi et al 2015 [ 25 ] PRO: Activity of daily living (walking during leisure time as self-reported in retrospective questionnaire ‘Baecke Questionnaire’) Not reported Participants inserted in the category of higher involvement in walking were 41% less likely to be inserted into the group with higher total expenditure (r = 0.59; 95% CI 0.39–0.89) Kabiri et al 2018 [ 26 ] Step Count No direct mobility measure (derived from MARCHE trial) The model predicted that a 554-step-per-day increase in mobility would reduce nursing home utilization by 2.8% The model predicted an increase of 554-step per day increase would reduce total medical expenditures by 0.9% Karl et al 2018 [ 27 ] DMO: Step Count (Self-reported hours of exercise per week. Accelerometer (worn during waking hours for 7 days) for uniaxial counts (counts/min) on the vertical axis for the deduction of activity levels and step counts) Not reported No significant results (Inactive participants (less than 10,000 steps per day), had higher direct healthcare costs as compared to active subjects) Bonnini et al 2020 [ 28 ] PerfO: Walking speed (maintained during a moderate 1-km treadmill-walking test) Every 1 km/hour increase in walking speed was associated with a 21% reduction in risk of hospitalization (HR 0.79) Hospitalization costs in the first, second and third propensity score tertile per patient were reduced from 1,281 to 341 $, from 904 to 383 $, and from 1,197 to 334 $ among low and high improvers in walking speed Okayama et al 2021 [ 29 ] PerfO: Walking speed (distance covered by walking up and down a 10 m course at a different dictated velocities, termed “incremental shuttle walking distance” (ISWD)) The mobile group had shorter cumulative lengths of hospital stay (41.3 vs. 72.9 days/person) than the less mobile group The mobile group had lower inpatient medical costs (16,680 $ vs. 25,458 $ /person) than the less mobile group Hirai et al 2021 [ 30 ] PRO: Walking Time (categorized average minutes of walking per week by questionnaire) Not reported Cumulative LTCI costs were USD 3200 for those who walked for less than 30 min, USD 2400 for those who walked for 30 to 60 min, and USD 2100 for those who walked fo...…”

“…Purser et al used the Reubens Physical Performance Test, a supervised performance test [ 23 ]. Walking speed was examined by Bonnini et al using a 1-km treadmill-walking test [ 28 ], and by Okayama et al using the Endurance shuttle walk test [ 29 ]. Simulation studies did not assess walking directly.…”