Impact of a Mobility Program
| Status: | Recruiting |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 50 - Any |
| Updated: | 12/14/2018 |
| Start Date: | December 12, 2016 |
| End Date: | March 31, 2020 |
| Contact: | Cynthia J Brown, MD MSPH |
| Email: | cynthia.brownd44b2@va.gov |
| Phone: | (205) 933-8101 |
Impact of a Hospital Mobility Program on Function After Discharge
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.
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.
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.
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.
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
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Birmingham, Alabama 35233
Principal Investigator: Cynthia J Brown, MD MSPH
Phone: 205-933-8101
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