Supervised hospital walking program reduces the need for nursing care

1. A supervised walking program was associated with reduced discharge rates to skilled-nursing facilities (SNF) from a Veterans Affairs (VA) hospital.

2. The supervised walking program did not result in a reduced length of hospital stay or a lower number of inpatient falls.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Inactivity during hospitalization has been identified as a major risk factor for hospital-associated disability and other adverse events. It can increase the odds of longer lengths of stay, the decline in function, and eventual discharge to an SNF. Admission to an SNF after hospitalization is a risk factor for long-term institutionalization. Walking programs have emerged as a strategy to reduce functional decline among hospitalized older patients. However, there is a knowledge gap in understanding the effect of walking programs on patient mobility and functional improvement compared to older adults who do not participate in these programs. Overall, this study found that hospitalizations that occurred during the implementation period of the STRIDE (AssiSTed EaRly MobIlity for HospitalizeD VEterans) program had lower odds of discharge to an SNF but no impact on the length of stay. This study was limited by having almost all male patients and clinicians treating these patients as unblinded. Nevertheless, these study’s findings are significant, as they demonstrate that supervised walking programs may be impactful in improving quality of care and functional status after hospitalization for older adults.

Click to read the study in AIM

Relevant Reading: Physical Performance in Peripheral Arterial Disease: A Slower Rate of Decline in Patients Who Walk More

In-Depth [randomized controlled trial]: This stepped-wedge, cluster randomized trial was conducted at eight VA hospitals between August 2017 and August 2019. Patients who were aged 60 years or older and admitted for two or more business days to a participating medical ward without a bedrest order were eligible for the study. Patients who resided in the United States territories were excluded due to incomplete data. The primary outcome measured was 1) discharge to an SNF as assessed using VA care (delivered and purchased) and CMS data files, as well as 2) length of stay measured in days. Outcomes in the primary analysis were assessed via a cross-sectional incomplete stepped wedge design with generalized linear mixed models with a logit link. Based on the primary analysis, the estimated rates of discharge to an SNF were 13% pre-STRIDE and 8% post-STRIDE. In adjusted models, the odds of discharge to an SNF were lower among eligible patients hospitalized in post-STRIDE time periods (odds ratio [OR], 0.6; 95% Confidence Interval [CI], 0.5 to 0.8) compared with pre-STRIDE. There were no significant differences in overall LOS (rate ratio, 1.0; 95% CI, 0.9 to 1.1) or having an inpatient fall (OR, 0.8; 95% CI, 0.5 to 1.1). In summary, this study demonstrates that supervised walking programs for elderly hospitalized adults may improve functional status and reduce the probability of discharge to an SNF but may not impact the overall length of stay.

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