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Mobility training for increasing mobility and functioning in older people with frailty.
Daniel Treacy1, Leanne Hassett2, Karl Schurr3
1Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, Australia.
The Cochrane Database of Systematic Reviews
|June 30, 2022
Summary
Mobility training significantly improves mobility and functioning in frail older adults living in the community. These benefits, particularly for mobility, are sustained for at least six months post-intervention.
Area of Science:
- Gerontology and Rehabilitation
- Evidence-based practice in geriatric care
- Clinical trial methodology in aging research
Background:
- Frailty affects 21% of community-dwelling individuals over 65, increasing vulnerability to adverse health outcomes.
- Frailty is linked to falls, reduced mobility, functional decline, and mortality.
- Mobility, defined by the WHO ICF as changing/maintaining body position and moving, is crucial for independence.
Purpose of the Study:
- To systematically review evidence on the benefits and safety of mobility training for frail older adults.
- To assess the impact of mobility interventions on overall functioning and mobility levels in the community-dwelling frail elderly.
Main Methods:
- Conducted an umbrella review of randomized controlled trials (RCTs) published up to June 2021.
- Searched multiple databases including CENTRAL, MEDLINE, Embase, AMED, and PEDro.
- Included 12 RCTs with 1317 participants (mean age 82) comparing various mobility training interventions against control groups.
Main Results:
- High-certainty evidence shows mobility training significantly improves mobility scores (mean increase of 1.00 point on SPPB), a clinically significant change, sustained at six months.
- Moderate-certainty evidence indicates mobility training likely improves functioning scores (mean increase of 8.58 points on Barthel Index), though not reaching clinical significance and not sustained long-term.
- Evidence regarding adverse events, nursing home admissions, falls, and mortality is of low to very low certainty, suggesting little to no difference or uncertainty in effects.
Conclusions:
- Mobility training is supported by high-certainty evidence for improving mobility in frail, community-dwelling older adults.
- Moderate-certainty evidence suggests potential improvements in functioning, with sustained mobility benefits at six months.
- Uncertainty remains regarding the impact on adverse events, falls, nursing home admissions, and mortality due to very low certainty evidence.
