Original research| Volume 97, ISSUE 9, SUPPLEMENT , S226-S231, September 2016

Download started.


Inpatient Walking Activity to Predict Readmission in Older Adults



      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.


      Prospective, observational clinical cohort study. Step counts during hospitalization were assessed via accelerometry. ADL function was assessed within 48 hours of admission.


      Acute care hospital.


      One hundred sixty-four ambulatory persons aged 65 years and older admitted to the hospital from the community with an acute medical illness.


      Not applicable.

      Main Outcome Measures

      Readmission back to the index hospital (yes vs no) within 30 days of discharge.


      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.


      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.


      List of abbreviations:

      ADL (activities of daily living), AUC (area under the curve), CI (confidence interval), EHR (electronic health record), OR (odds ratio), ROC (receiver operating characteristic)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • DeFrances C.J.
        • Lucas C.A.
        • Buie V.C.
        • Golosinskiy A.
        2006 National Hospital Discharge Survey.
        Natl Health Stat Report. 2008; 30: 1-20
        • Jha A.K.
        • Orav E.J.
        • Epstein A.M.
        Public reporting of discharge planning and rates of readmissions.
        N Engl J Med. 2009; 361: 2637-2645
      1. 111 th Congress. Patient Protection and Affordable Care Act, Pub L No. 111–148 (Jan 5, 2010).

        • Hernandez A.F.
        • Granger C.B.
        Prediction is very hard, especially about the future: comment on “factors associated with 30-day readmission rates after percutaneous coronary intervention”.
        Arch Intern Med. 2012; 172: 117-119
        • Coleman E.A.
        • Parry C.
        • Chalmers S.
        • Min S.J.
        The care transitions intervention: results of a randomized controlled trial.
        Arch Intern Med. 2006; 166: 1822-1828
        • Coleman E.A.
        • Min S.J.
        • Chomiak A.
        • Kramer A.M.
        Posthospital care transitions: patterns, complications, and risk identification.
        Health Serv Res. 2004; 39: 1449-1465
        • Kansagara D.
        • Englander H.
        • Salanitro A.
        • et al.
        Risk prediction models for hospital readmission: a systematic review.
        JAMA. 2011; 306: 1688-1698
        • Simonsick E.M.
        • Montgomery P.S.
        • Newman A.B.
        • Bauer D.C.
        • Harris T.
        Measuring fitness in healthy older adults: the Health ABC Long Distance Corridor Walk.
        J Am Geriatr Soc. 2001; 49: 1544-1548
        • Ostir G.V.
        • Berges I.
        • Kuo Y.F.
        • Goodwin J.S.
        • Ottenbacher K.J.
        • Guralnik J.M.
        Assessing gait speed in acutely ill older patients admitted to an acute care for elders hospital unit.
        Arch Intern Med. 2012; 172: 353-358
        • Fisher S.R.
        • Kuo Y.F.
        • Graham J.E.
        • Ottenbacher K.J.
        • Ostir G.V.
        Early ambulation and length of stay in older adults hospitalized for acute illness.
        Arch Intern Med. 2010; 170: 1942-1943
        • Gerin-Lajoie M.
        • Richards C.L.
        • McFadyen B.J.
        The circumvention of obstacles during walking in different environmental contexts: a comparison between older and younger adults.
        Gait Posture. 2006; 24: 364-369
        • Purser J.L.
        • Pieper C.F.
        • Poole C.
        • Morey M.
        Trajectories of leg strength and gait speed among sedentary older adults: longitudinal pattern of dose response.
        J Gerontol A Biol Sci Med Sci. 2003; 58: M1125-M1134
        • Persad C.C.
        • Jones J.L.
        • Ashton-Miller J.A.
        • Alexander N.B.
        • Giordani B.
        Executive function and gait in older adults with cognitive impairment.
        J Gerontol A Biol Sci Med Sci. 2008; 63: 1350-1355
        • Brandler T.C.
        • Wang C.
        • Oh-Park M.
        • Holtzer R.
        • Verghese J.
        Depressive symptoms and gait dysfunction in the elderly.
        Am J Geriatr Psychiatry. 2012; 20: 425-432
        • Fredman L.
        • Hawkes W.G.
        • Black S.
        • Bertrand R.M.
        • Magaziner J.
        Elderly patients with hip fracture with positive affect have better functional recovery over 2 years.
        J Am Geriatr Soc. 2006; 54: 1074-1081
        • Foster R.C.
        • Lanningham-Foster L.M.
        • Manohar C.
        • et al.
        Precision and accuracy of an ankle-worn accelerometer-based pedometer in step counting and energy expenditure.
        Prev Med. 2005; 41: 778-783
        • Resnick B.
        • Nahm E.S.
        • Orwig D.
        • Zimmerman S.S.
        • Magaziner J.
        Measurement of activity in older adults: reliability and validity of the Step Activity Monitor.
        J Nurs Meas. 2001; 9: 275-290
        • Fisher S.R.
        • Goodwin J.S.
        • Protas E.J.
        • et al.
        Ambulatory activity of older adults hospitalized with acute medical illness.
        J Am Geriatr Soc. 2011; 59: 91-95
        • Fulton J.P.
        • Katz S.
        • Jack S.S.
        • Hendershot G.E.
        Physical functioning of the aged.
        Vital Health Stat 10. 1989 Mar; : 1-48
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Brown C.J.
        • Redden D.T.
        • Flood K.L.
        • Allman R.M.
        The underrecognized epidemic of low mobility during hospitalization of older adults.
        J Am Geriatr Soc. 2009; 57: 1660-1665
        • Hopcroft P.
        • Peel N.M.
        • Poudel A.
        • Scott I.A.
        • Gray L.C.
        • Hubbard R.E.
        Prescribing for older people discharged from the acute sector to residential aged-care facilities.
        Intern Med J. 2014; 44: 1034-1037
        • Perkins N.J.
        • Schisterman E.F.
        The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve.
        Am J Epidemiol. 2006; 163: 670-675
        • Akobeng A.K.
        Understanding diagnostic tests 3: receiver operating characteristic curves.
        Acta Paediatr. 2007; 96: 644-647
        • Boyd C.M.
        • Xue Q.L.
        • Guralnik J.M.
        • Fried L.P.
        Hospitalization and development of dependence in activities of daily living in a cohort of disabled older women: the Women's Health and Aging Study I.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 888-893
        • Boyd C.M.
        • Landefeld C.S.
        • Counsell S.R.
        • et al.
        Recovery of activities of daily living in older adults after hospitalization for acute medical illness.
        J Am Geriatr Soc. 2008; 56: 2171-2179
        • Fisher S.R.
        • Graham J.E.
        • Brown C.J.
        • et al.
        Factors that differentiate level of ambulation in hospitalised older adults.
        Age Ageing. 2012; 41: 107-111
        • Bohannon R.W.
        Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis.
        Phys Ther. 2007; 87: 1642-1650
        • Fisher S.R.
        • Kuo Y.F.
        • Sharma G.
        • et al.
        Mobility after hospital discharge as a marker for 30-day readmission.
        J Gerontol A Biol Sci Med Sci. 2013; 68: 805-810
        • DeJong G.
        Bundling acute and postacute payment: from a culture of compliance to a culture of innovation and best practice.
        Phys Ther. 2010; 90: 658-662