Falls Efficacy Is Associated With Better Gait and Functional Outcomes After Rehabilitation in Older Patients

Objective: To examine the relationship between falls efficacy and the change in gait speed and functional status in older patients undergoing postacute rehabilitation. Design: Prospective cohort study. Setting: Postacute rehabilitation facility. Participants: Patients (N=180) aged 65 years and older (mean age +/- SD, 81.3 +/- 7.1y). Interventions: Not applicable. Main Outcome Measures: Data on demographics; functional, cognitive, and affective status; and falls efficacy using a 10-item version of the Falls Efficacy Scale (FES; range, 0-100) were collected upon admission. Data about gait speed and functional status (Barthel Index and Basic Activities of Daily Living [BADL]) were measured at admission and discharge. In addition, BADL performance was self-reported 1 month after discharge. Results: Compared with admission, all rehabilitation outcomes improved at discharge: gait speed (0.41 +/- 0.15 m/s vs 0.50 +/- 0.16 m/s; P<.001), Barthel Index score (68.4 +/- 16.3 vs 82.5 +/- 13.6; P<.001), and BADL (3.5 +/- 1.6 vs 4.7 +/- 1.3; P<.001). Adjusting for baseline status and other potential confounders, baseline FES independently predicted gait speed (adjusted coefficient: 0.002; 95% confidence interval [CI], 0.000-0.004; P = .025) and Barthel index (adjusted coefficient: 0.225; 95% CI, 0.014-0.435; P = .037) at discharge, with higher confidence at baseline predicting greater improvement. Baseline FES was also independently associated with self-reported BADL performance at the 1-month follow-up (adjusted coefficient: 0.020; 95% CI, 0.010-0.031; P<.001). Conclusions: In older patients, higher falls efficacy predicted better gait and functional rehabilitation outcomes, independently of baseline performance. These results suggest that interventions aiming at falls efficacy improvement during rehabilitation might also contribute to enhancing gait speed and functional status in patients admitted to this setting. (C) 2021 by the American Congress of Rehabilitation Medicine