Improving Patient Walking During Hospitalization

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

387 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-02

Study Completion Date

2025-06-30

Brief Summary

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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.

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Detailed Description

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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.

Conditions

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Early Mobility Older Adults Hospital Acquired Condition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

This study uses an incomplete stepped wedge cluster randomized controlled trial. In the incomplete stepped wedge design, inpatient units are randomly sequenced into the intervention. A baseline (control period) and 2 follow up data collection periods (intervention and post intervention period) occur for each unit. Incomplete stepped wedge cluster randomized trials are novel study designs that are particularly beneficial for evaluating service delivery interventions using a pragmatic design, when evaluations need to be completed at a system or population level, or it is impractical or cost prohibitive to roll out an intervention across multiple units simultaneously.

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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Pre-intervention/control

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.

Group Type NO_INTERVENTION

No interventions assigned to this group

Post-intervention

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.

Group Type EXPERIMENTAL

MOVIN

Intervention Type OTHER

MOVIN is a multi-component unit-based intervention comprised of five components that are implemented simultaneously in a hospital unit. The five components are: 1) psychomotor skills training, 2) unit ambulation culture, 3) communication, 4) resources, 5) ambulation environment.

Nurses

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

Group Type EXPERIMENTAL

Surveys and Focus groups

Intervention Type OTHER

Nurses will answer surveys about nurse behavior, changes in self-efficacy, frequency and distance of patient ambulation, documentation of ambulation, qualitative data collected to determine barriers to implementation

Interventions

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MOVIN

MOVIN is a multi-component unit-based intervention comprised of five components that are implemented simultaneously in a hospital unit. The five components are: 1) psychomotor skills training, 2) unit ambulation culture, 3) communication, 4) resources, 5) ambulation environment.

Intervention Type OTHER

Surveys and Focus groups

Nurses will answer surveys about nurse behavior, changes in self-efficacy, frequency and distance of patient ambulation, documentation of ambulation, qualitative data collected to determine barriers to implementation

Intervention Type OTHER

Eligibility Criteria

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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.