Pathophysiology
Research indicates that older adults with reduced muscle power exhibit a two- to three-fold greater risk of mobility impairment compared to those with lower muscle strength, highlighting the critical role of power in fall prevention (PMID: 25872612).
Alcazar et al. (2018) investigated force-velocity profiles in older adults (70-85 years) and found that both force deficit and velocity deficit mechanisms lead to impaired muscle power, indicating diverse pathophysiological pathways impacting muscle function in aging populations [PMID: 29567100].
Epidemiology
According to current reports, the prevalence of HAD among older adults hospitalized is 30% (Loyd et al., 2020). A recent systematic review further corroborated this, reporting a 37% incidence of HAD in older people (Giacomino et al., 2022). [PMID: 41132626]
Given the prevalence of sarcopenia and frailty in older adults, which are linked to increased risks of disability and mortality, structured exercise programs like functional gait training, as studied in the SSM Fisior® program (PMID: 41120990), offer a promising epidemiological approach to mitigate these conditions.
Mobility limitations are highly prevalent among individuals with chronic health conditions, significantly affecting their everyday functioning and increasing the reliance on caregiver assistance (Salbach NM et al., 2025; PMID: 40721264). This highlights the epidemiological importance of addressing mobility issues through accessible exercise programs.
The study utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) found that trajectories of social participation (SP) are linked with trajectories of functional ability (FA) among older adults aged ≥45 years across multiple follow-up visits from 2011 to 2018 (PMID: 36530681). High levels of SP were associated with protective effects against functional disability, highlighting the importance of maintaining social engagement for healthy aging.
According to Van Grootven and van Achterberg (2022), the incidence of disability in instrumental ADL among community-dwelling older adults ranges between 5% and 59%, highlighting a significant variability influenced by age and ADL type (PMID: 35637447).
Clinical Presentation
HAD refers to the loss of independence in at least one activity of daily living (ADL) at discharge compared to pre-hospitalization ability, encompassing both newly acquired disabilities and worsening pre-existing conditions during hospitalization (Covinsky et al., 2011) [PMID: 41132626]
The study emphasizes that mobility, particularly reduced gait, is a critical prognostic factor for older adults, underscoring the necessity for continuous monitoring of functional parameters such as gait to predict disability and mortality effectively (Seminerio et al., 2024; PMID: 39632851).
Psychiatric disabilities can lead to severe social and personal consequences including isolation and loss of daily structure due to internal and external barriers, underscoring the need for interventions like MA&R to facilitate meaningful activity engagement (PMID: 37280561).
Among older adults with mobility challenges, common barriers to adopting an active lifestyle include poor health status, fear of falling, and negative past experiences with physical activity, highlighting the need for tailored interventions like Coach2Move (PMID: 36200397).
The study highlights that nursing home residents, typically disenchanted with repetitive exercise routines, showed enthusiasm and improved outcomes with VR-enhanced physiotherapy programs targeting essential functional domains (PMID: 35627554).
The exploration of PROMs in the study (PMID: 35306008) underscores their role in capturing detailed functional changes, which can complement clinical assessments and offer a more holistic view of patient functional presentation during rehabilitation.
Sarcopenia in older adults is characterized by a progressive loss of muscle strength (1.5%-5% annually), leading to heightened risks of falls, fractures, physical disability, and mortality (PMID: 33493160). WB-EMS presents as a promising alternative to traditional resistance training to address these functional impairments (PMID: 33493160).
The iTUG test, as described by Bergquist et al. (2020), integrates sit-to-stand transitions, walking, and turning, providing a comprehensive assessment that can reflect the complex clinical presentation of seniors with functional monoparesis, aiding in understanding their functional limitations. (PMID: 32899143)
Diagnosis
Although primarily focused on intervention outcomes, the study highlights that videoconferencing can offer consistent functional performance data, which may support diagnostic assessments alongside traditional methods in older adults (PMID: 41313421).
By employing the SEPCO questionnaire for self-evaluation of physical, sensory, and cognitive deficits, clinicians can pre-identify patients who might face challenges in achieving rehabilitation goals, aiding in targeted diagnostic and intervention planning (PMID: 39702184).
Technological monitoring systems, including wearables and motion-tracking technologies, enable continuous assessment of health metrics like activity levels and movement patterns, facilitating early detection of health deterioration and fall risks in older patients (Seminerio et al., 2024; PMID: 39632851).
Development of detailed assessment standards for the Chinese version of the ICF-RS has shown good validity and reliability, but applying these standards through interviews and clinical examinations can be challenging for single raters, especially with patients having complex complaints or poor language expression (Zhang et al., 2023; PMID: 38047475).
The research utilizes Functional Movement Screening (FMS) exercises, which are scored systematically (ranging from 0 to 3) based on movement characteristics, potentially offering a tool for clinicians to diagnose and track progression in patients with functional monoparesis through automated assessment methods (PMID: 36616604).
