Abstract
Background
The demand for geriatric rehabilitation will drastically increase over the next years. It will be increasingly important to demonstrate the efficacy and effectiveness of geriatric rehabilitation. One component is the use of objective and valid assessment procedures. These should be understandable to patients, relevant for goal attainment, and able to document change. A number of currently used physical capacity measures have floor effects. The use of body-fixed sensor technology for monitoring physical activity is a possible supplement for the assessment during geriatric rehabilitation to overcome floor effects and directly monitor improvement of mobility as a component of geriatric rehabilitation in many patients.
Methods
The observational study with a pre–post design examined 65 consecutive geriatric hip fracture inpatients. Measurements were performed on admission and 2 weeks later. The capacity measures included gait speed, chair rise time, a balance test, 2-Minute-Walk test and the Timed-Up-and-Go test. Physical activity was measured over 9 h using body-fixed sensor technology and expressed as cumulated walking and walking plus standing (time on feet).
Results
Body-fixed sensors allowed direct measurement of physical activity in all patients available for testing. Cumulated walking and standing (time on feet) increased from a median 83.6 to 102.6 min. Cumulated walking increased from a median 7.0 to 16.3 min. The comparison with the physical capacity measures demonstrated a modest to fair correlation (rs = 0.455 and 0.653). This indicates that physical capacity measures are not the same construct as physical activity.
Conclusion
Body-fixed sensor-based assessment of physical activity was feasible even in geriatric patients with severe mobility problems and decreased the number of patients with missing data both on admission and 2 weeks later. Body-fixed sensor data documented change in activity level.
Zusammenfassung
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.
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Acknowledgment
The study was funded by the German Federal Ministry of Labor and Social Affairs (MEMBeR, GRR—58663–11/3). Petra Benzinger was supported by the Robert Bosch Foundation (Forschungskolleg Geriatrie). The sponsors had no influence on the design of the study, the interpretation of data, or on the final conclusions drawn.
Conflict of interest
On behalf of all authors, the corresponding author states that there are no conflicts of interest.
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Benzinger, P., Lindemann, U., Becker, C. et al. Geriatric rehabilitation after hip fracture. Z Gerontol Geriat 47, 236–242 (2014). https://doi.org/10.1007/s00391-013-0477-9
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DOI: https://doi.org/10.1007/s00391-013-0477-9