Background:
Functional decline during hospitalization of older adults is well-recognized and potentially preventable. Recent studies have suggested that clinically significant functional decline also affects hospitalized adults under 65 years of age, and that physical function is an important predictor of hospital readmissions. Despite the importance of function, we lack simple, efficient, and standardized measures to assess physical function in the hospital.
We applied a brief screening maneuver to assess ambulation (Dionne’s Egress Test) in a general adult inpatient population. We developed a schema for scoring performance on the maneuver, where scores ranged from 0 (bedbound) to 11 (independently ambulating), allowing us to measure day-to-day changes in patient performance. The purposes of this modified Egress Test (mET ) were to determine 1) if the test was safe and acceptable to medical inpatients and 2) if the test was sensitive to changes in physical function occurring during the hospital course.
Methods:
All patients admitted to a single medical team on an adult medicine inpatient service during the 10-week study period were eligible.The mET was offered to patients in their rooms on a daily basis (M-F) during regular working hours. If patients were not available, were occupied, or declined the test, the test was not performed on that day. The assessment was performed as part of a Quality Improvement initiative, and was determined to be Human Subjects Research Exempt by our Institutional Review Board. Performance on the mET and changes in function as measured by the novel scoring system were analyzed using simple descriptive statistics.
Results:
Of the 194 patients eligible for the mET, 188 (96.9%) completed the assessment on at least one hospital day, and 181 (93.3%) completed the mET on multiple days. There were no falls or injuries during the assessments. The mean mET score was 9.4 (standard deviation 2.22; median 11, range 8). The mean change in mET score between first day measured and last day measured was 0.42 (standard deviation, 2.3). Fourteen patients (7.5%) had declines between first and last measured mET, 140 (74.5%) had no change, and 34 (18.0%) had increases. When only highest and lowest mET scores were considered, 50 patients (28.2%) had changes in their physical function as measured by the mET during their hospitalization.
Conclusions:
The mET, a brief beside assessment of physical function, is sensitive to change during medical hospitalization. Approximately 1 in 3 hospitalized adults experienced changes in function that were measured by the mET. Further study is needed to investigate the external validity (i.e. self-reported ADLs, physical therapy assessment) and predictive ability (i.e. of hospital readmission, falls) of this brief bedside