Impact of a Hospital Mobility Program on Function after Discharge

 描述（由申请人提供）： 有强有力的证据表明，老年人的残疾在很大程度上是由导致住院的疾病和伤害造成的。数据显示，住院治疗大大增加了新的残疾或残疾恶化的可能性，以及残疾康复的可能性降低。我们的工作表明，即使在控制了疾病严重程度和合并症之后，低流动性也与不良结果相关，包括日常生活活动（ADL）下降，养老院安置和死亡。在住院期间检查增加流动性的影响的干预研究很少，通常测量住院结果，如住院时间。然而，在我们的VA资助的研究中，我们显示接受院内活动干预的患者，包括每天两次的步行帮助和解决活动障碍的行为策略，设置活动目标，并鼓励患者步行，与常规护理相比，出院后一个月的社区活动水平具有临床意义。这项初步工作仅限于对≥ 65岁的退伍军人进行一个月的随访。在我们对医院流动性计划的影响的理解中仍然存在一些重要的差距：1）医院流动性计划研究没有使用随机对照试验（RCT）设计来评估影响; 2）参与者的实际步数和步行时间没有被测量; 3）出院后30天以上的结果没有被检查;以及4）尚未确定最有可能从这种类型的干预中受益的患者的特征。对于这项高影响研究，我们建议在五个VA医院病房中使用阶梯楔形群随机设计，以比较年龄≥ 50岁的退伍军人队列中的移动计划（MP）与常规护理（UC）。我们将使用院内和院后评估检查MP和UC组出院后一年的活动能力和不良结局，包括功能下降、入住疗养院、急诊（艾德）就诊、住院和死亡。我们的总体假设是，在住院期间提供步行帮助的医院移动计划将减少观察到的移动能力丧失和与住院相关的不良后果，并且MP和UC之间的这种差异将在整个一年的随访期间保持不变。本研究项目的主要目的是测试活动计划在恢复到院前活动状态或更好方面的有效性，并减少不良结局，包括功能下降、艾德就诊、住院、入住疗养院和住院后一年内死亡;并确定改变活动干预对恢复至术前的影响的特征，住院后一年内的住院活动状态或更好，并减少不良结局。一个成功的行动干预，防止丧失行动能力或加快恢复到院前水平，可以显着影响生活质量，并减少残疾的数千名住院患者。这一系列研究有可能改变为所有患者提供的医院护理标准。

 DESCRIPTION (provided by applicant): There is strong evidence that disability among older adults is largely driven by illnesses and injuries that lead to hospitalizations. Data shows the likelihood of developing new or worsening disability, as well as a reduced likelihood of recovery from disability, is greatly increased with hospitalization. Our work has shown low mobility to be associated with adverse outcomes including decline in activities of daily living (ADLs), nursing home placement and death, even after controlling for illness severity and comorbidity. Intervention studies examining the effect o increasing mobility during hospitalization are sparse and typically measure in-hospital outcomes such as length of stay. However in our VA-funded study, we showed patients who received an in-hospital mobility intervention that included twice daily assistance with walking and a behavioral strategy that addressed barriers to mobility, setting of mobility goals, and encouraged patients to walk, had a clinically significant higher level of community mobility at one month post-discharge compared to usual care. This preliminary work was restricted to only one month of follow-up of veterans who were ≥ 65 years of age. A number of important gaps remain in our understanding of the impact of a hospital mobility program: 1) hospital mobility program studies have not used a randomized controlled trial (RCT) design to evaluate the impact; 2) the actual number of steps and time spent walking by participants has not been measured; 3) outcomes beyond 30 days post-discharge have not been examined; and 4) characteristics of patients most likely to benefit from this type of intervention has not been identified. For this high impact stud we propose to use a stepped wedge cluster randomization design on five VA hospital wards to compare a mobility program (MP) to usual care (UC) among a cohort of veterans age ≥ 50 years. We will examine mobility and adverse outcomes including functional decline, nursing home admission, emergency department (ED) visits, hospitalization and death in the MP and UC groups in the year after hospital discharge using in-hospital and post-hospital assessments. Our overarching hypothesis is that a hospital mobility program that provides assistance with ambulation during hospitalization will reduce the observed loss of mobility and adverse outcomes associated with hospitalization and this difference between MP and UC will be maintained throughout the year follow-up period. The major aims of this research project are to test the effectiveness of a mobility program on recovery to pre-hospital mobility status or better and reduction of adverse outcomes including functional decline, ED visits, hospitalization, nursing home admission and death in the year after hospitalization; and to identify characteristics that modify the effect of the mobility intervention on recovery to pre-hospital mobility status or better and reduction of adverse outcomes in the year after hospitalization. A successful mobility intervention that prevents loss of mobility or quickens recovery to pre-hospital levels could significantly impact quality of life and reduce disability for thousands of hospitalized patients. This line of research has the potential to change the standard of hospital care provided to all patients.