Effectiveness of three-week rehabilitation programs in improving mobility of patients with frailty syndrome: a subgroup analysis of the multicenter prospective study «POSTSCRIPTUM»

BACKGROUND: The concept of frailty suggests the potential reversibility of this syndrome. Research indicated that geriatric rehabilitation programs aimed at maintaining mobility and functional independence reduce the frequency of repeated hospitalizations.

AIM: To study the specifics of geriatric status to assess the potential effectiveness of rehabilitation programs in improving mobility and functional independence.

MATERIALS AND METHODS: A subgroup analysis was conducted based on the data obtained in the open prospective study «POSTSCRIPTUM» (Protocol of Geriatric Rehabilitation in Patients Aged 60 Years and Older Living in Moscow Boarding Houses or Nursing Homes). The analysis included 465 patients (82% women, mean age 78.6 ± 7.6 years). For the analysis, patients were divided into two groups depending on whether there was an improvement in the Short Physical Performance Battery (SPPB) score of at least 1 point following the rehabilitation program: groups «ΔSPPB ≥ 1» and «ΔSPPB < 1», respectively. A comparative analysis of baseline parameters and the dynamics of comprehensive geriatric assessment (CGA)results were performed upon completing the 21-day geriatric rehabilitation programs. Patients with a baseline maximum SPPB score («SPPB = 12», n = 112; 43%) were excluded from the analysis.

RESULTS: The «ΔSPPB ≥1» group included 202 (43%) patients, and the «ΔSPPB < 1» group included 263 (57%) patients. After excluding patients with SPPB = 12 from the analysis set, the proportion of patients in the «ΔSPPB ≥1» group was 57.3%. At baseline, the comparison groups did not differ in gender, body mass index, education level, marital status, prevalence of noncommunicable diseases or CGA results. The mean age was 78.7 ± 6.74 years in the «ΔSPPB ≥1» group and 81.2 ± 8.32 years in the «ΔSPPB < 1» group (p < 0.01). Both groups showed positive dynamics in the results of the Montreal Cognitive Assessment (MoCA) test, GDS-15, Insomnia Severity Index, and VAS scales. However, intergroup comparison revealed no differences in these indicators. The groups differed in dynamometry results: in the «ΔSPPB ≥1» group, they improved from 16.7 ± 6 kg to 18.0 ± 6.2 kg between Visits 1 and 2, p < 0.001 (intergroup delta comparison p < 0.001).

CONCLUSION: The subgroup analysis results indicate that the effectiveness of rehabilitation depends not only on baseline demographic and clinical characteristics but also on the initial geriatric status as determined by CGA. Comprehensive 21-day geriatric rehabilitation programs tailored to CGA results are effective in improving mobility, muscle strength, psychoemotional state, and sleep quality. However, the rate and magnitude of the effect on various domains may vary among patients with different baseline statuses.

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