A Randomized Trial of Gamification and Coaching to Improve Mobility after Hospitalization

通过游戏化和辅导提高住院后活动能力的随机试验

基本信息

批准号：
10663961
负责人：
Scott Ryan Greysen
金额：
$ 65.22万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-15 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10663961
关键词：
2 arm randomized control trial Acute Admission activity Adult Affect Age Aging Ambulatory Care American Beds Behavior Behavioral Behavioral Sciences Chronic Chronic Care Clinical Trials Communities Dangerousness Databases Diabetes Mellitus Discipline of Nursing Economics Effectiveness Elderly Emergency department visit Enrollment Ethnic Origin Family Friends Future Geriatrics Goals Habits Health Health system Heart failure Hospitalization Hospitals Hypertension Immobilization Impairment Incentives Individual Intervention Interview Measures Mediating Medical Medicine Methods Observational Study Patient Discharge Patients Performance Physical activity Pilot Projects Population Populations at Risk Psychology Race Randomized Recovery Risk Sampling Science Social Network Social support Surveys Testing Time United States Walking Work acute care behavioral economics care costs clinical implementation cohort comparison control coronavirus disease cost cost effective intervention design disability disability risk effective intervention effectiveness evaluation experience follow-up health care service utilization hospital readmission human old age (65+)imprint improved improved mobility innovation intervention participants middle age mortality multidisciplinary novel novel strategies patient engagement physically handicapped prevent primary outcome process evaluation prospective public health relevance randomized trial remote monitoring response secondary outcome social social engagement socioeconomic diversity success therapy design treatment arm virtual health wearable device

项目摘要

PROJECT SUMMARY / ABSTRACT Half of incident disability in older and middle-aged, adults with chronic conditions occurs after hospitalization. Often this cascade begins with mobility disability, a condition which affects 31 million adults in the United States and leads to loss of independence, increased health care utilization, and earlier mortality. Higher levels of physical activity after hospital discharge are associated with reduced disability; however, prospective interventions to promote and sustain healthy physical activity are currently lacking. We have successfully piloted a novel approach using behaviorally designed gamification and social support for physical activity promotion during a 12-week intervention among adults discharged from the hospital (N=232). The intervention led to larger increases in physical activity among older and middle-aged patients (age 50 to 65), those with higher social engagement, and lower baseline step counts. Our proposed study will build on results of this pilot to target a broader population of at-risk adults hospitalized for 1 of 3 chronic Ambulatory Care Sensitive Conditions affected by physical activity (hypertension, diabetes, and mild-moderate heart failure). Since high social support was found to lead to larger effects in the pilot study, we will add a virtual health coach to the intervention design to help patients increase their support levels. The goals are of this study are to increase physical activity after discharge from the hospital to reduce incident mobility disability associated with acute illness and to reduce acute and post-acute care utilization. We will also evaluate the sustainability of this approach over a longer period (6 months intervention, 6 months follow up) and qualitatively assess factors associated with higher or lower performance in a population with significant ethnic/racial and socioeconomic diversity. To achieve these goals, we have assembled an expert multidisciplinary team in behavioral economics, geriatrics, nursing science, clinical trials and implementation. We will study the novel application of this approach to patients who are discharged from Penn Medicine hospitals and follow them for 12 months after discharge. We will focus on 4 specific aims: 1) To evaluate the effectiveness of a 6-month intervention using gamification with social incentives and personalized coaching to increase physical activity among adults age ≥ 50 with chronic conditions at risk for disability (primary outcome); 2) To evaluate the sustainability of increased physical activity during a 6-month follow-up period (secondary outcome); 3) To evaluate the impact of physical activity on disability and acute care utilization during the study period (secondary outcomes); and 4) To conduct a mixed-methods process evaluation to explore factors associated with strong or poor response to the interventions. Our approach aligns with NIA's strategic priority to develop effective interventions to maintain function and prevent or reduce disability and also with national efforts to create an Aging Friendly Health System through the spread of scalable, sustainable, and cost-effective interventions.

项目摘要 /摘要在住院后，有一半的老年人和中年的事件残疾发生。经常这样做级联始于流动性残疾，这种情况影响了美国的3100万成年人，并导致损失独立款待，医疗保健利用率的增加以及更早的死亡率后，体育锻炼的水平较高。排放与残疾减少有关；但是，促进和维持健康的预期干预措施目前缺乏体育锻炼。我们已经成功地使用了行为设计的新方法在成年人的12周干预期间，游戏化和社会支持促进体育锻炼来自医院（n = 232）。干预措施导致较老的和中年的体育锻炼增加患者（50至65岁），社交参与度较高的患者和较低的基线步骤计数。我们拟议的研究将基于该飞行员的结果，以针对更广泛的高危成年人住院的人口。受体育锻炼影响（高血压，糖尿病和轻度 - 中度的慢性门诊护理敏感条件心脏衰竭）。由于发现高度的社会支持会在试点研究中产生更大的影响，因此我们将增加虚拟健康教练干预设计，以帮助患者提高支持水平。这项研究的目标是增加从医院出院后的身体活动，以减少与急性疾病相关的事件流动性残疾和减少急性和急性后护理利用。我们还将评估这种方法的可持续性周期（6个月干预，6个月的随访），并定性评估与较高或更低有关的因素在人群中的表现，具有重大的种族/种族和社会经济多样性。为了实现这些目标，我们有在行为经济学，老年医学，护士科学，临床试验和执行。我们将研究这种方法对从Penn Medicine出院的患者的新应用医院并在出院后12个月关注它们。我们将重点关注4个特定目标：1）评估使用游戏化和社会激励措施和个性化教练进行6个月干预的有效性年龄≥50岁的成年人的体育锻炼患有残疾风险（主要结果）； 2）评估在6个月的随访期内，体育锻炼增加的可持续性（次要结果）； 3）评估体育锻炼对研究期间残疾和急性护理利用的影响（次要结果）；和 4）进行混合方法的过程评估，以探索与反应强或不良反应相关的因素干预措施。我们的方法与NIA的战略优先事项保持一致，以制定有效的干预措施以维持功能并防止或减少残疾，以及国家通过国家建立老龄化友好卫生系统的努力可扩展，可持续和具有成本效益的干预措施的传播。