None listed
Conditions
Brief summary
Poor balance and mobility are consistently associated with increased risk of falling among people in hospitals. This study aims to implement and evaluate SureStep, an evidence-based group standing balance exercise program designed to help hospital patients improve their balance, mobility and reduce their risk of falls. The program is delivered by physiotherapists as part of new standard care and involves supervised group exercise sessions held on the recruited wards. Using a stepped wedge type III hybrid design, recruited hospital wards will begin the program at randomly assigned times, allowing comparison between the original usual care and the SureStep program as new standard care primarily on the exercise dose and physical level of patients on ward. The study will assess feasibility, acceptability, cost-effectiveness and sustainability of the program. We hypothesise that SureStep will be feasible, safe and cost-effective to deliver, which will be sustained over time to support better mobility for hospitalised adults.
Interventions
Intervention name: SureStep, a group-based standing balance exercise program
SureStep is an evidence-based group standing balance exercise class, involving a total of 7 different exercise stations. Stage 1 of this project involved consultations with staff and patients to adapt this evidence-based program to other hospital wards. Stage 2 (current registration) involves evaluation of the program adapted from Stage 1 at the new hospital wards as a new standard of care.
All wards included in Stage
Intervention name: SureStep, a group-based standing balance exercise program SureStep is an evidence-based group standing balance exercise class, involving a total of 7 different exercise stations. Stage 1 of this project involved consultations with staff and patients to adapt this evidence-based program to other hospital wards. Stage 2 (current registration) involves evaluation of the program adapted from Stage 1 at the new hospital wards as a new standard of care. All wards included in Stage 1 will be invited to participate in Stage 2. Guided by the results of Stage 1, at least 4 wards from 3 hospitals (St George Private Hospital, Prince of Wales Hospital and Bulli Hospital) will be included in Stage 2. These represent both private and public hospitals in Sydney, NSW. Stage 2 will adopt a Hybrid Type III stepped wedge study design, in which each participating ward will begin delivering SureStep at different time points, based on operational readiness rather than fixed scheduling. Wards that have completed Stage 1 and are ready to commence implementation will be grouped and randomisation will occur within each readiness group to determine the sequence of implementation. Additional wards will be randomised to subsequent time periods once they become ready following Stage 1 activities. Each ward will participate in three sequential phases: a 3-month pre-implementation phase (original standard care), a 3-month implementation phase (SureStep as new standard care), and a 3-month sustainment phase. The primary objective of Stage 2 is to evaluate the impact of implementing SureStep as part of new physiotherapy usual care on both implementation outcomes (dose of exercise, reach, fidelity, feasibility, cost, staff confidence, safety, acceptability, patient satisfaction and sustainability) and effectiveness outcomes (physical activity level, falls, hospital length of stay, hospital readmissions, mobility and mobility-related quality of life). The secondary objectives involve investigating the sustainability of SureStep on implementation and effectiveness outcomes post-implementation phase as well as investigating the cost of implementing SureStep to each hospital ward and estimate the cost-effectiveness compared to pre-implementation via a modelled analysis. Stage 2 involves implementing the adapted SureStep program in new hospital wards as part of new standard of physiotherapy care. Wards that have completed Stage 1 and are ready to commence implementation will be grouped and randomisation will occur within each readiness group to determine the sequence of implementation. The consultation in Stage 1 reflected that exercises in SureStep are commonly prescribed by ward physiotherapists as individual therapy. The adaptations focused mainly on the delivery format of the program and the implementation processes, rather than the modifications to the exercise content. Therefore, the adapted program consists of the same set of simple balance and mobility exercises but is organised into a structured group format with adjusted dosage. Specifically, the adapted SureStep program involves a sequence of balance and mobility exercises, including catching and passing, stepping forward, stepping sideways, stepping grid, weight shifting forward and backward, heel raises and reaching and moving objects completed in a semi-circuit group setting. Patients will rotate to the next exercise station or change to the next exercise until they have completed all exercise stations in class. A maximum of 3 to 8 patients will be able to attend each class in person, monitored by up to 4 physiotherapists/allied health assistants/students. The minimal dosage of SureStep across all the wards would be no less than 2 times per week, 45 minutes per session for at least 2 classes per patient. The dosage of exercises will be recorded for each patient during each class to facilitate progression of each patient. These adaptations were made to ensure the underlying core functions (e.g. to provide safely delivered, progressively challenging high-dose, task-specific and engaging standing balance exercise within routine ward resources) of the original SureStep are achieved. SureStep exercise classes will be delivered by hospital staff, who will be supported by research staff during the implementation period. Research staff can provide assistance and support to hospital staff, including education and training for class delivery, collating and organising outcome measures, preparation for promotion materials (e.g., email/poster/leaflet to inform ward staff, exercise summary and exercise checklist for patients) and ongoing in-person and online evaluation to facilitate the success of the implementation, as guided by the consultation in Stage 1. Trainings for hospital staff will be provided by research staff for up to 4 hours across the three months prior to the first participant enrolment. Any additional support from research team will be further discussed with the staff as part of the evaluation process in Stage 2.
