Functional Disturbance, Mobility Limitation
Conditions
Keywords
Elderly, Geriatric, Mobility, Inpatient, Functional Decline, Mobility Intervention, Gait speed, Maximum distance walked, Cost impact, length of stay, Multidisciplinary, Implementation study, 4Ms (Mobility, Mentation, Medication, What Matters), Nursing screen, Group therapy
Brief summary
During hospitalisations, older inpatients commonly face issues such as immobility, loss of independence, and functional decline. This leads them down the cascade of dependency with consequent increased risk of adverse outcomes, institutionalisation as well as higher post-acute care costs. The investigators hypothesize that by implementing a mobility intervention in the inpatient setting, patients would be able to maintain their function upon discharge and avoid the cascade of dependency. As such, the investigators aim to do this by implementing and evaluating a mobility intervention, while optimising reversible factors affecting mobility among inpatients admitted to a geriatric unit in Singapore. The investigators will also examine the cost impact of a mobility focused model of care and also adopt the effectiveness-implementation hybrid Type 2 design where both effectiveness and implementation spheres are tested simultaneously.
Detailed description
Aim 1: To examine the effectiveness of multicomponent, mobility-focused model of care in reducing iatrogenic complications and improving patient outcomes. Adopting the Institute for Healthcare Improvement's (IHI) 4Ms framework (Mobility, Mentation, Medication, and What Matters), the investigators will examine the effectiveness of timely and individually catered mobility interventions which not only increase mobilization but also optimize factors inhibiting mobility for elderly inpatients. It is hypothesized that the mobility outcomes, such as maximum distance walked and mobilization frequency will be significantly improved for patients who receive the intervention compared to those who receive standard care. Aim 2: To examine the cost impact of a mobility-focused model of care. The investigators will examine whether the cost of these multicomponent, mobility-focused interventions can be offset from cost savings from early mobilisation benefits, by comparing healthcare utilization costs between-groups. Further to that, a cost effectiveness analysis will be performed should functional effectiveness be observed. For the primary cost impact objective, it is hypothesized that the cost savings arising from reduction in bed days of hospitalization and other medical costs incurred during study period will outweigh the cost of implementing this model of care. In addition, it is also hypothesized that the proposed intervention will be cost-effective through achieving better functional outcomes for patients, with lower costs required. Aim 3: To evaluate the implementation outcomes of multicomponent, mobility-focused model of care in the process of this intervention. It is hypothesized that this intervention will have good acceptability, feasibility, penetration, implementation costs and sustainability.
Interventions
OTHERMulticomponent, mobility-focused intervention
The intervention group will receive early therapist review (within one working day of admission to HOME unit), to be mobilised at least three times a day. They will also receive additional group exercise therapy sessions, as well as nurse screening for geriatric syndromes. Besides that, they will be screened for 4Ms (Mobility, Mentation, Medication, What Matters) by doctor on admission.
Sponsors
Geriatric Education and Research Institute
National Healthcare Group, Singapore
JurongHealth
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
It is a quasi-experimental design study.
Eligibility
Sex/Gender
ALL
Age
21 Years to 110 Years
Healthy volunteers
Yes
Inclusion criteria
* Newly admitted patients to the geriatric service * Aged 75 years and above * Mobile with or without the use of a walking aid
Exclusion criteria
* Vancomycin-resistant enterococcus (VRE) status * Requires droplet or airborne precautions * Critically ill * Haemodynamically instability * Requires more than 4-hourly parameters * Systolic blood pressure \<90 mmHg * Heart rate \>100beats/min * Non-ambulant patients * With advanced dementia (Functional Assessment Staging Scale \[FAST\] 7 dementia) * Fulfills direct admission to another subspecialty unit
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in maximum distance walked | Upon admission and at the point of discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | The total distance covered by the research participant (in meter) |
| Mobilisation frequency | Through the duration of admission | Number of times mobilised. The average mobilisation frequency will be calculated by dividing the sum by the number of admission days. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in gait speed | Upon admission and at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | 4 meter gait speed test (meter/second) |
| Change in modified barthel score | Upon admission, at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay), and one-month post discharge | The score ranges from 0 to 100 with 0 as the worst outcome |
| Inpatient length of stay and discharge location | The duration of admission and upon discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | The duration of admission (days) and the location the respective participant is discharged to |
| Presence of common iatrogenic complications such as delirium, injurious falls, pressure ulcers, and venous thromboembolisms | At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | Each of the complication will be measured in nominal scale; 0 denotes the absence of the complication while 1 denotes the presence of the complications. The total number of complications arise will be calculated. The greater the number indicates poorer outcome |
| Gross amount of patient's bill during index admission, considering subsidy level | At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | The total gross amount of participant's bill during index admission. The subsidy level will be documented |
| The intervention related costs for group therapy | At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | The number of group therapy sessions attended by the participant multiply by the cost for one group therapy session. The subsidy level will be documented. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Healthcare utilisation data and associated costs | 1-month follow-up post-discharge | Number of visits (associated with index admission) to emergency department, specialist outpatient clinic, general practitioner and the associated costs within 30 days post-discharged |
| Ambulatory status | 1-month follow-up post-discharge | Self-reported by the participant. Four options: 0 denotes bed-bound, 1 denotes chair-bound, 2 denotes assisted (furniture cruiser, walking frame, rollator frame, quadstick, single point stick); 4 denotes independent |
| Fall | 1-month follow-up post-discharge | 0 denotes no fall; 1 denotes fall(s) occured (within 30days post-discharged) |
| Utilisation of community resources | 1-month follow-up post-discharge | Self-reported by the participant: Five options: 0 denotes home care; 1 denotes day care; 2 denotes meals on wheels; 3 denotes medical escort service; 4 denotes home personal care |
| Readmission | 1-month follow-up post-discharge | The number of readmission due to the index admission within 30 days post discharged |
| Mortality | 1-month follow-up post-discharge | 1 denotes survival while 0 denotes the participant passed away |
Countries
Singapore
Contacts
Primary ContactMelanie Tan Dr
Outcome results
None listed