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Falls Efficacy Is Associated With Better Gait and Functional Outcomes After Rehabilitation in Older Patients

  • Giulia Belloni
    Correspondence
    Corresponding author Giulia Belloni, MD, Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Route de la Corniche 10, 1010 Lausanne, Switzerland.
    Affiliations
    Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne

    Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne
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  • Laurence Seematter-Bagnoud
    Affiliations
    Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne

    Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne
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  • Hélène Krief
    Affiliations
    Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne
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  • Kamiar Aminian
    Affiliations
    Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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  • Christophe J. Büla
    Affiliations
    Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne
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Published:January 23, 2021DOI:https://doi.org/10.1016/j.apmr.2020.12.017

      Highlights

      • Falls efficacy (FE) represents the confidence in performing daily activities without falling.
      • This study examined FE as a determinant of successful inpatient geriatric rehabilitation.
      • Higher FE predicted better gait speed and functional status at discharge from rehabilitation.
      • Interventions in rehabilitation aimed at enhancing FE may contribute to patient progress.

      Abstract

      Objective

      To examine the relationship between falls efficacy and the change in gait speed and functional status in older patients undergoing postacute rehabilitation.

      Design

      Prospective cohort study.

      Setting

      Postacute rehabilitation facility.

      Participants

      Patients (N=180) aged 65 years and older (mean age ± SD, 81.3±7.1y).

      Interventions

      Not applicable.

      Main Outcome Measures

      Data on demographics; functional, cognitive, and affective status; and falls efficacy using a 10-item version of the Falls Efficacy Scale (FES; range, 0-100) were collected upon admission. Data about gait speed and functional status (Barthel Index and Basic Activities of Daily Living [BADL]) were measured at admission and discharge. In addition, BADL performance was self-reported 1 month after discharge.

      Results

      Compared with admission, all rehabilitation outcomes improved at discharge: gait speed (0.41±0.15 m/s vs 0.50±0.16 m/s; P<.001), Barthel Index score (68.4±16.3 vs 82.5±13.6; P<.001), and BADL (3.5±1.6 vs 4.7±1.3; P<.001). Adjusting for baseline status and other potential confounders, baseline FES independently predicted gait speed (adjusted coefficient: 0.002; 95% confidence interval [CI], 0.000-0.004; P=.025) and Barthel index (adjusted coefficient: 0.225; 95% CI, 0.014-0.435; P=.037) at discharge, with higher confidence at baseline predicting greater improvement. Baseline FES was also independently associated with self-reported BADL performance at the 1-month follow-up (adjusted coefficient: 0.020; 95% CI, 0.010-0.031; P<.001).

      Conclusions

      In older patients, higher falls efficacy predicted better gait and functional rehabilitation outcomes, independently of baseline performance. These results suggest that interventions aiming at falls efficacy improvement during rehabilitation might also contribute to enhancing gait speed and functional status in patients admitted to this setting.

      Keywords

      List of abbreviations:

      BADL (Basic Activities of Daily Living), CI (confidence interval), FE (falls efficacy), FES (Falls Efficacy Scale), MMSE (Mini Mental State Examination)
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