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Factors associated with walking in older medical inpatients.

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journal contribution
posted on 25.04.2022, 13:44 authored by Ruth McCullagh, Dahly Darren, Frances HorganFrances Horgan, Suzanne Timmons

Objective: To identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization.

Design: A cohort study.

Setting: Acute hospitalized care.

Participants: Premorbidly mobile, nonsurgical, nonelective inpatients (50% women) aged ≥65 years (N=154), with an anticipated ≥3-day inpatient stay were recruited consecutively within 48 hours of hospital admission. Of the 227 patients screened, 69 did not meet study criteria and 4 refused.

Interventions: Not applicable.

Main outcome measures: Age, comorbidities (Cumulative Illness Rating Scale), cognitive status (6-item Cognitive Impairment Test), falls history and efficacy (Falls Efficacy Scale-International), physical performance (short physical performance battery), and medications were recorded within 2 days of admission. Walking activity (step count) was recorded for 7 days or until discharge. Daily events (procedures, falls, fear of falling, ordered bedrest, devices or treatments that hindered walking [eg, intravenous fluids, wall-mounted oxygen therapy], patient- and nurse-reported medial status, fatigue, sleep quality, physiotherapy, or occupational therapy intervention) were measured on concurrent weekdays. Their associations with daily (log) step count were estimated using linear mixed-effects models, adjusted for patient-characteristics measured at admission.

Results: Approximately half of the variability in step count was described at the within-patient level. Multivariable models suggested positive associations with Wednesdays (+25% in step count; 95% confidence interval, 4-53), admission physical performance (+15%, 8-22), improving medical status (+33%, 7-64), negative associations with devices or treatments that hinder walking (-29%, -9 to -44), and instructed bedrest (-69%, -55 to -79).

Conclusion: Day-to-day step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients.

Funding

Irish Health Research Board (HRB, HPF 2013)

History

Comments

The original article is available at https://www.sciencedirect.com/

Published Citation

McCullagh R, Darren D, Horgan NF, Timmons S. Factors associated with walking in older medical inpatients. Arch Rehabil Res Clin Transl. 2020;2(1):100038

Publication Date

11 January 2020

PubMed ID

33543067

Department/Unit

  • School of Physiotherapy

Research Area

  • Population Health and Health Services

Publisher

Elsevier BV

Version

  • Published Version (Version of Record)