Effectiveness of Exercise in Older Adults Discharged From the ER After Minor Injuries: The CEDeComS Stepped-Wedge Trial.

BACKGROUND: Older adults consulting Emergency Departments (EDs) for minor injuries are at risk for new functional impairments in the 6 months following their injuries. OBJECTIVE: To compare the effects of exercise programs versus usual ED practices on functional status and physical performance at 3-6 months in at-risk older adults with minor injuries. DESIGN AND SETTINGS: Stepped-wedge randomized trial in six Canadian EDs from 2017 to 2020. Participants aged ≥ 65 years were screened for low, moderate, or high risk of functional decline and assessed three times: baseline at ED, 3 and 6 months. INTERVENTION AND MEASURES: Multicomponent (flexibility, balance, strengthening, aerobic) and risk-level adapted exercise programs targeting moderate- and high-risk patients, 3×/week for 12 weeks, at home or in community groups. CONTROL: Usual ED care. MEASURES: Functional decline was defined as a 2/28-point loss from baseline on the Older Americans Resources and Services (OARS) scale. Basic physical performance (leg strength, balance, walking speed) was measured using the Short Physical Performance Battery (SPPB) test. Generalized linear mixed log-binomial regressions were used to examine the effects of the intervention on outcomes compared to usual ED care, stratified by risk level. RESULTS: The intervention and control phases included 277 and 205 moderate-risk individuals, and 249 and 128 high-risk individuals, respectively. Among moderate-risk individuals, functional loss in intervention participants at 3 months was half that of controls: 12% [95% CI: 8%-17%] vs. 25% [95% CI: 18%-34%], RR: 0.48 [0.26, 0.90]. CONCLUSION: 12-week multicomponent exercises implemented early after minor injuries are associated with lower proportions of functional decline at 3 months in moderate-risk seniors and may help those at high risk recover some physical performance. TRIAL REGISTRATION: ClinicalTrials.gov, ID Cedecoms NCT03991598.