The development of FAMCAT (PMID: 35306008) emphasizes its utility in assessing multiple functional domains concurrently, which can contribute to a more thorough diagnostic evaluation of patients undergoing rehabilitation.
The MoveStrong program evaluated by Rodrigues et al. (2021) utilized functional assessments such as gait speed and chair rise to gauge the impact of balance and strength training on physical performance in pre-frail older adults (PMID: 34559837). These assessments provide indirect insights into the program's efficacy and potential clinical utility in monitoring progress.
Bergquist et al. (2020) highlighted that the iTUG test, enhanced with inertial sensor data, could serve as a diagnostic aid by offering detailed spatial and temporal metrics of mobility tasks, which could be particularly useful in diagnosing and evaluating conditions like functional monoparesis. (PMID: 32899143)
Dockx et al. (PMID: 32847518) emphasize that the COSFI provides a structured approach to diagnosing functional independence issues, encompassing not just physical limitations but also psychological and social determinants that impact an older adult's ability to perform daily activities independently.
The study by Martins AC et al. (2020; PMID: 32075307) emphasizes the importance of identifying individual risk factors through baseline evaluations to customize multifactorial exercise interventions aimed at preventing falls.
The sonification of spine curvature and barbell horizontal displacement during deadlift movements can serve as a diagnostic tool to identify biomechanical flaws that predispose individuals to injury (Lorenzoni et al., 2019; PMID: 31461448).
The study highlighted discrepancies between self-reported dependency and professional observation, indicating that direct assessment methods are crucial for accurately diagnosing dependency in older adults (PMID: 28876414).
Management
A study involving pre-frail and frail older adults demonstrated that videoconference assessments were valid and reliable for measuring improvements in strength and balance over a 12-week intervention period, comparable to in-person assessments (PMID: 41313421). This suggests telehealth can effectively monitor functional independence improvements without compromising reliability.
To prevent functional decline, older adults should incorporate muscle-strengthening exercises two days per week at moderate or higher intensity, along with multicomponent training including functional balance and strength exercises three days per week at moderate or greater intensity, as advised by the World Health Organisation (WHO, 2020) [PMID: 41132626]
A randomized clinical trial published in BMC geriatrics (2025) by Alegre-Tamariz et al. (PMID: 41120990) demonstrated that integrating the SSM Fisior® program into structured physical activity workshops led to significant improvements in physical performance, strength, and functional independence among older adults, highlighting its potential as a practical intervention for enhancing clinical outcomes.
A virtual, community-based, task-oriented group exercise program with healthcare-community partnership participation showed potential to enhance everyday functioning among individuals with mobility limitations, addressing barriers such as transportation and accessibility issues typically associated with in-person programs (Salbach NM et al., 2025; PMID: 40721264).
A prospective observational study involving 12 rehabilitation centers in France (June 2018 - October 2020) utilized the SEPCO questionnaire to assess patients upon admission. Patients identified as more frail across selected domains of the SEPCO questionnaire showed lower improvements in locomotion post-rehabilitation, suggesting predictive utility for tailored management strategies (PMID: 39702184).
The PRO-HOME study, funded by the Italian Ministry of Health, utilized technologically equipped facilities with wearables and sensors to monitor clinical, functional, and cognitive parameters continuously in older patients undergoing protected discharge. This multidimensional approach aims to prevent acute events and enhance safety through integrated alert systems like fall detectors and medication reminders (Seminerio et al., 2024; PMID: 39632851).
A Delphi expert survey demonstrated that grouping the 30 categories of the Chinese version of the ICF-RS into four categories tailored to different professionals (6 for physicians, 7 for nurses, 9 for physiotherapists, and 8 for occupational therapists) enhances agreement between assessments compared to a single rater approach, facilitating more efficient and comprehensive evaluations in complex clinical scenarios (Zhang et al., 2023; PMID: 38047475).
The categorization of ICF-RS categories among different healthcare professionals (6 for physicians, 7 for nurses, 9 for physiotherapists, and 8 for occupational therapists) aims to make assessments more feasible and relevant within routine clinical practice, addressing the limitations of single-rater evaluations (Zhang et al., 2023; PMID: 38047475).
A multicenter randomized controlled trial (RCT) involving 18 years or older participants with psychiatric disabilities demonstrated that MA&R, when added to standard mental health care, showed significant improvements in activity engagement as measured by the self-report version of the Profiles of Occupational Engagement in people with Severe Mental Illness (POES-S) instrument (PMID: 37280561).
The study by Spilz A and Munz M (PMID: 36616604) proposes developing a deep learning-based system for automatically assessing functional movement exercises, such as those used in Functional Movement Screening (FMS), which could enhance home-based physiotherapy management for patients with functional monoparesis by ensuring correct exercise execution without continuous professional oversight.
Given the findings that high social participation trajectories are protective for functional disability, interventions aimed at enhancing social engagement (such as community programs, social activities, and support networks) may help maintain or improve functional ability in older adults (PMID: 36530681).
