Factors associated with walking in older medical inpatients.
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.
Irish Health Research Board (HRB, HPF 2013)
CommentsThe original article is available at https://www.sciencedirect.com/
Published CitationMcCullagh 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 Date11 January 2020
- School of Physiotherapy
- Population Health and Health Services
- Published Version (Version of Record)