Impact of a Mobility Program

VA Office of Research and Development

Status: Completed

Conditions: Hospitalization

Treatments: Behavioral: Walking; Behavioral: Friendly visit

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT02674503

E1995-R

Details and patient eligibility

About

After hospitalization, many older adults experience more difficulty getting around in the community and performing one or more of their basic activities of daily living (ADLs) like bathing or dressing. The goals of this study are to test the effectiveness of a mobility intervention, compared to usual care, on change in mobility after hospitalization, to determine the impact on one-year outcomes such as nursing home placement and to identify which Veterans benefit the most from the intervention. Ultimately, the goal is to improve recovery after hospitalization and reduce disability in hospitalized Veterans.

Full description

For this high impact study the investigators propose to use a stepped wedge cluster randomization design on five VA hospital wards to compare a mobility program (MP) to usual care (UC) among a cohort of Veterans age 50 years. The investigators will examine pre to post-hospital mobility and adverse outcomes including functional decline, nursing home admission, emergency department (ED) visits, hospitalization and death in the MP and UC groups in the year after hospital discharge. The primary outcome of mobility will be measured by the University of Alabama at Birmingham (UAB) Life-Space Assessment (LSA).10-13 Secondary measures of mobility will include self-reported ability to walk mile and drive a car, as described by Gill, et al.14 The investigators will identify patient specific characteristics that modify the effect of the mobility intervention on post-hospital mobility and adverse outcomes to determine which hospitalized patients are most likely to benefit from this intervention.

Note, Secondary outcome measures were curtailed as the original PI, Dr. Brown, retired.

Enrollment: 132 patients

Sex: All

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 50 years admitted to one of the five hospital wards of the Birmingham VA Medical Center (VAMC) for any medical illness, e.g.:

  • Pneumonia
  • Heart failure
  • Chronic obstructive pulmonary disease (COPD) exacerbation
  • Or other medical (versus surgical) indication for hospitalization

• Patients will be recruited within 48 hours of hospitalization, followed throughout their hospitalization and for one year after hospital discharge.

Exclusion criteria

• Patients admitted for brief observation will be excluded, e.g.:

  • 23-hour observation for possible myocardial infarction
  • Additional exclusion criteria will include:
  • Inability to walk across a small room 2 weeks prior to admission
  • Inability to walk safely with assistance, based on a strength and balance screen (see Training of Walkers, below for details)
  • Having a pulmonary embolus, unstable angina or other medical diagnosis deemed by the primary physician to be a contraindication to walking
  • Being on hospice or comfort care
  • Being in a semi-private room with another currently enrolled participant
  • Non-English speaking, blind, or deaf

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

132 participants in 2 patient groups, including a placebo group

Intensive

Experimental group

Description:

MP patients will participate in a program of progressive walking and transfer training up to three times a day, seven days a week throughout the hospital stay.

Treatment:

Behavioral: Walking

Friendly visit

Placebo Comparator group

Description:

UC patients will receive three times a day "friendly visits", seven days a week by members of the research team to control for the daily attention that MP patients receive.

Treatment:

Behavioral: Friendly visit