Prognosis & Follow-up
Research indicates that remote assessments via videoconferencing can reliably track functional improvements in pre-frail and frail older adults over time, facilitating continuous monitoring and tailored interventions (PMID: 41313421). This approach supports ongoing prognosis and follow-up care without necessitating frequent in-person visits.
Only 17.1% of hospitalized older adults regained their baseline function one year post-discharge, indicating a significant risk of long-term disability if functional recovery does not occur within the first month (Boyd et al., 2008) [PMID: 41132626]
The SSM Fisior® program showed potential not only in improving immediate physical function but also in contributing to healthier aging trajectories by enhancing metrics crucial for aging populations, thereby possibly reducing long-term healthcare system burdens, as indicated by the study authors (PMID: 41120990).
Participants in a virtual exercise program demonstrated improvements in everyday function, suggesting that such interventions could be effective for follow-up and ongoing management strategies for individuals with mobility limitations (Salbach NM et al., 2025; PMID: 40721264).
The study found that patients who self-reported higher frailty levels using the SEPCO questionnaire exhibited poorer locomotor functional independence measure improvements upon completion of rehabilitation programs, indicating potential for guiding prognosis and follow-up care (PMID: 39702184).
Telemonitoring through devices like smartwatches and motion-tracking cameras captures actual daily performance outside clinical settings, providing a more precise evaluation of functional status compared to traditional assessments (Seminerio et al., 2024; PMID: 39632851).
Special Populations
The study specifically addresses pre-frail and frail older adults, demonstrating that remote videoconference assessments are particularly valuable for this population due to their frequent need for monitoring and intervention (PMID: 41313421).
The study promotes equitable access to research participation through targeted recruitment strategies and provision of necessary accommodations like mobile devices and data plans, benefiting underrepresented groups with mobility limitations (Salbach NM et al., 2025; PMID: 40721264).
Designed for individuals aged 18 years or older with psychiatric disabilities assessed through the MINI ICF Rating for limitation of Activities and Participation in Psychological Disorders, MA&R aims to address specific needs within this special population (PMID: 37280561).
The study specifically targeted older adults over 75 years residing in nursing facilities, demonstrating the tailored benefits of VR-enhanced physiotherapy for this demographic (PMID: 35627554).
Kramer et al. developed a group-based version (gLiFE) delivered in seven sessions to multiple participants, which resulted in participants implementing an average of 9.5 out of 14 LiFE activities into their daily routines [PMID: 33522904].
Dockx et al. (PMID: 32847518) highlight that the COSFI can effectively differentiate functional independence levels between older adults living independently versus those in residential care settings, emphasizing the importance of context in evaluating functional independence.
Given the increased risk of functional decline in older adults due to social distancing and quarantine protocols, telehealth exercise programs specifically designed for this population could play a crucial role in mitigating these adverse effects (PMID: 32372072).
Key Recommendations
Based on the findings from the SSM Fisior® program study (PMID: 41120990), it is recommended that rehabilitation programs for older adults include functional gait training to improve neuromuscular muscle quality and functional independence, aligning with evidence suggesting structured exercise yields significant benefits. (Evidence: Strong)
Given the predictive value of the SEPCO questionnaire in identifying patients likely to have suboptimal rehabilitation outcomes, integrating this tool into standard clinical practice could enhance tailored rehabilitation approaches and patient outcomes (PMID: 39702184). (Evidence: Moderate)
Given the challenges faced by single raters in comprehensively evaluating patients with complex conditions, recommending a team evaluation method involving physicians, nurses, physiotherapists, and occupational therapists for ICF-RS assessments could improve clinical practice (Zhang et al., 2023; PMID: 38047475). (Evidence: Strong)
Given the limitations of current home-based physiotherapy supervision, integrating automated assessment technologies, such as those proposed by Spilz A and Munz M (PMID: 36616604), could significantly improve patient outcomes by maintaining exercise quality and adherence in rehabilitation settings for functional monoparesis. (Evidence: Moderate)
Based on the stepped wedge trial results, personalized physical therapy approaches such as Coach2Move are recommended for clinical practice to improve physical activity and functional mobility in older adults, potentially offering cost-effective benefits (PMID: 36200397). (Evidence: Strong)
Given the positive reception and outcomes observed in the study, integrating VR solutions into standard physiotherapy practices for seniors could be recommended to improve rehabilitation efficacy (PMID: 35627554). (Evidence: Moderate)
Weiss et al. (PMID: 35306008) highlight the benefits of integrating PROM-based tools like FAMCAT into EHR systems, leveraging adaptive measures and CAT to enhance the precision and discrimination of functional assessments in rehabilitation settings. (Evidence: Strong)
Rodrigues et al. (2021) recommend the adoption of structured exercise programs such as MoveStrong, which integrates balance and functional strength training with education on adequate protein consumption, to enhance physical performance and reduce fall risks in older adults with chronic conditions (PMID: 34559837). (Evidence: Strong)
References
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