Hospital mobility program linked to preserved mobility following in-patient admission

1. Patients admitted to medical wards who underwent a mobility program (MP) demonstrated preserved mobility 1-month post-hospitalization compared to usual care.

2. Although the results were positive, the inclusion criteria were relatively strict and the outcomes were based on self-reported functional status, both of which may affect the validity and generalizability of the results.

Evidence Rating Level: 2 (Good)       

Study Rundown: Patients in hospital often undergo functional loss from to low mobility during their admission. Older adults with low baseline function are at particularly high risk for this. The described study sought to evaluate the effect of an in-hospital mobility program (MP) on functional status following hospitalization for patients admitted to medical wards at a single institution. The program included twice daily ambulation coupled with a behavioral intervention integrating social cognitive therapy and goal-setting.

Patients who underwent MP demonstrated mobility scores equivalent to their preadmission status while those who received usual care (UC) demonstrated significant decline. Although only half of the potential walks in the intervention program were used, there was still a positive outcome with regards to the level of functional ability retained in the intervention group. While this was a randomized trial, the study population was very selective and included only those with good pre-hospital mobility, cognitive function, and lack of in-hospital delirium. The outcomes were also based on self-reported data, which affects the validity of the results. Studies at multiple sites with more broad patient selection may be needed to confirm generalizability of these results.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Assisted Early Mobility for Hospitalized Older Veterans: Preliminary Data from the STRIDE Program

In-Depth [randomized controlled trial]: This study was a single-blind randomized controlled trial of patients admitted to medical wards at the Birmingham Veterans Affairs Medical Center between 2010 and 2011. Patients were selected to participate if they were 65 years of age or older, cognitively intact, walking at baseline (2 weeks prior to admission), and not delirious (Confusion Assessment Method score of 0). Of the 100 patients, 8 patients did not complete study due to death, transfer to ICU, delirium, or withdrawn consent. The intervention consisted of twice daily 20 to 30-minute mobility exercises with a research assistant, and counseling on behavioral intervention and goal-setting. Usual care included any physiotherapy deemed necessary by the medical team, and twice daily control visits by research assistants without mobility exercises or counseling. Functional assessment was performed at baseline, admission, and 1-month post-hospitalization by Katz ADL score. Mobility was evaluated at the same time intervals with the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA).

The population was predominantly male (97%), with mean (SD) length of stay of 3.6 (2.3) days. At 1-month post-hospitalization, there was no difference in ADL function between MP and UC groups (mean [SD] 8.2 [0.30] vs. 8.2 [0.32], p=0.99). The MP patients had preserved LSA scores from admission (mean [SD] 53.9 [4.15]) to after hospitalization (52.6 [4.39]) while the UC group had lower LSA score after hospitalization (41.8 [3.15], p=0.02).

Image: PD

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