Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients? A single-blinded randomized controlled trial.

OBJECTIVE: To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients. DESIGN: A single-blinded randomized controlled trial. SETTING: Department of Geriatric Rehabilitation in university hospital. PARTICIPANTS: A sample of 71 patients were successively included and randomized either to the treatment group (TG) (n = 36) or the control group (CG) (n = 35). Fifteen participants dropped out (TG n = 7; CG n = 8), leaving 56 participants with a mean age of 79 (SD 7). INTERVENTION: Participants in the treatment group were treated in groups with progressive resistance strength training in addition to standard care. Progressive resistance strength training of the lower extremities was performed in three sets of 12-15 repetitions, intensity 60-70% of one repetition maximum, in four 50-minute sessions per week. MAIN MEASURES: The effect was evaluated by timed up & go test, 30-second chair-stand test, 10-m walk test, three tasks (transfer, walking, stairs) of the Barthel Index, and use of walking aids. RESULTS: Significant improvements in the 10-m walk test (P < 0.01) and Barthel Index (walking) (P = 0.01) were demonstrated within the treatment group but not in the control group. Both groups had significant improvements in timed up & go, 30-second chair-stand (modified) and Barthel Index (transfer and walking). No significant difference was found between groups except for the Barthel Index (stairs) (P = 0.05). Analysis by the mixed-effects model showed that the treatment group improved more than the control group in all outcome variables. CONCLUSION: The results indicate that for older hospitalized patients progressive resistance strength training as additional training may have an effect compared to standard care, but no statistically significant effects were demonstrated when measured by functional outcomes.

Intra- and interrater reliability and agreement of the Danish version of the Dynamic Gait Index in older people with balance impairments.

OBJECTIVES: To examine the intrarater and interrater reliability and agreement of the Danish version of the Dynamic Gait Index (DGI) in hospitalized and community-dwelling older people with balance impairments. DESIGN: Reliability study. SETTING: University hospital and outpatient rehabilitation. PARTICIPANTS: A convenience sample of older people (≥65y); 24 subjects from a hospital and 24 from an outpatient rehabilitation center. All subjects had either 1 or more falls within the last year or balance impairments evaluated by a physical therapist. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All subjects carried out the DGI twice with a 1.5-hour interval. Each subject was rated by 3 physical therapists in the first attempt (1 for intrarater and 2 for interrater comparison) and by the intrarater in the second attempt, in both settings. The reliability was calculated using the intraclass correlation coefficient (ICC, 2.1), while agreement was calculated as the smallest real difference (SRD). RESULTS: The ICC for intrarater and interrater reliability of the total DGI was .90 and .92 at the hospital, while the SRD was 2.72 and 2.58 points, respectively. Correspondingly, the ICC for intrarater and interrater reliability of the total DGI at the rehabilitation center was .89 and .82, while the SRD was 3.49 and 3.99 points, respectively. CONCLUSIONS: The intrarater and interrater reliability of the total DGI ranged from good to excellent in hospitalized and community-dwelling older people. Improvements of 3 and 4 DGI points for hospitalized and community-dwelling older people, respectively, should be regarded as a real change (with a 95% certainty).