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Research ArticleOriginal Research

Reduced Step Count and Clinical Frailty in Hospitalized Adults With Community-Acquired Pneumonia

Hayley Rice, Kylie Hill, Robin Fowler, Carol Watson, Grant Waterer and Megan Harrold
Respiratory Care April 2020, 65 (4) 455-463; DOI: https://doi.org/10.4187/respcare.06992
Hayley Rice
School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia.
Department of Physiotherapy, Royal Perth Hospital, Western Australia.
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Kylie Hill
School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia.
Department of Physiotherapy, Royal Perth Hospital, Western Australia.
Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia.
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  • For correspondence: [email protected]
Robin Fowler
School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia.
Department of Physiotherapy, Royal Perth Hospital, Western Australia.
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Carol Watson
School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia.
Department of Physiotherapy, Royal Perth Hospital, Western Australia.
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Grant Waterer
Respiratory Medicine, Royal Perth Hospital, Western Australia, and with The University of Western Australia, Perth, Australia.
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Megan Harrold
School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia.
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Abstract

BACKGROUND: In adults hospitalized with community-acquired pneumonia (CAP), increasing ward-based walking may reduce length of stay (LOS). There are few data to describe ward-based walking in this population. In adults hospitalized with CAP, we aimed to report variables of walking and non-walking time, to determine whether demographic or clinical variables influenced daily step count, and to determine whether daily step count influenced LOS.

METHODS: Following admission, daily step count and variables related to walking and non-walking time were quantified using the StepWatch Activity Monitor. Details regarding demographics, clinical characteristics, clinical care, and LOS were extracted from the medical records and hospital electronic data systems. Frailty was calculated via the 7-point Clinical Frailty Scale; disease severity was measured via the CURB-65 score. Health care utilization at 30 d following discharge was measured via telephone interview.

RESULTS: Two hundred participants completed the study, of whom 121 contributed ≥ 24 h of data from the StepWatch Activity Monitor. The median (interquartile range (IQR)) number of daily steps was 926 (457–1706). These were accumulated over 66 (41–121) min/d, with a usual bout duration of 3 (2–4) min and 1-min peak cadence of 56 (43–74) steps/min. An average of 93% (89–96) of waking hours was spent in non-walking time. In the multivariable model, increased frailty was retained as a predictor of lower step count (incidence rate ratio [IRR] 0.59, 95% CI 0.41–0.85). For every increase in 500 steps/d, LOS reduced by 11% (IRR 0.89, 95% CI 0.80–0.99).

CONCLUSIONS: Subjects hospitalized with CAP did very little walking, most of which was accumulated in short bouts at a low intensity. Compared with subjects with mild frailty, those with moderate to severe frailty took 59% fewer steps per day. Those with a higher daily step count had a shorter LOS.

  • community-acquired pneumonia
  • hospital
  • physical activity
  • physiotherapy
  • rehabilitation
  • respiratory

Footnotes

  • Correspondence: Kylie Hill PhD PT, School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia. E-mail: k.hill{at}curtin.edu.au.
  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (4)
Respiratory Care
Vol. 65, Issue 4
1 Apr 2020
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Reduced Step Count and Clinical Frailty in Hospitalized Adults With Community-Acquired Pneumonia
Hayley Rice, Kylie Hill, Robin Fowler, Carol Watson, Grant Waterer, Megan Harrold
Respiratory Care Apr 2020, 65 (4) 455-463; DOI: 10.4187/respcare.06992

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Reduced Step Count and Clinical Frailty in Hospitalized Adults With Community-Acquired Pneumonia
Hayley Rice, Kylie Hill, Robin Fowler, Carol Watson, Grant Waterer, Megan Harrold
Respiratory Care Apr 2020, 65 (4) 455-463; DOI: 10.4187/respcare.06992
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Keywords

  • community-acquired pneumonia
  • hospital
  • physical activity
  • physiotherapy
  • rehabilitation
  • respiratory

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