Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial

• Published in: The journals of gerontology. Series A, Biological sciences and medical sciences Vol. 76; no. 11; pp. 1988 - 1996
• Main Authors: Ullrich, Phoebe, Werner, Christian, Bongartz, Martin, Eckert, Tobias, Abel, Bastian, Schönstein, Anton, Kiss, Rainer, Hauer, Klaus
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01-11-2021
• Subjects: Aged; Aged, 80 and over; Balance; Clinical trials; Cognitive ability; Cognitive Dysfunction; Dementia; Exercise Therapy; Humans; Independent Living; Mobility; Older people; Patient Discharge; Physical training; Placebos; Rehabilitation; Walking; Clinical trials; Home care; Exercise; Physical activity; Post-ward rehabilitation
• ISSN: 1079-5006; 1758-535X
• DOI: 10.1093/gerona/glaa254

Abstract
Background
Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM.
Methods
Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used.
Results
One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different.
Conclusions
The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.