Activity Level and Intensity of Older Adults in Skilled Nursing Rehabilitation Measured via Actigraphy

Increasing activity has been shown to improve outcomes in patients receiving post-acute rehabilitation, but little is known about the activity duration and intensity that are actually occurring throughout the rehabilitative stay for older adults in skilled nursing facilities. The purpose of this study was to quantify duration and intensity of movement in older adults receiving rehabilitation in a skilled nursing facility, using 4-limb actigraphy.

Observational study of 92 older adults admitted for rehabilitation services at 2 skilled nursing facilities. All participants wore actigraph accelerometers (wGT3X+) on bilateral wrists and ankles for 24 hours, inclusive of 1 session each of physical and occupational therapy. Using actigraphy data, we calculated (a) movement duration (time the dominant or noninvolved upper or lower limb was active) and (b) movement intensity (sum of activity counts per minute for the dominant or noninvolved upper or lower limb).

Over the 24-hour period, the lower limb moved a total median [interquartile range] of 01:10 (hours:minutes) [01:01] and the upper limb moved a total average (SD) of 04:45 (02:00). When participants did move, it was at low intensities with 61 [87] and 610 [623] activity counts per minute for lower limb out-of-therapy time and during physical therapy, respectively. For the upper limb, activity counts per minute were 689 (388) for out-of-therapy movement and 1359 (695) during physical therapy. However, neither the lower or upper limb reached a moderate-intensity level (2690-6166 counts per minute).

Older adults receiving rehabilitation in 2 skilled nursing facilities had low movement duration and movement intensity both in and out of therapy.

Rehabilitation interventions for older adults should target and increase movement duration and intensity, during and after skilled nursing facility care.