Development of the Lie-to-Sit-to-Stand-to-Walk Transfer (LSSWT) test for early mobilization in older patients in geriatric rehabilitation.

BACKGROUND: Early discharge from a rehabilitation center is only possible, if patients are able to do basic transfers independently (e.g., get up from bed and walk to the toilet). Against this background, the Lie-to-Sit-to-Stand-to-Walk Transfer (LSSWT) test was developed in order to quantify complex transfer abilities in older adults. This study was to evaluate the reliability and validity of this instrument. MATERIAL AND METHODS: A total of 24 older patients (80.25±8.10 years) of a geriatric rehabilitation unit performed the LSSWT test. Expert ratings were used to measure criterion validity. The Timed Up & Go test (TUG) was administered to assess construct validity. Furthermore, the time score of the LSSWT test was correlated with the Trunk Control Test (TCT), balance performance, the Chair Stand Test (CST) and gait speed. Intra- and interrater reliability were measured, conducting the LSSWT test on consecutive days. RESULTS: The coefficients of correlation between the LSSWT test and the expert ratings as well as the TUG test were r=-0.82 and r=0.83, respectively. Furthermore, the association with the TCT, balance, CST, and gait speed were r=-0.51, r=-0.45, r=0.47, and r=-0.72, respectively. The results of intrarater reliability and interrater reliability were ICC=0.96 and ICC=0.77, respectively. CONCLUSION: The study shows that the LSSWT test is a valid measure for quantifying difficulties in transfer abilities of patients during geriatric rehabilitation. The good correlation between LSSWT test and TUG test indicates good construct validity, but also that the LSSWT test provides additional information. Interrater reliability was moderate; therefore, the training of the supervisors should be re-evaluated. Further research is needed to establish cut-off values for discharge decision and to analyze the use of the LSSWT test in different subgroups.

Evaluation of an ergonomically modified bed to enhance mobilization in geriatric rehabilitation. A pilot study.

The number of older patients with decreased capacity to independently perform a sit-to-stand transfer will increase during the next decade. It was hypothesized that an ergonomically modified bed prototype would either allow patients to stand up from the prototype independently or with reduced impact on the lower extremities. Standing up from the prototype was examined by force plate measurements in 30 patients of a geriatric rehabilitation hospital (median age 83.5 years). Nine of the patients were not able to stand up from the bed without arm rests, but were able to stand up with the help of arm rests. In those 21 patients, able to stand up even without arm rests, the use of arm rests caused a lower maximum vertical ground reaction force (p=0.03). No differences in quality concerning using or not using the armrests were documented neither for the time to stand up nor for symmetry of ground reaction force. In summary, the study shows that an ergonomically modified bed adds increased independency during the sit-to-stand transfer in selected patients. The reduction of peak vertical ground reaction force by using arm rests could be beneficial for certain patient groups.