A randomised controlled trial to measure the effects of an augmented prescribed exercise programme (APEP) on length of stay, physical ability and quality of life in frail older medical patients in the acute setting

Abstract

The aim of this thesis was to measure the effectiveness of additional exercises on length of stay, physical performance and quality of life for frail older medical inpatients. The thesis, in three phases (1) identified a suitable and accurate motion sensor to measure walking in hospital, (2) measured walking in hospital, and (3) measured the effectiveness of an augmented prescribed exercise programme (APEP) for frail older acute medical (RCT). Phase 1: A scholarly review identified two accelerometers and three pedometers showing potential, and a validation study (n=32), identified one of these as suitably accurate. Phase 2: The accelerometer was used to measure the association between walking (step-count) and (1) length of stay, (2) physical performance and (3) potential influencers of walking (n=154). More walking (50%) was associated with a 6% shorter hospital stay. Better physical performance on admission predicted 15% more walking, and assigned bed-rest and tethering treatments were associated with less walking (70% and 30% respectively). Phase 3: The effectiveness of the APEP was measured (n=190), using length of stay as the primary outcome measure. Twice-daily exercise sessions were delivered; strengthening/balance to the intervention group, stretching/relaxation to the control group. Many (35%) patients were transferred to sub-acute care. A 30% shorter length of stay (patients discharged directly home only), was detected, however, failed to reach significant significance (n=128), (HR 1.3 (CI 0.90-1.87) p=0.1). Improved physical performance at discharge (β 0.88 (CI 0.2-1.57) p=0.01), quality of life at follow-up (β 0.28 (CI 0.91-0.47) p=0.004) and less negative events (pooled falls, prolonged hospital stays, deaths and long-term care admissions) (OR 0.42 (0.2-0.92) p=0.03, post hoc analysis) were detected. The results indicate that older inpatients’ inactivity is associated with length of stay. Additional exercises improved physical performance and quality of life. Its effect on length of stay remains inconclusive.