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）： 有强有力的证据表明，老年人的残疾很大程度上是由导致住院的疾病和伤害造成的。数据显示，住院后出现新的残疾或残疾恶化的可能性以及残疾康复的可能性大大降低。研究表明，即使在控制了疾病严重程度和合并症之后，流动性低下仍与不良后果相关，包括日常生活活动（ADL）下降、疗养院安置和死亡。通常测量然而，在我们由 VA 资助的研究中，我们向患者展示了接受院内活动干预的患者，其中包括每天两次的步行辅助以及解决活动障碍的行为策略、设定活动目标。 ，并鼓励患者步行，与常规护理相比，出院后一个月的社区活动能力具有临床显着更高的水平。这项初步工作仅限于对 65 岁以上退伍军人进行一个月的随访。我们的工作中仍然存在一些重要的差距了解医院流动计划的影响：1) 医院流动计划研究未使用随机对照试验 (RCT) 设计来评估影响；2) 尚未测量参与者的实际步数和行走时间； 3）尚未检查出院后 30 天后的结果；4）尚未确定最有可能从此类干预中受益的患者特征。五个 VA 医院病房比较流动性在年龄≥ 50 岁的退伍军人群体中，我们将检查 MP 和 UC 中的活动能力和不良后果，包括功能下降、入住疗养院、急诊科 (ED) 就诊、住院和死亡。我们的总体假设是，在住院期间提供步行帮助的医院流动计划将减少观察到的与住院相关的活动能力丧失和不良后果。 MP和UC将在整个过程中保持不变该研究项目的主要目的是测试活动计划对于恢复到院前活动状态或更好以及减少不良后果（包括功能下降、急诊就诊、住院、入住疗养院）的有效性。住院后一年内的死亡和死亡；并确定改变活动干预对恢复到院前活动状态或更好的影响的特征，并减少住院后一年内的不良后果 成功的活动干预可以防止活动能力丧失。或加速恢复到院前水平显着影响数千名住院患者的生活质量并减少残疾，这一系列研究有可能改变向所有患者提供的医院护理标准。

项目成果

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

使用局部麻醉而非全身麻醉进行腹股沟疝修补术可缩短手术时间并增强术后恢复。

• 发表时间: 2021-05
• 影响因子: 3
• 作者: Balentine, Courtney J;Meier, Jennie;Berger, Miles;Hogan, Timothy P;Reisch, Joan;Cullum, Munro;Zeh, Herbert;Lee, Simon C;Skinner, Celette Sugg;Brown, Cynthia J
• 通讯作者: Brown, Cynthia J

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

局部麻醉可以减少体弱退伍军人脐疝修复的并发症。

• 发表时间: 2021
• 作者: Meier, Jennie;Berger, Miles;Hogan, Timothy P;Reisch, Joan;Cullum, C Munro;Lee, Simon C;Skinner, Celette Sugg;Zeh, Herbert;Brown, Cynthia J;Balentine, Courtney J
• 通讯作者: Balentine, Courtney J

After Three Decades of Study, Hospital-Associated Disability Remains a Common Problem.

经过三个十年的研究，医院相关残疾仍然是一个常见问题。

• 发表时间: 2020-03
• 影响因子: 6.3
• 作者: Brown; Cynthia J
• 通讯作者: Cynthia J

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

使用局部麻醉进行腹股沟疝气修复可减少老年患者的并发症。

• 发表时间: 2021
• 作者: Balentine, Courtney J;Meier, Jennie;Berger, Miles;Reisch, Joan;Cullum, Munro;Lee, Simon C;Skinner, Celette Sugg;Brown, Cynthia J
• 通讯作者: Brown, Cynthia J