Impact of a Hospital Mobility Program on Function after Discharge

医院流动计划对出院后功能的影响

• 批准号: 10336345
• 负责人: Alayne Denise Markland
• 金额: --
• 依托单位: BIRMINGHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10336345
• 关键词: Accelerometer; Activities of Daily Living; Address; Admission activity; Age; Age-Years; Bathing; Bed rest; Beds; Behavioral; Biometry; Caring; Cessation of life; Characteristics; Cognitive; Communities; Data; Elderly; Emergency department visit; Exercise Tolerance; Exposure to; Foundations; Funding; Geriatrics; Gills; Goals; Hospitalization; Hospitals; Injury; Intervention; Intervention Studies; Intervention Trial; Knowledge; Lead; Length of Stay; Life; Measures; Nursing Homes; Observational Study; Outcome; Outcome Measure; Participant; Patient Self-Report; Patients; Positioning Attribute; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Research; Research Project Grants; Resources; Science; Severity of illness; Social support; Solid; Sterile coverings; Time; Veterans; Walking; Wireless Technology; Work; adverse outcome; clinically significant; cognitive function; cohort; comorbidity; depressive symptoms; design; disability; effectiveness evaluation; effectiveness testing; experience; follow-up; functional decline; functional disability; improved; innovation; intervention program; middle age; mortality; prevent; primary outcome; programs; public health relevance; pulmonary function; treatment as usual; trial design; ward

 DESCRIPTION (provided by applicant): There is strong evidence that disability among older adults is largely driven by illnesses and injuries that lead to hospitalizations. Data shows the likelihood of developing new or worsening disability, as well as a reduced likelihood of recovery from disability, is greatly increased with hospitalization. Our work has shown low mobility to be associated with adverse outcomes including decline in activities of daily living (ADLs), nursing home placement and death, even after controlling for illness severity and comorbidity. Intervention studies examining the effect o increasing mobility during hospitalization are sparse and typically measure in-hospital outcomes such as length of stay. However in our VA-funded study, we showed patients who received an in-hospital mobility intervention that included twice daily assistance with walking and a behavioral strategy that addressed barriers to mobility, setting of mobility goals, and encouraged patients to walk, had a clinically significant higher level of community mobility at one month post-discharge compared to usual care. This preliminary work was restricted to only one month of follow-up of veterans who were ≥ 65 years of age. A number of important gaps remain in our understanding of the impact of a hospital mobility program: 1) hospital mobility program studies have not used a randomized controlled trial (RCT) design to evaluate the impact; 2) the actual number of steps and time spent walking by participants has not been measured; 3) outcomes beyond 30 days post-discharge have not been examined; and 4) characteristics of patients most likely to benefit from this type of intervention has not been identified. For this high impact stud we propose to use a stepped wedge cluster randomization design on five VA hospital wards to compare a mobility program (MP) to usual care (UC) among a cohort of veterans age ≥ 50 years. We will examine mobility and adverse outcomes including functional decline, nursing home admission, emergency department (ED) visits, hospitalization and death in the MP and UC groups in the year after hospital discharge using in-hospital and post-hospital assessments. Our overarching hypothesis is that a hospital mobility program that provides assistance with ambulation during hospitalization will reduce the observed loss of mobility and adverse outcomes associated with hospitalization and this difference between MP and UC will be maintained throughout the year follow-up period. The major aims of this research project are to test the effectiveness of a mobility program on recovery to pre-hospital mobility status or better and reduction of adverse outcomes including functional decline, ED visits, hospitalization, nursing home admission and death in the year after hospitalization; and to identify characteristics that modify the effect of the mobility intervention on recovery to pre-hospital mobility status or better and reduction of adverse outcomes in the year after hospitalization. A successful mobility intervention that prevents loss of mobility or quickens recovery to pre-hospital levels could significantly impact quality of life and reduce disability for thousands of hospitalized patients. This line of research has the potential to change the standard of hospital care provided to all patients.

 描述（由申请人提供）： 有证据表明，不舒适的成年人在很大程度上受到疾病和伤害的驱动。 。鼓励患者走路时，在临时医疗后，临床上有显着的社区流动性尚未确定尚未鉴定出对参与者的实际步骤和行走的实际步骤和时间的随机对照试验（RCT）。对于这个高影响力的螺柱，我们建议在五个VA医院病房上使​​用群集随机化设计，以比较一个年龄≥50岁的退伍军人中的移动性计划（MP）。急诊室（ED）在<br ospital and Hospital Assssmesssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssmesssssssmessssssssments急诊科（ED）。有些人将维持thear的随访期。在住院后的一年，不良行动或加快室内的疾病可能会对生活质量产生重大影响，并减少数千个研究的患者。所有合理性。

项目成果

Using local rather than general anesthesia for inguinal hernia repair is associated with shorter operative time and enhanced postoperative recovery.

• DOI: 10.1016/j.amjsurg.2020.08.024
• 发表时间: 2021-05
• 期刊: American journal of surgery
• 影响因子: 3
• 作者: Balentine CJ;Meier J;Berger M;Hogan TP;Reisch J;Cullum M;Zeh H;Lee SC;Skinner CS;Brown CJ
• 通讯作者: Brown CJ

Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients.

• DOI: 10.1016/j.jss.2020.08.054
• 发表时间: 2021-03
• 期刊: The Journal of surgical research
• 作者: Balentine CJ;Meier J;Berger M;Reisch J;Cullum M;Lee SC;Skinner CS;Brown CJ
• 通讯作者: Brown CJ

Local Anesthesia is Associated with Fewer Complications in Umbilical Hernia Repair in Frail Veterans.

• DOI: 10.1016/j.jss.2021.04.006
• 发表时间: 2021-10
• 期刊: The Journal of surgical research
• 作者: Meier J;Berger M;Hogan TP;Reisch J;Cullum CM;Lee SC;Skinner CS;Zeh H;Brown CJ;Balentine CJ
• 通讯作者: Balentine CJ