Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project
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Date
2008
Authors
Nolan, Jo
Thomas, Susan
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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© 2008 Nolan and Thomas; licensee BioMed Central Ltd.
Rights Holder
Nolan and Thomas; licensee BioMed Central Ltd.
Abstract
Background: The aim of this project was primarily to assess the feasibility of individual exercise programs for older
hospitalised patients at risk of functional decline, and secondarily to evaluate impact on discharge outcomes.
Methods: Design: Cohort service improvement project
Setting: 500 bed acute metropolitan hospital
Subjects: Patients aged 70 and older admitted to Flinders Medical Centre under the general medical, aged care and
respiratory units from June to November 2006, at intermediate or high risk of functional decline, and able to commence
exercise within 48 hours of admission
Intervention: Functional Maintenance Program (FMP); an individually tailored exercise program to maintain functional
mobility, prescribed and progressed by a physiotherapist, and supervised by an Allied Health Assistant (AHA), provided
in addition to usual physiotherapy care
Outcome measures: Feasibility (number of admissions suitable, commencing and complying with FMP). Impact (length of
hospital stay (LOS), Aged Care Assessment Team (ACAT) referrals and approvals, hospital readmissions within 28 days,
and functional mobility (Elderly Mobility Scale))
Data Analysis: Descriptive and logistic regression analysis
Results: Of 1021 admissions of patients aged 70 or older to general medical, aged care and respiratory units, 22% (n =
220) were identified within 48 hours as suitable for FMP: 196 (89%) commenced FMP within 48 hours of admission (FMP
patients); 24 (11%) received usual physiotherapy (usual care patients). Feasibility of individually tailored exercise
programs for older medical patients was supported by high uptake (89%), low withdrawal (17%) shown by those who
commenced FMP, and good compliance with exercise sessions (70%). Logistic regression analysis showed a statistically
significant decreased likelihood of referral for nursing home admission (OR = 0.228, 95% CI 0.088–0.587) and decreased
likelihood of approval for admission to residential care (OR = 0.307, 95% CI 0.115–0.822) in favour of FMP. Although
trends of an average 15.7% LOS reduction, 8% fewer readmissions and improved functional mobility were demonstrated
in favour of FMP patients, these results were not statistically significant.
Conclusion: It is feasible to identify older medical patients likely to benefit from an exercise program to maintain
functional abilities, and to commence within 48 hours of admission.
Description
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Citation
Nolan, J. and Thomas, S. (2008). Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project. BMC Health Services Research, 8(250)