Sponsors
The University of Sydney
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patient participants aged greater than or equal to 18 years in the ward will be included in the ward-level effectiveness outcomes (i.e. observed physical activity, falls, hospital length of stay and hospital readmissions). Falls, hospital length of stay and hospital readmission data will be collected as part of the new routine practice of the wards. Observation will be conducted by the research team members. Only information related to patient physical activity (e.g. patient position, activity, social interaction, their location while doing those activities etc.) will be collected. Patient and family member/carer survey and interview participants currently at or discharged from the participating ward will be included if they are considered cognitively and medically well enough to participate in a survey or interview with the clinical advice from the treating health professionals. Specifically, patient participants aged greater than or equal to 18 years must meet all of the following criteria to be eligible for SureStep class as assessed by the treating physiotherapists: • Able to sit independently • Able to stand for at least 10–30 seconds without assistance, with or without walking aids • Able to fully weight bear • Require minimal supervision to 1 assist during the class • Able to follow simple instructions • Willing to participate in the exercise class • No medical contraindications to participating in standing balance exercises These criteria ensure that participants can safely engage in the group-based balance exercise class and benefit from its progressive and functional design. Health professionals eligible to participate in this study (e.g. interviews and/or focus groups, surveys or implementation activities) must meet the following criteria: • Currently employed at one of the participating wards (St George Private Hospital, Prince of Wales Hospital or Bulli Hospital) • Directly involved in the delivery, support, or coordination of the SureStep balance exercise program (e.g. physiotherapists, allied health assistants, students, nurses, or members of the multidisciplinary team) • Willing to participate in the implementation of SureStep and/or provide verbal consent for evaluation activities (i.e. interviews and/or focus groups, surveys)
Exclusion criteria
Patient and family member/carers are excluded from survey and/or interviews if they are not considered cognitively and/or medically well enough to participate with the clinical advice from the treating health professionals. Patient participants will be excluded from the SureStep exercise class if they meet any of the following criteria: • Have medical contraindications to standing or balance exercises (e.g. unstable fractures, acute illness, or other safety concerns) • Unable to follow simple instructions due to cognitive impairment, significant communication difficulties, or language barrier that cannot be reasonably accommodated (e.g. through translation from interpreter/family/research team support, translated materials, or non-verbal demonstration) • Unable to sit or stand independently, even with aids • Require more than 1 physical assistance to participate safely in the class • Unwilling to participate in the program Health professionals will be excluded from this study (e.g. interviews and/or focus groups, surveys or implementation activities) if they meet the following criteria: • Not currently employed at one of the participating wards (St George Private Hospital, Prince of Wales Hospital or Bulli Hospital) • Not directly involved in the delivery, support, or coordination of the SureStep balance exercise program • Not willing to participate in implementation activities or give verbal consent for evaluation activities (interviews/focus groups, surveys)
Outcome results
None listed