A Randomized Trial of Gamification and Coaching to Improve Mobility after Hospitalization

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PROJECT SUMMARY / ABSTRACT Half of incident disability in older and middle-aged, adults with chronic conditions occurs after hospitalization. Often this cascade begins with mobility disability, a condition which affects 31 million adults in the United States and leads to loss of independence, increased health care utilization, and earlier mortality. Higher levels of physical activity after hospital discharge are associated with reduced disability; however, prospective interventions to promote and sustain healthy physical activity are currently lacking. We have successfully piloted a novel approach using behaviorally designed gamification and social support for physical activity promotion during a 12-week intervention among adults discharged from the hospital (N=232). The intervention led to larger increases in physical activity among older and middle-aged patients (age 50 to 65), those with higher social engagement, and lower baseline step counts. Our proposed study will build on results of this pilot to target a broader population of at-risk adults hospitalized for 1 of 3 chronic Ambulatory Care Sensitive Conditions affected by physical activity (hypertension, diabetes, and mild-moderate heart failure). Since high social support was found to lead to larger effects in the pilot study, we will add a virtual health coach to the intervention design to help patients increase their support levels. The goals are of this study are to increase physical activity after discharge from the hospital to reduce incident mobility disability associated with acute illness and to reduce acute and post-acute care utilization. We will also evaluate the sustainability of this approach over a longer period (6 months intervention, 6 months follow up) and qualitatively assess factors associated with higher or lower performance in a population with significant ethnic/racial and socioeconomic diversity. To achieve these goals, we have assembled an expert multidisciplinary team in behavioral economics, geriatrics, nursing science, clinical trials and implementation. We will study the novel application of this approach to patients who are discharged from Penn Medicine hospitals and follow them for 12 months after discharge. We will focus on 4 specific aims: 1) To evaluate the effectiveness of a 6-month intervention using gamification with social incentives and personalized coaching to increase physical activity among adults age ≥ 50 with chronic conditions at risk for disability (primary outcome); 2) To evaluate the sustainability of increased physical activity during a 6-month follow-up period (secondary outcome); 3) To evaluate the impact of physical activity on disability and acute care utilization during the study period (secondary outcomes); and 4) To conduct a mixed-methods process evaluation to explore factors associated with strong or poor response to the interventions. Our approach aligns with NIA's strategic priority to develop effective interventions to maintain function and prevent or reduce disability and also with national efforts to create an Aging Friendly Health System through the spread of scalable, sustainable, and cost-effective interventions.