The relationships between step count and hospitalisation‐associated outcomes in acutely hospitalised older adults – A systematic review

Although low ambulation among older adults has been linked to a broad range of adverse outcomes during and after acute hospitalisation, a systematic inquiry of the link between step count and these consequences is required. Therefore, the main purpose of this study is to systematically review the relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults.The electronic databases MEDLINE, CINAHL, and Embase were searched for studies including older adults (above age 65) hospitalised in acute internal wards. The search included the following key terms: 'accelerometer', 'step count', 'hospital', 'internal ward', and 'older adults'. Step count measurement linked to short- and/or long-term outcome(s) during and/or after hospitalisation. All types of articles (except reviews) in English from 1990 to May 2020 were considered. The Newcastle-Ottawa Scale was used to assess the quality of the included observational studies. Randomised controlled trials (RCT) were evaluated using the PEDro scale. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed.The search yielded 1340 articles, and of those, the inclusion criteria were met by 12 studies: eight prospective, three interventional (one randomised controlled trial), and one case-control. These studies included three major adverse hospitalisation outcomes associated with step count: functional decline, longer length of stay, and higher re-hospitalisation rate; however, the large heterogeneity in the studies' methodology makes meta-analysis impossible.Daily step count during hospitalisation of older adults is negatively associated with adverse outcomes, but causation cannot be inferred due to inconsistent outcomes and various methodological limitations. More studies are needed to illuminate causal pathways and mechanisms underlying these relationships, especially to differentiate between the relative contribution of personal versus environmental factors.