Functional mobility trajectories of hospitalized older adults admitted to acute geriatric wards: A retrospective observational study in an English university hospital.

AIM: The mobility trajectories of hospitalized older people are heterogeneous, and there is a need to understand patient groups with similar trajectories. Our aims were to identify mobility trajectories of older patients admitted to geriatric wards in an English university hospital, and describe patient characteristics and outcomes associated with different mobility groups. METHODS: A retrospective observational study of first admissions to geriatric wards for 3 months starting 1 May 2016 was carried out. Anonymized routinely collected clinical data was extracted from the electronic patient records: age, sex, Clinical Frailty Scale score, presence of delirium (yes/no), diagnosis of dementia (yes/no), Charlson Comorbidity Index, falls in the past year and the highest recorded Modified Early Warning Score in the Emergency Department. Physiotherapists routinely collected the Elderly Mobility Scale on admission and discharge; this information was entered in a K-means cluster analysis to identify mobility trajectory groups. We compared clinical characteristics and outcomes between these groups and used logistic regression models to determine independent predictors of group membership. RESULTS: The overall functional trajectory was improvement, from a median Elderly Mobility Scale of 11 on admission to 14 on discharge. Cluster analysis identified five mobility trajectory groups: low-low (n = 117), intermediate-intermediate (n = 95), intermediate-high (n = 205), low-high (n = 89) and high-high (n = 209). Higher frailty and the presence of cognitive impairment were associated with the low-low and intermediate-intermediate group membership, and negatively associated with the high-high group membership. CONCLUSIONS: The majority of hospitalized patients experienced functional improvement. Frailty and cognitive impairment might be associated with poorer mobility trajectories and hence require early identification. Geriatr Gerontol Int 2019; 19: 305-310.

Convergence Insufficiency Identifies Athletes at Risk of Prolonged Recovery From Sport-Related Concussion.

BACKGROUND: Sensitive and specific screening methods are needed to identify athletes at risk of prolonged recovery after sport-related concussion (SRC). Convergence insufficiency (CI) is a common finding in concussed athletes. PURPOSE: To assess the relationship between CI and recovery after SRC at the initial office visit. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: In this retrospective cohort study, 270 athletes (147 male, 123 female), mean ± SD age 14.7 ± 2.0 years (range, 10-21 years), with the diagnosis of SRC who presented for initial office visit between January 2014 and January 2016 were evaluated for near point of convergence (NPC). The athletes were categorized into 2 groups: normal near point of convergence (NPC ≤6 cm), and convergence insufficiency (NPC >6 cm). These athletes were then followed to determine recovery time. RESULTS: Athletes presented for initial office visit at a mean of 5.2 ± 4.2 days (range, 1-21 days) after SRC. Half of the athletes had CI after SRC (50.4%; n = 136). Athletes with CI (NPC 12.3 ± 4.7 cm) took significantly longer to recover after SRC, requiring 51.6 ± 53.9 days, compared with athletes with normal NPC (4.1 ± 1.3 cm), who required 19.2 ± 14.7 days ( P < .001). After controlling for potential confounding variables, CI significantly increased the odds of prolonged recovery (≥28 days from injury) by 12.3-fold ( P < .001; 95% confidence interval, 6.6-23.0). CI screening correctly classified 75.2% of our sample with 84.2% sensitivity and 70.0% specificity. The positive predictive value for CI and prolonged recovery was 62.5%, and the negative predictive value was 88.1%. CONCLUSION: CI at the initial office visit identified athletes at increased risk of prolonged recovery after SCR. Clinicians should consider measuring NPC in concussed athletes as a quick and inexpensive prognostic screening method.