Geriatric rehabilitation after hip fracture: Role of body-fixed sensor measurements of physical activity

Hintergrund Der Bedarf an geriatrischer Rehabilitation wird in den nächsten Jahren deutlich ansteigen. Von zunehmender Bedeutung wird sein, die Effizienz und Wirksamkeit geriatrischer Rehabilitation nachzuweisen. Die Anwendung von objektiven und validen Messverfahren ist hierbei eine wichtige Komponente. Deren Ergebnisse sollten für den Patienten verständlich und relevant für das Erreichen der Ziele sein. Darüber hinaus sollen Veränderungen im Verlauf der Rehabilitation messbar sein. Viele der aktuell verwendeten Assessmentverfahren zur Messung der körperlichen Kapazität weisen Bodeneffekte auf. Die Verwendung von am Körper getragenen Sensoren zur Messung von körperlicher Aktivität stellt eine mögliche Ergänzung des Assessments während der geriatrischen Rehabilitation dar. Solche Messungen vermeiden Bodeneffekte und überwachen direkt die Verbesserung der Mobilität als wichtiger Aspekt der geriatrischen Rehabilitation. Methoden Die Beobachtungsstudie mit einem Prä-post-Design untersuchte konsekutiv 65 Patienten einer geriatrischen Rehabilitationseinrichtung. Die Untersuchungen erfolgten bei Aufnahme sowie 2 Wochen später. Die Messungen der körperlichen Kapazität umfassten das Gehtempo, die Aufstehzeit von einem Stuhl, einen Gleichgewichtstest, die Gehstrecke über zwei Minuten und den Timed Up and Go Test. Die körperliche Aktivität wurde mit einem am Körper getragenen Sensor gemessen. Ergebnisse Die Messung der körperlichen Aktivität konnte bei allen Patienten durchgeführt werden, die für ein Assessment zur Verfügung standen. Die kumulierte Geh- und Standzeit nahm im Mittel von 83,6 auf 102,6 min zu. Die kumulierten Gehzeiten verlängerten sich im Mittel von 7,0 auf 16,3 min. Die Assoziation mit Messungen der Kapazität zeigte eine nur mäßige bis gute Korrelation (rs?=?0,45-0,65). Dies zeigt, dass die Ergebnisse der Kapazitätsmessungen nicht identisch mit den Messergebnissen der körperlichen Aktivität sind. Schlussfolgerung Die Messung der körperlichen Aktivität mit am Körper getragenen Sensoren war auch bei geriatrischen Patienten mit schweren Mobilitätseinschränkungen möglich und reduzierte damit die Anzahl der Patienten ohne Messergebnisse. Die Messung liefert objektive Werte, die eine Veränderung im Rahmen der Rehabilitation abbilden können

Physical activity of moderately impaired elderly stroke patients during rehabilitation

In older adults, physical activity (PA) is promoted for public health preventive effort. It is also a major target in the rehabilitation process. Existing assessment tools in the clinical routine do not include any aspects of PA or participation and are often prone to floor or ceiling effects. The aim of this study was to document the process of rehabilitation by activity monitoring without floor or ceiling effects. Ninety-two stroke patients of a geriatric rehabilitation unit (mean age 82 years, +/- 6.21 years, 61% women) were included in an observational study to assess physical capacity (balance, chair rise, gait speed) and PA at admission and two weeks thereafter. PA was measured through an ambulatory activity monitor based on accelerometers and gyroscopes and showed no floor or ceiling effects. Floor effects were however documented for measures of physical capacity (admission 5-11%; follow-up 2-9%) and ceiling effects were registered for the balance test (admission 17.4%; follow-up 22.8%). Improvements were documented for measures of physical capacity as well as for PA (all p < 0.001). We conclude that the assessment of PA by activity monitoring is a valuable measure to document objectively the process of rehabilitation without floor or ceiling effects

Characterization of patients admitted to specialized geriatric acute care hospital units with the German version of the Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening-instrument: a cross-sectional study

Abstract Background The Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening tool records major geriatric problems, originally applied in the emergency department. Particularly, the distinction of compensated and uncompensated problems is an interesting and new approach. Therefore, we translated the SEISAR in German language and used it to characterize patients in specialized geriatric hospital wards in Germany and to gather initial experience regarding its usability and practicability. Methods The tool was translated by three independent specialists in geriatric medicine and backtranslated for quality-assurance by a non-medical English native speaker. In a second step, 8 acute care geriatric hospital departments used the translated version to characterize all consecutive patients admitted over a period of one month between December 2019 and May 2020 at time of admission. Results Most of the 756 patients (78%) lived in an own apartment or house prior to hospital admission. Participants had on average 4 compensated and 6 uncompensated problems, a Barthel-Index of 40 pts. on admission with a median increase of 15 points during hospital stay, and a median length of stay of 16 days in the geriatric hospital department. Conclusion SEISAR is an interesting standardized brief comprehensive geriatric assessment tool for the identification of compensated and uncompensated health problems in older persons. The data of this study highlights the number, variability, and complexity of geriatric problems in patients treated in specialized acute care geriatric hospital wards in Germany. Trial registration German Clinical trial register (DRKS-ID: DRKS00031354 on 27.02.2023)

Guidelines for clinical applications of spatio-temporal gait analysis in older adults

info:eu-repo/semantics/publishe

German version of the de Morton mobility index

The English version of the de Morton Mobility Index (DEMMI) enables allied health professions in an inpatient setting to assess the mobility of geriatric patients in a reliable, valid, easy and fast way, without showing any floor or ceiling effects. The aim of this study was the DEMMI's cross-cultural adaption into German language with further analysis of some of its psychometric properties based on this process. Translation was done in a multistage procedure following international recommendations. Within clinical pilot testing the DEMMI was routinely applied over a period of 3 weeks in a geriatric hospital. User experiences were evaluated in a qualitative way and DEMMI test results were analyzed with the focus on practicability and responsiveness. A German DEMMI version has been translated and performed with 133 patients. The test takes approximately 10 min to administer, is save and easy to use and does not show any floor or ceiling effects. The DEMMI is valid for the whole mobility spectrum, that is why mobility changes can be realized sufficiently in contrast to the Timed Up And Go Test. The DEMMI is already applicable in the German-speaking world. However, further research on its validity and reproducibility are desirable