Improving Patient Walking During Hospitalization

University of Wisconsin (UW)

Status

Active, not recruiting

Conditions

Hospital Acquired Condition

Older Adults

Early Mobility

Treatments

Other: Surveys and Focus groups

Other: MOVIN

Study type

Interventional

Funder types

Other

Other U.S. Federal agency

Identifiers

NCT04479943

1R01HS026733-01A1 (U.S. AHRQ Grant/Contract)

2020-0010

A549000 (Other Identifier)

Protocol Version 08/19/2024 (Other Identifier)

NUR/FACULTY AFFAIRS/ADMIN (Other Identifier)

Details and patient eligibility

About

The MOVIN (Mobilizing Older adult patients Via a systems-based Intervention) randomized controlled trial is designed to evaluate the impact of the MOVIN intervention on improving the functional ability of older adult hospital patients and reducing their healthcare utilization post-hospitalization. MOVIN is a program to increase patient ambulation while hospitalized. The study's hypothesis is that MOVIN will improve functional outcomes for hospitalized older adult patients by producing a change in nursing practice and culture of ambulation on inpatient units. MOVIN is a unit-based intervention. Therefore all patients on this unit are exposed to the intervention once it is implemented regardless of whether or not they participate in the trial. The study will enroll 360-420 total hospitalized participants 65 years and older for the duration of their stay.

Full description

Up to 65% of hospitalized older adults will lose the ability to ambulate independently during their hospital stay. Loss of independent ambulation has been identified as a hospital-acquired disability and is a critical patient safety concern, resulting in permanent loss of function for 50% of older adults one-year post discharge. Functional loss is associated with multiple negative outcomes including a 33% increase in new nursing home placement, increase in length of hospital stay, need for home health services, falls, caregiver burden, decreased quality of life, and increased mortality. Given the rapid increase in the elderly population, loss of independent ambulation primarily due to the process of care in hospital settings may significantly increase future healthcare costs and further exacerbate concerns related to patient care quality.

Lack of walking during hospitalization has been directly linked to loss of independent ambulation in older adults. Nurses are responsible for promoting and maintaining patient independent mobility. However, the investigators research has identified multiple personal and organizational barriers that prevent nurses from walking patients. The investigators have developed and pilot tested a novel systems based multi-component intervention to improve ambulation of older adult patients, Mobilizing Older adult patients Via a systems-based INtervention (MOVIN).

MOVIN is comprised of five components: 1) psychomotor skills training; 2) communication tools; 3) ambulation pathways; 4) ambulation resources; and 5) unit ambulation culture. The Investigators pilot study of MOVIN demonstrated a statistically significant increase in frequency and weekly distance of patient ambulation as well as changes in nursing practice and unit culture. Notably, these changes have been sustained for greater than two years after completion of the study.

The investigators' goal is to eliminate loss of independent ambulation in hospitalized older adults. In pursuit of this goal, the specific aims are to:

Specific Aim 1:Test the effectiveness of MOVIN to improve functional ability of older adult patients at discharge, and 1, 3 and 6 months post discharge
Specific Aim 2: Test the effectiveness of MOVIN to reduce healthcare utilization of older adults at discharge, and 1, 3 and 6 months post discharge
- 2.A. To analyze a return on investment of MOVIN based on program costs and health utilization measures across different hospitals
Specific Aim 3: Measure change in nurse behaviors and unit culture and identify ongoing systems barriers that impact translation of MOVIN across inpatient units and different hospitals.

Enrollment

387 patients

Sex

All

Ages

65+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

age 65 years or older
able to walk with or without assistance
living in the community (not long term care) prior to admission
have an ambulation order
admitted to hospital's general adult medical unit
able to consent
able to speak and understand English
at least 24h planned length of stay after initial study enrollment.

Exclusion criteria

activated Power of Attorney
lower extremity amputation
on hospice
bed rest order or activity restriction
wheelchair bound

Trial design

Primary purpose

Prevention

Allocation

Randomized

Interventional model

Sequential Assignment

Masking

Single Blind

387 participants in 3 patient groups

Pre-intervention/control

No Intervention group

Description:

160-200 older adult patients (age 65 or older) will be recruited on four units across two hospitals (two units per hospital) over 6-8 months prior to implementation of the unit-based MOVIN intervention.

Post-intervention

Experimental group

Description:

160-200 older adult patients (age 65 or older) will be recruited on four units across two hospitals (two units per hospital) over 6-8 months after MOVIN has been implemented on the unit.

Treatment:

Other: MOVIN

Nurses

Experimental group

Description:

Nurses will complete surveys and provide qualitative data to assess barriers to implementation

Treatment:

Other: Surveys and Focus groups