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.

项目概要/摘要患有慢性病的中老年人中有一半的残疾事故通常发生在住院后。级联始于行动障碍，这种疾病影响了美国 3100 万成年人并导致损失的独立性增加了医疗保健的利用率，并提高了出院后的体力活动水平。出院与残疾减少相关；然而，促进和维持健康的前瞻性干预措施目前缺乏体力活动，我们已经成功地尝试了一种使用行为设计的新方法。在出院成人的 12 周干预期间，通过游戏化和社会支持促进身体活动干预措施导致老年人和中年人的体力活动大幅增加。患者（50 至 65 岁）、社交参与度较高且基线步数较低的患者。我们提出的研究将建立在该试点结果的基础上，针对更广泛的因三分之一住院的高危成人人群受体力活动影响的慢性门诊护理敏感病症（高血压、糖尿病和轻度至中度由于在试点研究中发现高社会支持会带来更大的影响，因此我们将添加虚拟健康。指导干预设计，以帮助患者提高支持水平。这项研究的目标是提高。出院后进行体力活动，以减少与急性疾病相关的行动障碍事件，以及以减少急性和急性后护理的使用，我们还将评估这种方法在较长时间内的可持续性。期（6 个月干预，6 个月随访）并定性评估与较高或较低相关的因素为了实现这些目标，我们必须在具有显着民族/种族和社会经济多样性的人群中表现出色。组建了行为经济学、老年病学、护理科学、临床试验和我们将研究这种方法对从 Penn Medicine 出院的患者的新应用。医院并在出院后对其进行 12 个月的跟踪我们将重点关注 4 个具体目标： 1) 评估使用游戏化、社会激励和个性化辅导进行为期 6 个月的干预的有效性年龄 ≥ 50 岁、患有慢性疾病、有残疾风险的成年人的体力活动（主要结果）； 6 个月随访期间体力活动增加的可持续性（次要结果）；3) 评估研究期间体力活动对残疾和急症护理利用的影响（次要结果）； 4) 进行混合方法过程评估，以探索与强或弱反应相关的因素我们的方法与 NIA 的战略重点相一致，即制定有效的干预措施以维持功能。预防或减少残疾，并通过国家努力创建老年友好型卫生系统推广可扩展、可持续且具有成本效益的干预措施。