Help Optimise and Mobilise Elders (H.O.M.E)

NCT ID: NCT05484063

Last Updated: 2022-08-02

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-07-25

Study Completion Date

2023-09-30

Brief Summary

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During hospitalisations, older inpatients commonly face issues such as immobility, loss of independence, and functional decline. This leads them down the cascade of dependency with consequent increased risk of adverse outcomes, institutionalisation as well as higher post-acute care costs. The investigators hypothesize that by implementing a mobility intervention in the inpatient setting, patients would be able to maintain their function upon discharge and avoid the cascade of dependency. As such, the investigators aim to do this by implementing and evaluating a mobility intervention, while optimising reversible factors affecting mobility among inpatients admitted to a geriatric unit in Singapore. The investigators will also examine the cost impact of a mobility focused model of care and also adopt the effectiveness-implementation hybrid Type 2 design where both effectiveness and implementation spheres are tested simultaneously.

Detailed Description

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Aim 1: To examine the effectiveness of multicomponent, mobility-focused model of care in reducing iatrogenic complications and improving patient outcomes. Adopting the Institute for Healthcare Improvement's (IHI) 4Ms framework ("Mobility", "Mentation, "Medication", and "What Matters"), the investigators will examine the effectiveness of timely and individually catered mobility interventions which not only increase mobilization but also optimize factors inhibiting mobility for elderly inpatients. It is hypothesized that the mobility outcomes, such as maximum distance walked and mobilization frequency will be significantly improved for patients who receive the intervention compared to those who receive standard care.

Aim 2: To examine the cost impact of a mobility-focused model of care. The investigators will examine whether the cost of these multicomponent, mobility-focused interventions can be offset from cost savings from early mobilisation benefits, by comparing healthcare utilization costs between-groups. Further to that, a cost effectiveness analysis will be performed should functional effectiveness be observed. For the primary cost impact objective, it is hypothesized that the cost savings arising from reduction in bed days of hospitalization and other medical costs incurred during study period will outweigh the cost of implementing this model of care. In addition, it is also hypothesized that the proposed intervention will be cost-effective through achieving better functional outcomes for patients, with lower costs required.

Aim 3: To evaluate the implementation outcomes of multicomponent, mobility-focused model of care in the process of this intervention. It is hypothesized that this intervention will have good acceptability, feasibility, penetration, implementation costs and sustainability.

Conditions

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Mobility Limitation Functional Disturbance

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

It is a quasi-experimental design study.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Intervention

Intervention group will receive a multicomponent, mobility-focused intervention during the course of inpatient admission.

Group Type EXPERIMENTAL

Multicomponent, mobility-focused intervention

Intervention Type OTHER

The intervention group will receive early therapist review (within one working day of admission to HOME unit), to be mobilised at least three times a day. They will also receive additional group exercise therapy sessions, as well as nurse screening for geriatric syndromes. Besides that, they will be screened for 4Ms (Mobility, Mentation, Medication, What Matters) by doctor on admission.

Control

The control group will receive usual care as per current ward practice.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Multicomponent, mobility-focused intervention

The intervention group will receive early therapist review (within one working day of admission to HOME unit), to be mobilised at least three times a day. They will also receive additional group exercise therapy sessions, as well as nurse screening for geriatric syndromes. Besides that, they will be screened for 4Ms (Mobility, Mentation, Medication, What Matters) by doctor on admission.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Newly admitted patients to the geriatric service
* Aged 75 years and above
* Mobile with or without the use of a walking aid

Exclusion Criteria

* Vancomycin-resistant enterococcus (VRE) status
* Requires droplet or airborne precautions
* Critically ill
* Haemodynamically instability
* Requires more than 4-hourly parameters
* Systolic blood pressure \<90 mmHg
* Heart rate \>100beats/min
* Non-ambulant patients
* With advanced dementia (Functional Assessment Staging Scale \[FAST\] 7 dementia)
* Fulfills direct admission to another subspecialty unit
Minimum Eligible Age

21 Years

Maximum Eligible Age

110 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Geriatric Education and Research Institute

OTHER_GOV

Sponsor Role collaborator

National Healthcare Group, Singapore

OTHER_GOV

Sponsor Role collaborator

JurongHealth

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Melanie Tan Dr

Role: PRINCIPAL_INVESTIGATOR

Ng Teng Fong General Hospital

Lau Lay Khoon Dr

Role: PRINCIPAL_INVESTIGATOR

Geriatric Education and Research Institute

Locations

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Ng Teng Fong Hospital

Singapore, , Singapore

Site Status

Geriatrics Education and Research Institute

Singapore, , Singapore

Site Status

Countries

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Singapore

Central Contacts

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Melanie Tan Dr

Role: CONTACT

Facility Contacts

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Melanie Tan Dr

Role: primary

Lau Lay Khoon Dr

Role: primary

References

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Other Identifiers

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GERI1627

Identifier Type: -

Identifier Source: org_study_id

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