Promoting Activity in Geriatric Rehabilitation: A Randomized Controlled Trial of Accelerometry

Abstract

BackgroundLow activity levels in inpatient rehabilitation are associated with adverse outcomes. The study aimed to test whether activity levels can be increased by the provision of monitored activity data to patients and clinicians in the context of explicit goal setting.MethodsA randomized controlled trial in three sites in Australia included 255 inpatients aged 60 and older who had a rehabilitation goal to become ambulant. The primary outcome was patients’ walking time measured by accelerometers during the rehabilitation admission. Walking times from accelerometry were made available daily to treating therapists and intervention participants to motivate patients to improve incidental activity levels and reach set goals. For the control group, ‘usual care’ was followed, including the setting of mobility goals; however, for this group, neither staff nor patients received data on walking times to aid the setting of daily walking time targets.ResultsThe median daily walking time in the intervention group increased from 10.3 minutes at baseline to 32.1 minutes at day 28, compared with an increase from 9.5 to 26.5 minutes per day in the control group. Subjects in the intervention group had significantly higher non-therapy walking time by about 7 minutes [mean (95% CI): 24.6 (21.7, 27.4)] compared to those in the control group [mean(95% CI): 17.3 (14.4, 20.3)] (p = 0.001).ConclusionsDaily feedback to patients and therapists using an accelerometer increased walking times during rehabilitation admissions. The results of this study suggest objective monitoring of activity levels could provide clinicians with information on clinically important, mobility-related activities to assist goal setting.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12611000034932 http://www.ANZCTR.org.au/

Change of Objectively-Measured Physical Activity during Geriatric Rehabilitation

“…Our findings are in line with previous studies [8,15,16,18,19] although the observed effects varied and outcomes were limited to walking duration and up-time. Two studies in different disease groups were performed from 2008-2010 in the same geriatric hospital as the present study with a similar design but a much smaller sample size and a different sensor system [15,16].…”

“…Three studies used the same sensor system as in the current study, two of them evaluated daily walking duration [8,18] and one study used upright duration as the outcome measure [19]. The results were inconsistent, reflecting much smaller sample sizes, different study designs and settings.…”

“…During rehabilitation, physicians have to decide how to use limited resources and time in the best interest of the patient and the health system [7]. A precise measurement of physical activity could be used for goal setting, to give clinicians guidance on the physical status of a patient, to readjust therapy and to estimate the remaining demands to reach a sufficient level of activity [8]. It also enables an objective documentation of the rehabilitation progress, indicates whether the patient is able to live independently after discharge and provides evidence for the need of an extension of the rehabilitation.…”

“…Although inertial sensor devices have been widely used in cohort studies with community-dwelling older persons, there are only few studies in patients during geriatric rehabilitation [8,[15][16][17][18][19]. These studies had small sample sizes, showed inconsistent results and were not implemented in the clinical routine to document the progress during rehabilitation.…”

Testing the effect of discharge destination on outcomes for people with isolated lower limb fractures

“…There are hypothetical reasons why inpatient rehabilitation may not be beneficial, or even harmful, for some patients. It is recognised that patients in rehabilitation wards are generally inactive for most of the day and that the ward environment facilitates rest in bed. The amount of therapy promoting mobility provided each day is limited.…”