Background: Lack of mobility in the inpatient hospital setting hastens functional decline in elderly patients and is associated with increased risk of complications such as falls, delirium, venous thromboembolism (VTE), and skin breakdown. These adverse outcomes drive increased cost as patients spend additional time in both the acute and post-acute care settings. Physical activity is thus widely recognized as an important factor for improving outcomes in hospitalized patients; however, numerous challenges to its implementation exist. To our knowledge, no study has investigated the implementation of a mobility protocol by a dedicated caregiver on elderly patients in a regular nursing medical inpatient unit. The objective of this study was to assess the feasibility and effectiveness of dedicated ambulator-assisted physical activity in elderly inpatients.
Methods: This was a randomized controlled trial on four medical regular nursing floors at a large academic medical center (Cleveland Clinic Main Campus). Patients greater than or equal to 60 years of age and meeting mobility thresholds were enrolled per our informed consent process approved by the IRB.
Patients randomized to the intervention group were asked to participate in the ambulation protocol 3 times daily under the supervision of the dedicated ambulator PCNA. Those in the control group received usual care from the care team.
A mobility tracking device directly recorded daily steps taken while the patient was in the hospital.
The following data were collected during the trial – number of daily visit attempts, service duration, level of ambulation, and any reasons for patient refusal. Additionally, outcome measures collected from the electronic health record included discharge disposition, length of stay, mortality, falls, new venous thromboembolism or pneumonia, 30-day readmission, and change in mobility score.
Results: The trial successfully enrolled 102 patients over a 12 month period, 52 in the control arm and 50 in the intervention arm. Baseline characteristics between the two groups were the same.
We were able to successful ambulate patients on the medical floor. On average, patients were visited on 63% of the days patients were enrolled in the study and each patient had, on average, 6.5 successful attempts at ambulation. Total additional duration of mobility was 71 minutes over an average length of stay on protocol of 3 days.
Intervention patients had 48.9% more daily steps than control patients (994 daily steps vs 668 daily steps) (p value = 0.038).
A per protocol analysis of the intervention showed improvement in objective mobility via the 6-clicks score by 0.688 (p value = 0.044) and also saw an increased number of patient who were discharged to home (68% versus 62% – not statistically significant).
The trial was not powered to detect a difference in other clinical outcomes measures (Length of Stay, Stroke, VTE, hospital acquired pneumonia, readmissions at 30 days, disposition or falls).
Conclusions: This pilot trial proves the feasibility of a dedicated resource to implement ambulation interventions among elderly medical inpatients. While the size of the trial limited the ability to detect significant differences in clinical outcomes, the increased number of steps and trend towards more patients being discharged to home is highly encouraging. This sets the stage for a larger multicenter randomized trial to assess this interventions impact on outcomes that are clinically and financially meaningful.