Overground Robotic Program Preserves Gait in Individuals With Multiple Sclerosis and Moderate to Severe Impairments: A Randomized Controlled Trial.

OBJECTIVE: To determine how overground robotic (OR) training added to ongoing rehabilitation affects gait speed, lower extremity function, functional mobility, and fatigue in individuals with multiple sclerosis (MS) and moderate to severe gait impairments. DESIGN: Randomized controlled trial. SETTING: Outpatient setting at the Multiple Sclerosis Association of Bizkaia, an association serving MS patients in Bizkaia, Spain. PARTICIPANTS: Individuals with MS (N=36) participated in this interventional study. Inclusion criteria were age of 18 years or older, Expanded Disability Status Scale score between 4.5 and 7, and the need for assistive devices for walking outdoors. INTERVENTIONS: The control group (CG) engaged in an ongoing rehabilitation program consisting of weekly 1-hour individualized sessions. The intervention group (OR group) also participated in this program in addition to a twice-weekly individualized and progressive OR gait training intervention for 3 months, aiming to reach a maximum of 40 minutes by the end of the 3-month period. MAIN OUTCOME MEASURES: Primary outcome was the 10-meter walking test (10MWT). Secondary variables included the Short Physical Performance Battery, the timed Up and Go (TUG) test, and the Modified Fatigue Impact Scale. RESULTS: The OR group maintained 10MWT performance and significantly improved on the TUG test (P=.049, medium effect size) without increasing fatigue perception. The CG demonstrated a decline on the 10MWT (P=.044, small effect size) and reduced fatigue (P=.024, medium effect size). No time per group interaction was observed for any variable. CONCLUSION: The evaluated intervention could preserve gait speed and significantly improve functional mobility without increasing perceived fatigue in participants. Thus, OR exoskeletons could be considered a tool to deliver intensive practice of good-quality gait training in individuals with MS and moderate to severe gait impairments. Further studies are necessary to confirm these preliminary results.

Determinants of participation in a post-hospitalization physical exercise program for older adults.

BACKGROUND: Older patients often experience a decline in physical function and cognitive status after hospitalization. Although interventions involving physical exercise are effective in improving functional performance, participation in physical exercise interventions among older individuals is low. We aimed to identify factors that contribute to exercise refusal among post-hospitalized older patients. METHODS: A cross-sectional study of recruitment data from a randomized controlled trial was conducted involving 495 hospitalized people ≥70 years old. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We determined physical function with the Short Physical Performance Battery (SPPB), nutritional status with the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ). Student's t, Mann-Whitney U, or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model. RESULTS: Among the analyzed patients, 88.8% declined participation in the physical exercise program. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.07-1.19), poor nutritional status (OR: 0.81; 95% CI: 0.69-0.95), and reduced home accessibility (OR: 0.27; 95% CI: 0.08-0.94) were predictors of participation refusal. Moreover, patients who declined participation had worse performance on the SPPB (P < 0.05) and its tests of balance, leg strength, and walking speed (P < 0.05). No differences were found between groups in other variables. CONCLUSIONS: This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with increased age, poor nutritional status, and reduced home accessibility. Our findings support the need for intervention design that accounts for these factors to increase older patient participation in beneficial exercise programs. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619000093189 , (date: January 22, 2019, retrospectively registered).

Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason.

BACKGROUND AND PURPOSE: Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason. METHODS: This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors. RESULTS AND DISCUSSION: In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization. CONCLUSIONS: Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.

Malnutrition and Poor Physical Function Are Associated With Higher Comorbidity Index in Hospitalized Older Adults.

Background: The Charlson Comorbidity Index (CCI) is the most widely used method to measure comorbidity and predict mortality. There is no evidence whether malnutrition and/or poor physical function are associated with higher CCI in hospitalized patients. Therefore, this study aimed to (i) analyze the association between the CCI with nutritional status and with physical function of hospitalized older adults and (ii) examine the individual and combined associations of nutritional status and physical function of older inpatients with comorbidity risk. Methods: A total of 597 hospitalized older adults (84.3 ± 6.8 years, 50.3% women) were assessed for CCI, nutritional status (the Mini Nutritional Assessment-Short Form [MNA-SF]), and physical function (handgrip strength and the Short Physical Performance Battery [SPPB]). Results: Better nutritional status (p < 0.05) and performance with handgrip strength and the SPPB were significantly associated with lower CCI scores among both men (p < 0.005) and women (p < 0.001). Patients with malnutrition or risk of malnutrition (OR: 2.165, 95% CI: 1.408-3.331, p < 0.001) as well as frailty (OR: 3.918, 95% CI: 2.326-6.600, p < 0.001) had significantly increased the risk for being at severe risk of comorbidity. Patients at risk of malnutrition or that are malnourished had higher CCI scores regardless of being fit or unfit according to handgrip strength (p for trend < 0.05), and patients classified as frail had higher CCI despite their nutritional status (p for trend < 0.001). Conclusions: The current study reinforces the use of the MNA-SF and the SPPB in geriatric hospital patients as they might help to predict poor clinical outcomes and thus indirectly predict post-discharge mortality risk.

Nutritional status and physical performance using handgrip and SPPB tests in hospitalized older adults.

