Comparison of Posthospitalization Function and Community Mobility in Hospital Mobility Program and Usual Care Patients A Randomized Clinical Trial
Comparison of Posthospitalization Function and Community Mobility in Hospital Mobility Program and Usual Care Patients A Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2016.1870
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发表时间：
2016-07-01
影响因子：
39
通讯作者：
Allman, Richard M.
中科院分区：
文献类型：
--
作者：
Brown, Cynthia J.;Foley, Kathleen T.;Allman, Richard M.
住院期间活动能力低下很常见，与日常生活活动能力的丧失或下降以及社区活动能力的限制有关。目的探讨院内活动计划（MP）对出院后功能和社区活动的影响。设计、环境和参与者：本单盲随机临床试验采用蒙面评估器对MP和常规护理（UC）进行比较。2010年1月12日至2011年6月29日，在伯明翰退伍军人事务医疗中心住院的患者在住院期间进行随访，并在出院后进行1个月的电话随访。100名65岁或以上的住院患者被随机分配到MP组或UC组。患者在住院前2周认知完整并能行走。数据分析时间为2012年11月21日至2016年3月14日。干预措施：MP组的患者每天最多走动两次，并使用行为策略来鼓励活动。UC组患者每天两次就诊。主要结果和测量方法分别采用Katz ADL量表和阿拉巴马大学伯明翰分校老龄化生活空间评估研究（LSA）评估自我报告ADL和社区流动性的变化。LSA根据一个人报告在过去4周内移动的距离来衡量社区流动性。结果100例患者中，8例未完成研究（MP组6例，UC组2例）。患者平均年龄73.9岁，男性97例（97.0%），黑人19例（19.0%），中位住院时间为3天。基线时各组间无显著差异。在所有时期，各组的ADL能力相似；然而，在住院后1个月，MP组的LSA评分（LSA评分，52.5）明显高于UC组（LSA评分，41.6）（P = 0.02）。对于MP组，住院后1个月的LSA评分与入院时的LSA评分相似。UC组的LSA得分下降了大约10分。结论和相关性单纯MP干预对ADL功能无影响。然而，MP干预使患者能够维持住院前的社区流动性，而UC组的患者则出现了临床显着下降。较低的生活空间流动性与死亡、养老院入院和功能衰退的风险增加有关，这表明在UC组中观察到的下降将具有重要的临床意义。
IMPORTANCE Low mobility is common during hospitalization and associated with loss or declines in ability to perform activities of daily living (ADL) and limitations in community mobility.OBJECTIVE To examine the effect of an in-hospital mobility program (MP) on posthospitalization function and community mobility.DESIGN, SETTING, AND PARTICIPANTS This single-blind randomized clinical trial used masked assessors to compare a MP with usual care (UC). Patients admitted to the medical wards of the Birmingham Veterans Affairs Medical Center from January 12, 2010, through June 29, 2011, were followed up throughout hospitalization with 1-month posthospitalization telephone follow-up. One hundred hospitalized patients 65 years or older were randomly assigned to the MP or UC groups. Patients were cognitively intact and able to walk 2 weeks before hospitalization. Data analysis was performed from November 21, 2012, to March 14, 2016.INTERVENTIONS Patients in the MP group were assisted with ambulation up to twice daily, and a behavioral strategy was used to encourage mobility. Patients in the UC group received twice-daily visits.MAIN OUTCOMES AND MEASURES Changes in self-reported ADL and community mobility were assessed using the Katz ADL scale and the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), respectively. The LSA measures community mobility based on the distance through which a person reports moving during the preceding 4 weeks.RESULTS Of 100 patients, 8 did not complete the study (6 in the MP group and 2 in the UC group). Patients (mean age, 73.9 years; 97 male [97.0%]; and 19 black [19.0%]) had a median length of stay of 3 days. No significant differences were found between groups at baseline. For all periods, groups were similar in ability to perform ADL; however, at 1-month after hospitalization, the LSA score was significantly higher in the MP (LSA score, 52.5) compared with the UC group (LSA score, 41.6) (P = .02). For the MP group, the 1-month posthospitalization LSA score was similar to the LSA score measured at admission. For the UC group, the LSA score decreased by approximately 10 points.CONCLUSIONS AND RELEVANCE A simple MP intervention had no effect on ADL function. However, the MP intervention enabled patients to maintain their prehospitalization community mobility, whereas those in the UC group experienced clinically significant declines. Lower life-space mobility is associated with increased risk of death, nursing home admission, and functional decline, suggesting that declines such as those observed in the UC group would be of great clinical importance.