Staying Active with Multimorbidity In Acute hospital (StAMInA) Trial: a randomised controlled trial investigating the feasibility of allied health assistant delivered mobility rehabilitation for patients with multimorbidity in an acute hospital setting

Name of intervention: Allied health assistant provision of routine acute mobility rehabilitation Who will deliver the intervention and what is their training: The intervention will be delivered by a senior allied health assistant (grade 3). The allied health assistant will have a certificate IV allied health assistant qualification. A mid-level (grade 2) physiotherapist will supervise the senior allied health assistant as per health network clinical supervision guidelines. This supervision will include monthly meetings to discuss professional and clinical skill development in the management of people with multimorbidity. It will also involve direct supervision/observation of the senior allied health assistant’s management of patients with multimorbidity. Note that this is the only difference between the exposure and comparator groups; all other procedures/protocols are the same. Mode of delivery: Individual, face-to-face Dose: Daily therapy provided on weekdays (i.e. daily therapy 5x per week) until discharge from acute hospital. Initial physiotherapy assessment may occur on a Saturday. The duration of each session will vary dependent on patient needs but will typically range from 10 to 40 minutes. Location/Timing: All therapy will be provided to patients with multimorbidity on the acute general medical ward at Frankston Hospital. Therapy will be provided by the allied health assistant following an initial physiotherapy assessment of the patient. The allied health assistant will be delegated provision of routine acute mobility rehabilitation if the patient is transferred to sitting out of bed during the physiotherapy assessment and appropriate for mobilisation (i.e. transfers and walking). This process will involve the physiotherapist completing an initial assessment and providing a handover to the allied health assistant. Procedures and personalisation: Routine acute mobility rehabilitation of patients with multimorbidity may include any form of skills-based and/or functional strengthening exercise and education, including but not limited to: 1) Mobilisation (i.e. transfers and walking) including progression of gait aid and practice of transfers (e.g. bed to chair) 2) Standing (e.g. squats, heel raises) and seated exercises (e.g. knee extension). The dose and intensity of these exercises will not be specified as the focus is on practicing muscle control for key muscles and joints important for mobilisation (i.e. skills-based). 3) Education on correct use of gait aid, falls risk strategies, correct performance of exercises; provided via verbal conversation All therapy will be prescribed by the physiotherapist who conducts the initial assessment and tailored to the individual needs of the patient. Therefore, how a patient mobilises (e.g. use of gait aid or no gait aid), the types of exercises they perform, and the intensity of exercises will be prescribed by the physiotherapist and will vary between participants based on their individual needs. All prescribed therapy will be implemented by the allied health assistant. As per standard protocol, following treatment of the patient with multimorbidity the allied health assistant will inform the physiotherapist, who completed the initial assessment, of the details of the session and the patient’s progress in their ability to mobilise. The physiotherapist will use this feedback to determine the discharge plan and re-assess the patient as required. Fidelity: The fidelity of the intervention will be determined by measuring the time and occasions of service each patient spends with i) the physiotherapist and ii) the allied health assistant.