BACKGROUND & AIMS: Malnutrition and poor physical performance are highly prevalent within hospitalized older adults, and both have in common the loss of muscle mass. Likewise, there is growing interest in identifying markers of physical performance, other than just measuring muscle mass, that might be useful for managing malnutrition. This study aimed to (i) characterize the physical condition of hospitalized older adults in comparison to previously published reference percentile values of same age adults and (ii) to examine the association between the nutritional status and physical performance of older inpatients. METHODS: A total of 604 inpatients (age 84.3 ± 6.8 years, 50.3% women) participated in this cross-sectional study. Patients were assessed for nutritional status (Mini Nutritional Assessment-Short Form (MNA-SF)) and physical performance (handgrip strength and the Short Physical Performance Battery (SPPB)). RESULTS: During hospitalization, 65.7% of the inpatients were at risk of malnutrition or malnourished. More than a half of the older inpatients were unfit (≤P25) for handgrip strength (52.0%) and SPPB total score (86.3%) as well as for two of its subtests, gait speed (86.7%) and 5 times sit-to-stand (91.1%) tests. Patients' nutritional status was significantly associated with better physical performance within all tests (all p < 0.001), as their nutritional status improved so did their physical performance (all p for trend <0.001). Hence, being at risk of malnutrition or malnourished significantly increased the likelihood for being classified as unfit according to handgrip strength (OR: 1.466, 95% CI: 1.045-2.056), SPPB total score (OR: 2.553, 95% CI: 1.592-4.094) and 4-m walking test (OR: 4.049, 95% CI: 2.469-6.640) (all p < 0.05), and as frail (OR: 4.675, 95% CI: 2.812-7.772) according to the SPPB frailty threshold (p < 0.001). CONCLUSIONS: This study reinforces the use of handgrip strength and SPPB, as well as its subtests (gait speed and 5 times sit-to-stand tests), in hospitalized older adults as alternative measures of muscle mass for malnutrition management. Hence, it seems that risk of malnutrition or malnutrition assessed by MNA-SF might help to predict poor physical performance in older inpatients.

Nutritional Status Is Associated with Function, Physical Performance and Falls in Older Adults Admitted to Geriatric Rehabilitation: A Retrospective Cohort Study.

Nutritional status is relevant to functional recovery in patients after an acute process requiring rehabilitation. Nevertheless, little is known about the impact of malnutrition on geriatric rehabilitation. This study aimed to determine the association between nutritional status at admission and the evolution of functional and physical outcomes, as well as the capability of nutritional status to identify fallers among patients admitted to geriatric rehabilitation for different reasons. This was a retrospective cohort study of 375 patients. Data collected included age, gender, diagnosis at admission, comorbidities, cognitive and nutritional status, functional and physical measurements, length of stay, mortality and falls. Orthogeriatric patients with worse nutritional status according to the Mini Nutritional Assessment-Short Form (MNA-SF) had a significantly lower Barthel Index at admission and discharge with worse functional gain and poorer outcomes in the Short Physical Performance Battery (SPPB). However, in hospital-deconditioned patients, the MNA-SF score was not significantly associated with functional and physical recovery. Poor nutritional status at admission increased the risk of experiencing at least one fall during rehabilitation in orthogeriatric patients. However, hospital-deconditioned patients who fell had better SPPB scores than those who did not fall. Our results demonstrate the importance of nutritional status in the clinical evolution of orthogeriatric patients throughout the rehabilitation process.

Multicomponent Physical Exercise in Older Adults after Hospitalization: A Randomized Controlled Trial Comparing Short- vs. Long-Term Group-Based Interventions.

Multicomponent physical exercise is effective in curbing the effect of hospitalization in older adults. However, it is not well established which characteristics of the exercise interventions would optimize intervention sustainability and efficacy. This study compared the effects of two group-based multicomponent exercise interventions of different lengths in older adults after hospitalization. Fifty-five participants were randomly assigned to a short-term group-based branch (SGB, n = 27) or to a long-term group-based branch (LGB, n = 28). The SGB participated in a six-week multicomponent group-based exercise-training program followed by 18 weeks of home-based exercise. The LGB completed 12 weeks of each phase. Physical function, physical activity, quality of life, anthropometrics, and nutritional status were assessed at baseline, after 12 weeks, and after 24 weeks of intervention. Both groups improved physical function and nutritional status and increased physical activity after 12 weeks of intervention (paired student's t-test, p < 0.01), and maintained the positive effects during the following 12 weeks. No group-by-time interaction was observed in any of the studied variables using mixed-model ANOVA. Based on these findings, we determined that 6 weeks of a group-based exercise intervention caused similar functional and nutritional benefits to a longer group-based intervention of 12 weeks when both are continued at home until 24 weeks.

Effects of Leucine-Enriched Whey Protein Supplementation on Physical Function in Post-Hospitalized Older Adults Participating in 12-Weeks of Resistance Training Program: A Randomized Controlled Trial.

Age-related strength and muscle mass loss is further increased after acute periods of inactivity. To avoid this, resistance training has been proposed as an effective countermeasure, but the additional effect of a protein supplement is not so clear. The aim of this study was to examine the effect of a whey protein supplement enriched with leucine after resistance training on muscle mass and strength gains in a post-hospitalized elderly population. A total of 28 participants were included and allocated to either protein supplementation or placebo supplementation following resistance training for 12 weeks (2 days/week). Physical function (lower and upper body strength, aerobic capacity and the Short Physical Performance Battery (SPPB) test), mini nutritional assessment (MNA) and body composition (Dual X-ray Absorptiometry) were assessed at baseline and after 12 weeks of resistance training. Both groups showed improvements in physical function after the intervention (p < 0.01), but there were no further effects for the protein group (p > 0.05). Muscle mass did not improve after resistance training in either group (p > 0.05). In conclusion, 12 weeks of resistance training are enough to improve physical function in a post-hospitalized elderly population with no further benefits for the protein-supplemented group.