Cynthia J Brown1, Kathleen T Foley2, John D Lowman3, Paul A MacLennan4, Javad Razjouyan5, Bijan Najafi5, Julie Locher6, Richard M Allman7. 1. Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Care Center, Birmingham, Alabama2Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham. 2. School of Occupational Therapy, College of Health Sciences, Brenau University, Atlanta, Georgia. 3. School of Health Professions, University of Alabama at Birmingham, Birmingham. 4. Department of Surgery, University of Alabama at Birmingham, Birmingham. 5. College of Medicine, University of Arizona, Tucson7currently with Baylor College of Medicine, Houston, Texas. 6. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham. 7. Geriatrics and Extended Care, Department of Veterans Affairs, Washington, DC.
Abstract
IMPORTANCE: Low mobility is common during hospitalization and associated with loss or declines in ability to perform activities of daily living (ADL) and limitations in community mobility. OBJECTIVE: To examine the effect of an in-hospital mobility program (MP) on posthospitalization function and community mobility. DESIGN, SETTING, AND PARTICIPANTS: This single-blind randomized clinical trial used masked assessors to compare a MP with usual care (UC). Patients admitted to the medical wards of the Birmingham Veterans Affairs Medical Center from January 12, 2010, through June 29, 2011, were followed up throughout hospitalization with 1-month posthospitalization telephone follow-up. One hundred hospitalized patients 65 years or older were randomly assigned to the MP or UC groups. Patients were cognitively intact and able to walk 2 weeks before hospitalization. Data analysis was performed from November 21, 2012, to March 14, 2016. INTERVENTIONS: Patients in the MP group were assisted with ambulation up to twice daily, and a behavioral strategy was used to encourage mobility. Patients in the UC group received twice-daily visits. MAIN OUTCOMES AND MEASURES: Changes in self-reported ADL and community mobility were assessed using the Katz ADL scale and the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), respectively. The LSA measures community mobility based on the distance through which a person reports moving during the preceding 4 weeks. RESULTS:Of 100 patients, 8 did not complete the study (6 in the MP group and 2 in the UC group). Patients (mean age, 73.9 years; 97 male [97.0%]; and 19 black [19.0%]) had a median length of stay of 3 days. No significant differences were found between groups at baseline. For all periods, groups were similar in ability to perform ADL; however, at 1-month after hospitalization, the LSA score was significantly higher in the MP (LSA score, 52.5) compared with the UC group (LSA score, 41.6) (P = .02). For the MP group, the 1-month posthospitalization LSA score was similar to the LSA score measured at admission. For the UC group, the LSA score decreased by approximately 10 points. CONCLUSIONS AND RELEVANCE: A simple MP intervention had no effect on ADL function. However, the MP intervention enabled patients to maintain their prehospitalization community mobility, whereas those in the UC group experienced clinically significant declines. Lower life-space mobility is associated with increased risk of death, nursing home admission, and functional decline, suggesting that declines such as those observed in the UC group would be of great clinical importance. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00715962.
RCT Entities:
IMPORTANCE: Low mobility is common during hospitalization and associated with loss or declines in ability to perform activities of daily living (ADL) and limitations in community mobility. OBJECTIVE: To examine the effect of an in-hospital mobility program (MP) on posthospitalization function and community mobility. DESIGN, SETTING, AND PARTICIPANTS: This single-blind randomized clinical trial used masked assessors to compare a MP with usual care (UC). Patients admitted to the medical wards of the Birmingham Veterans Affairs Medical Center from January 12, 2010, through June 29, 2011, were followed up throughout hospitalization with 1-month posthospitalization telephone follow-up. One hundred hospitalized patients 65 years or older were randomly assigned to the MP or UC groups. Patients were cognitively intact and able to walk 2 weeks before hospitalization. Data analysis was performed from November 21, 2012, to March 14, 2016. INTERVENTIONS:Patients in the MP group were assisted with ambulation up to twice daily, and a behavioral strategy was used to encourage mobility. Patients in the UC group received twice-daily visits. MAIN OUTCOMES AND MEASURES: Changes in self-reported ADL and community mobility were assessed using the Katz ADL scale and the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), respectively. The LSA measures community mobility based on the distance through which a person reports moving during the preceding 4 weeks. RESULTS: Of 100 patients, 8 did not complete the study (6 in the MP group and 2 in the UC group). Patients (mean age, 73.9 years; 97 male [97.0%]; and 19 black [19.0%]) had a median length of stay of 3 days. No significant differences were found between groups at baseline. For all periods, groups were similar in ability to perform ADL; however, at 1-month after hospitalization, the LSA score was significantly higher in the MP (LSA score, 52.5) compared with the UC group (LSA score, 41.6) (P = .02). For the MP group, the 1-month posthospitalization LSA score was similar to the LSA score measured at admission. For the UC group, the LSA score decreased by approximately 10 points. CONCLUSIONS AND RELEVANCE: A simple MP intervention had no effect on ADL function. However, the MP intervention enabled patients to maintain their prehospitalization community mobility, whereas those in the UC group experienced clinically significant declines. Lower life-space mobility is associated with increased risk of death, nursing home admission, and functional decline, suggesting that declines such as those observed in the UC group would be of great clinical importance. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00715962.
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