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Unlocking the black box of geriatric physiotherapy

Quantification of physical activity and walking parameters during inpatient geriatric rehabilitation therapy sessions

Entschlüsselung der Blackbox „geriatrische Physiotherapie“

Quantifizierung von Parametern der körperlichen Aktivität und des Gehens während stationärer geriatrischer Rehabilitationstherapiesitzungen

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Abstract

Background

Physiotherapy and occupational therapy are currently described using the duration of treatment (days or weeks), the frequency of therapy sessions (on a daily or 3–5 days per week basis) and considering the duration of a session (e.g., 30 or 45 min). The content is often poorly defined and the intensity is rarely reported. Using digital technology some of these shortcomings can be overcome. The cumulative parameters of walking and activity sessions, the duration of walking, the time spent in an upright or lying/sitting position and the number of steps can now be analyzed. In this study, we examined the parameters during non-treatment periods and therapy time in patients recovering from fragility fractures.

Methods

The study is a secondary data analysis of a trial that examined the improvement of physical activity (PA) and self-efficacy of fragility fracture patients. Changes in mobility parameters were measured using the ActivPal3 sensor during the 1st and 3rd weeks of rehabilitation and 104 patients were analyzed (mean age 82.5 years). Parameters included the time during supervised treatment, the mean number of steps, cumulative time in an upright position and walking duration, the number of walking intervals of > 10 s and sit to stand transfers.

Results

Patients received 3–4 therapy sessions adding up to 90–120 min per day. More than 50% of the daily walking activities were achieved in these sessions until discharge. With this amount of therapeutic input most parameters meaningfully improved from baseline to the second measurement. The number of steps increased by 30%, the mean time in an upright position increased by 26% and the mean time spent walking increased by 49%.

Conclusion

The sensor-derived measurements describe the amount of walking activity administered during the supervised therapy sessions. This could be used as a starting point for future trials to improve the outcomes or as a standard of process evaluation for clinical services.

Zusammenfassung

Hintergrund

Physiotherapie und Ergotherapie werden derzeit meist mit der Behandlungsdauer (Tage oder Wochen), der Häufigkeit der Therapie (täglich oder 3‑ bis 5‑mal pro Woche) und der Dauer pro Therapiesitzung (z. B. 30 oder 45 min) dokumentiert. Der Inhalt ist oft unzureichend beschrieben. Durch den Einsatz digitaler Technologie können einige diese Defizite überwunden werden. In dieser Studie werden diese Parameter während der behandlungsfreien und der Therapiezeit bei Patienten untersucht, die sich in Rehabilitation nach Fragilitätsfrakturen befinden.

Methoden

Bei der vorliegenden Studie handelt es sich um eine sekundäre Datenanalyse einer Studie, welche die Verbesserung der physischen Aktivität sowie die Veränderung der Angst und Selbstwirksamkeit von Patienten nach Fragilitätsfrakturen untersucht hat. Veränderungen der Gangparameter wurden mit dem ActivPal3-Sensor während der 1. und 3. Woche des Rehabilitationsaufenthalts gemessen. Es nahmen 104 Patienten mit einem Durchschnittsalter von 82,5 Jahren teil. Zu den gemessenen Parametern gehörten die Zeit während der supervidierten Behandlung sowie die Anzahl der Schritte, kumulativen Gangzeit, Gangintervalle von mehr als 10 s und der Sitz-Stand-Transfers.

Ergebnisse

Die Patienten erhielten 3–4 Therapien mit insgesamt 90–120 min pro Tag. Etwa 50 % der täglichen Geh- und Schrittaktivität wurden bis zur Entlassung während der Therapie erbracht. Bei dieser Menge an therapeutischer Behandlung verbesserten sich die meisten Parameter von der initialen Erhebung bis zur zweiten Messung. Die Anzahl der Schritte stieg um mehr als 30 % an, die durchschnittliche Zeit in Standpositionen verbesserte sich um 26 % und die durchschnittliche Gehzeit erhöhte sich um 49 %.

Schlussfolgerung

Die von Sensoren abgeleiteten Messungen beschreiben den Umfang der Gangaktivität, die während der Therapieeinheiten erreicht wurde. Dies könnte als Grundlage für die Entwicklung neuer Forschungsansätze genutzt werden oder der Prozessevaluation zukünftiger klinische Standards dienen.

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Authors and Affiliations

  1. Physiotherapy Department, University of West Attica, 12243, Egaleo, Athens, Greece

    Marios Stefanakis & Vasiliki Sakellari

  2. Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany

    Jochen Klenk, Karin Kampe, Matthias Klimek, Klaus Pfeiffer &  Clemens Becker

  3. Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany

    Jochen Klenk & Matthias Klimek

  4. Unit Digitale Geriatrie, Universitätsklinikum Heidelberg, Bergheimerstr. 20, 69115, Heidelberg, Germany

    Clemens Becker

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  1. Marios Stefanakis
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  2. Vasiliki Sakellari
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  7. Clemens Becker
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Correspondence to Marios Stefanakis or Clemens Becker.

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Conflict of interest

M. Stefanakis, V. Sakellari, J. Klenk, K. Kampe, M. Klimek, K. Pfeiffer and C. Becker declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Stefanakis, M., Sakellari, V., Klenk, J. et al. Unlocking the black box of geriatric physiotherapy. Z Gerontol Geriat 55, 637–643 (2022). https://doi.org/10.1007/s00391-022-02126-3

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