Article

OBJECTIVE: To compare the 30-day readmission predictive power of in-hospital
walking activity and in-hospital activities of daily living (ADLs) in older
acutely ill patients. In addition, we sought to identify preliminary walking
thresholds that could support the targeting of interventions aimed at minimizing
rehospitalizations. DESIGN: Prospective, observational clinical cohort study.
Step counts during hospitalization were assessed via accelerometry. ADL function
was assessed within 48 hours of admission. SETTING: Acute care hospital.
PARTICIPANTS: One hundred sixty-four ambulatory persons aged 65 years and older
admitted to the hospital from the community with an acute medical illness.
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Readmission back to the
index hospital (yes vs no) within 30 days of discharge. RESULTS: Twenty-six
patients (15.8%) were readmitted within 30 days of discharge. Walking activity
during hospitalization was more strongly and significantly associated with 30-day
readmission (odds ratio=0.90; 95% confidence interval, 0.82-0.98) than ADL
function (odds ratio=0.45; 95% confidence interval, 0.14-1.45) after adjusting
for relevant readmission risk factors. The predictive accuracy (area under the
curve) was highest for models that included walking activity and changed little
with the addition of ADLs. A walking threshold of 275 steps or more per day
identified patients at reduced 30-day readmission risk. CONCLUSIONS: Walking
activity was a stronger predictor of readmission than ADLs. Monitoring patient
activity during hospitalization may provide clinicians with valuable information
on early readmission risk not captured by measures of ADLs. Further study is
needed to replicate these findings and monitor walking activity
posthospitalization to further advance our understanding of readmission risk.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS