Gait outcomes of older adults receiving subacute hospital rehabilitation following orthopaedic trauma: a longitudinal cohort study

Abstract

ObjectivesThis study aimed to describe gait speed at admission and discharge from inpatient hospital rehabilitation among older adults recovering from orthopaedic trauma and factors associated with gait speed performance and discharge destination.DesignA longitudinal cohort study was conducted.SettingAustralian tertiary hospital subacute rehabilitation wards.ParticipantsPatients aged ≥60 years recovering from orthopaedic trauma (n=746, 71% female) were eligible for inclusion.InterventionsUsual care (multidisciplinary inpatient hospital rehabilitation).Primary and secondary outcome measuresGait speed was assessed using the timed 10 m walk test. The proportion of patients exceeding a minimum gait speed threshold indicator (a priori 0.8 m/s) of community ambulation ability was calculated. Generalised linear models were used to examine associations between patient and clinical factors with gait speed performance and being discharged to a residential aged care facility.ResultsAt discharge, 18% of patients (n=135) exceeded the 0.8 m/s threshold indicator for community ambulation ability. Faster gait speed at discharge was found to be associated with being male (B=0.43, 95% CI −0.01 to 0.87), admitted with pelvic (B=0.76, 95% CI 0.14 to 1.37) or multiple fractures (B=1.13, 95% CI 0.25 to 2.01) (vs hip fracture), using no mobility aids (B=−0.93, 95% CI −1.89 to 0.01) and walking at a faster gait speed at admission (B=5.77, 95% CI 5.03 to 6.50). Factors associated with being discharged to residential aged care included older age (OR 1.06, 95% CI 1.03 to 1.10), longer length of stay (OR 1.01, 95% CI 1.01 to 1.02), having an upper limb fracture (vs hip fracture) (OR 2.81, 95% CI 1.32 to 5.97) and lower Functional Independence Measure cognitive score (OR 0.89, 95% CI 0.86 to 0.92).ConclusionsPatients with a range of injury types, not only those presenting to hospital with hip fractures, are being discharged with slow gait speeds that are indicative of limited functional mobility and a high risk of further adverse health events.

Gait speed as an indicator of prosthetic walking potential following lower limb amputation

“…29 Gait speeds of more than 0.8 m/s have been associated with being able to successfully walk in the community following stroke 12 and post orthopaedic injury. 30 However, the extent to which people with lower limb amputation being discharged from hospital rehabilitation are able to walk at speeds associated with successful ambulation in the community is unknown. The relationship between gait speed and community mobility in people following lower limb amputation has received relatively little investigation.…”

“…and the total MMSE range was[24][25][26][27][28][29][30] FIM-Motor on admission for the sample was 74 (69-78).Outcomes of People with Lower Limb Amputation at Hospital DischargeThe outcomes of people with lower limb amputation at their discharge assessment are presented inTable 2. Median (IQR) length of stay was 59 (23-83) days.…”

Functional outcomes of people with lower limb amputation following inpatient rehabilitation

“…Study 3 focused on those with unilateral amputation and showed that prosthetic gait speed was associated with K-level and motor function (FIM-Motor). However, gait speeds observed across all K-levels were typically slower than minimum thresholds associated with functional community ambulation (Matthew, 2017;Perry, 1995). Median prosthetic gait speed for the study cohort was 0.52 m/s (IQR 0.37-0.67).…”

“…Gait speeds of more than 0.8 m/s have been associated with being able to successfully walk in the community following stroke (Perry, 1995) and post orthopaedic injury (Matthew, 2017).…”

“…This thesis highlighted that gait speed of people with lower limb amputation at discharge from inpatient rehabilitation tended to be slower than speeds required for community walking in other population groups such as people who have experienced a stroke (Perry, 1995) and those with orthopaedic injuries (Matthew, 2017).…”