Physical Activity During Hospitalization and Hospital-Associated Disability

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• Acute Disease 286
• Motor Activity 2,374

Keywords

• Hospital-associated disability
• Geriatric
• Physical activity
• Hospital mobility
• Older adults

Study population

Groups and cohorts

• Acutely Hospitalized Older Adults

  A prospective cohort of 170 adults aged 65 years or older acutely admitted to the Department of Geriatrics or the Department of Cardiology at Copenhagen University Hospital - Hvidovre. Participants will be consecutively recruited within 48 hours of admission and followed during hospitalization and at 1, 4, and 8 weeks after discharge.

  Other: Physical Activity During and After Hospitalization

Interventions

• OtherPhysical Activity During and After Hospitalization

  Participants will receive standard care throughout hospitalization. In addition to standard care, participants will take part in a single supervised assessment of their ability and preferences for different types of physical activity. The assessment includes hallway walking (200 steps, with walking aids or assistance if needed) and resistance exercise consisting of three sets of 8-12 repetition maximum sit-to-stands. Participants will also be asked about their preference for group-based functional training and about their motivation and barriers related to physical activity. Physical activity will be objectively measured using SENS motion® sensor technology continuously during hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. Self-reported mobility during hospitalization will also be assessed. After discharge, participants' experiences, motivation, barriers, and preferences related to physical activity and rehabilitation will be explored th

Primary outcomes

1. Hospital-associated disability

   Hospital-associated disability (HAD) is defined as a new decline in functional independence in at least one activity compared with the participant's pre-admission level. Functional independence is assessed using three components: six basic activities of daily living from the Katz Index (bathing, dressing, toileting, transferring, continence, and feeding); five instrumental activities of daily living inspired by the Lawton IADL Index (shopping, housekeeping, laundry, food preparation, and medication management); and four mobility-related activities (walking 400 meters without rest, climbing or descending one flight of stairs without rest, carrying 5 kg, and driving a car). Each activity is scored as unable to perform (0), able to perform with assistance (1), or able to perform independently (2). Participants with a decline in independence in at least one activity compared with their retrospectively assessed pre-admission level are classified as having HAD.

   Time frame: At inclusion and 1, 4 and 8 weeks after discharge

2. Imagined ability to perform physical activity during hospitalization

   Participants' imagined ability to perform physical activity during hospitalization will be assessed by asking whether they can imagine performing the activity daily during hospitalization. Imagined ability will be assessed for hallway walking (200 steps) and resistance exercise (three sets of 8-12 sit-to-stand repetitions) and group-based functionel training.

   Time frame: At inclusion

3. Actual ability to perform physical activity during hospitalization

   Participants' actual ability to perform physical activity during hospitalization will be assessed by asking them to perform hallway walking (200 steps) and resistance exercise (three sets of 8-12 sit-to-stand repetitions). For each activity, actual ability will be categorized as able to complete the activity as defined, 0) unable to complete the activity, 1) able to complete the activity with assistance and 2) able to complete the activity independently. Reasons for inability to complete an activity will be recorded.

   Time frame: At inclusion

4. Preferred type of physical activity during hospitalization

   Participants will be asked which type of physical activity they prefer: hallway walking, resistance training and group-based functional training. (Group-based functional training will be assessed as a preference only and will not be physically performed as part of the assessment).

   Time frame: At inclusion

Secondary outcomes

1. Mean Daily steps

   Number of daily steps assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

   Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up

2. Mean daily uptime

   Daily time spent in uptime assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

   Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up

3. Mean daily walking

   Daily time spent walking assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

   Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up

4. Mean daily standing

   Daily time spent standing assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

   Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up

5. Mean daily lying/sitting

   Daily time spent sitting or lying assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

   Time frame: From inclusion through hospital discharge, an average of 5 days; and 7 consecutive days before the 8-week follow-up

Other outcomes

1. Self-reported mobility

   Self-reported mobility by the Acute Care Mobility Assessment. A score of 0-12 can be obtained, with 0 reflecting poor mobility and 12 reflecting a high level of mobility.

   Time frame: Days 2, 4 and 6 after inclusion during hospitalization

2. Life space mobility

   By the Life Space Assessment-DK, which measure mobility and level of dependence in mobility. A score of 0-120 can be obtained, with 0 reflecting poor mobility and 120 reflecting high mobility

   Time frame: At inclusion and 4 and 8 weeks post discharge

3. Self-reported pre-admission (2 weeks prior to admission) and post discharge mobility

   By the New Mobility Score, which assesses the ability to walk indoors and outdoors and the ability to go shopping. A score from 0-9 can be obtained, with 0 reflecting low mobility and 9 reflecting high mobility.

   Time frame: At inclusion and 1, 4 and 8 weeks post discharge

4. Frailty pre-admission (2 weeks prior to admission)

   By the Clinical Frailty Scale, which is a clinical evaluation of the degree of frailty of a person. It is scored by health care professionals on a scale from 1 (very fit) to 9 (terminally ill)

   Time frame: At inclusion

5. Cognitive status

   By the Orientation Memory Concentration Test, which is a screening of cognitive function. A score from 0 to 28 obtained, with lower scores reflecting poorer cognition (0-7: highly impaired; 8-17 points: moderately impaired; 18-24 points: mildly impaired; 25-28 points: no or insignificant impairment).

   Time frame: At inclusion

6. Basic mobility

   By the Cummulated Ambulation Score, which assessed the ability of a person to get in and out of bed, sit to stand from a chair and walk. It is scored from 0 to 6 with 0 reflecting inability to perform the 3 activities and a score of 6 reflecting independence in the three activities.

   Time frame: At inclusion, day 2, 4 and 6 after inclusion during hospitalization and 8 weeks post discharge

7. Gait speed

   By the 4-meter gait speed test. It assesses the patient's current gait speed on a 4-meter course. The test is scored in m/s.

   Time frame: At inclusion and 8 weeks post discharge

8. Readmission

   Number of readmissions within 6 months post discharge

   Time frame: 6 month post discharge

9. Handgrip strength

   Handgrip strength of the dominant hand assessed using a handheld dynamometer. Three attempts are performed, and the highest measured value is used for analysis.

   Time frame: At inclusion and 8 weeks post discharge

10. Lower-extemity muscle strenght

    Assessed by Sit-to-stand test, as the number of times the participant can rise from and sit down on a chair during 30 seconds.

    Time frame: At inclusion and 8 weeks post discharge

11. Concern about falling

    Concern about falling during activities of daily living assessed by the 7-item Short Falls Efficacy Scale (Short FES-I). Each item is scored from 1 to 4, giving a total score from 7 to 28, with higher scores indicating greater concern about falling.

    Time frame: At inclusion and 1, 4 and 8 weeks post discharge

Individual participant data

Plan to share: No — Due to Danish data protection legislation, individual participant data cannot be publicly shared. Access to pseudonymized data may be granted upon reasonable request and approval by the Danish Data Protection Agency.