Can an innovative physical therapy program enhance mobility in middle aged and older Veterans with slow walking speed? A randomized controlled trial.

Abstract

To investigate the efficacy of an innovative physical therapy program targeting mobility. Single blinded randomized controlled trial SETTING: Outpatient care VA regional tertiary care center PARTICIPANTS: Community-dwelling middle aged and older Veterans with slow walking speed. Live Long Walk Strong (LLWS) is an 8-week 10 (1-hour/session) session outpatient physical therapy program. It was designed to enhance mobility by targeting impairments linked to mobility decline. It was compared to participants within a waitlist control group. Walking speed (primary outcome) and secondary outcomes included the Short Physical Performance Battery (SPPB), Activity Measure for Post Acute Care (AM-PAC), leg power, trunk extensor muscle endurance, gait coordination, and exercise self-efficacy. We experienced a 25% dropout rate, which was in part due to the COVID-19 pandemic shutdowns of human research. We observed significantly faster (p<.05) walking speed (mean 0.08 +/- .02 m/s) after 8 weeks among LLWS participants. Similarly, there were significant improvements SPPB (.95 +/- .32) and AM-PAC (2.1 +/-0.8) among LLWS participants. We also observed significantly greater improvements in leg power and self-efficacy among LLWS participants. No significant differences were observed for trunk muscle endurance or gait coordination, however significantly greater improvement in gait coordination was observed within sensitivity analyses. Our study demonstrates that LLWS enabled statistically significant and clinically meaningful gains in mobility among middle aged and older adult Veterans with slow walking speed. Future analyses of this clinical trial will be able to evaluate long term outcomes and be better powered to evaluate changes in the attributes LLWS targets.