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

Brown, Cynthia J.

doi:10.1111/jgs.16349

Cited by 23 publications

(18 citation statements)

References 13 publications

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“…It appears that walking more than 900 steps per day during hospitalization is critical for the preservation of functioning [ 8 ]. Despite years of research, however, hospital-associated functional decline and mobility limitations remain a common challenge [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients—the WALK-Copenhagen project (WALK-Cph)

Pedersen

Kirk

Olesen

et al. 2022

Pilot Feasibility Stud

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Background Mobility interventions can prevent functional decline among older patients, but implementation of such interventions may be complicated by barriers in the clinical setting. The WALK-Copenhagen project (WALK-Cph) is aimed at promoting a 24-h mobility among older medical patients during hospitalization. The WALK-Cph intervention was co-designed by researchers and stakeholders to tailor the intervention to the clinical context. The aim of this study was to investigate the feasibility and implementation fidelity of the WALK-Cph intervention before evaluating clinical effectiveness in a randomized controlled trial (ClinicalTrials.gov NCT03825497). Methods The WALK-Cph intervention consisted of six components: a welcome folder explaining the importance of in-hospital activity, a WALK-plan prescribing up to three daily walking sessions during and after hospitalization, a WALK-path in the hallway that patients were motivated to use daily, exercise posters in the hallways and bedrooms, self-service on beverages and clothes, and discharge with a WALK-plan. The present study reports on phase 2 of WALK-Cph and consists of a feasibility and a fidelity component. The study was conducted at the two WALK-Cph intervention departments after the initiation of the WALK-Cph intervention. A cohort of older medical patients (+65) was recruited for the feasibility study to assess recruitment and data collection procedures and the method for assessment of activity. Simultaneously, implementation fidelity was assessed by observing clinical practice and intervention delivery at the intervention departments. Results A feasibility cohort of 48 patients was included. Inclusion was considered feasible with recruitment rates between 62% and 70% of all eligible patients. Also, data collection was conducted without obstacles, and all patients accepted to wear activity monitors. The fidelity observations showed that three of the six intervention components were partially implemented as planned whereas three components were not implemented as planned. Conclusion The WALK-Cph intervention was found feasible, and although the intervention was not implemented with fidelity, the level of fidelity was considered sufficient to continue with further testing of the WALK-Cph intervention in a large-scale trial. Trial registration ClinicalTrials.gov NCT03825497 (retrospectively registered). Protocol PubMed ID (PMID): 29523569.

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Section: Introductionmentioning

confidence: 99%

Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients—the WALK-Copenhagen project (WALK-Cph)

Pedersen

Kirk

Olesen

et al. 2022

Pilot Feasibility Stud

View full text Add to dashboard Cite

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“…In older adults (>65 years), low levels of mobility and excessive bed rest during hospitalization have been linked with decreased independency after discharge, institutionalization, readmission and death [1][2][3][4][5][6][7][8]. As argued in a recent editorial [9], hospital associated disabilities are still common despite three decades of study and knowledge about modifiable factors during hospitalization-e.g., limited mobility. Several studies have reported low levels of mobility in older patients hospitalized for medical illness (henceforth: older medical patients) [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Is Promotion of Mobility in Older Patients Hospitalized for Medical Illness a Physician’s Job?—An Interview Study with Physicians in Denmark

et al. 2020

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: The aim of this study was to identify the most common barriers and facilitators physicians perceive regarding their role in the promotion of mobility in older adults hospitalized for medical illness as part of on an intervention to promote mobility. Twelve physicians at two medical departments were interviewed face-to-face using semi-structed interviews based on the Theoretical Domains Framework. The physicians’ perceived barriers to promoting mobility were: the patients being too ill, the department’s interior does not fit with mobility, a culture of bedrest, mobility not being part their job, lack of time and resources and unwillingness to accept an extra workload. The facilitators for encouraging mobility were enhanced cross-professional cooperation focusing on mobility, physician encouragement of mobility and patient independence in e.g., picking up beverages and clothes. The identified barriers and facilitators reflected both individual and social influences on physicians’ behaviors to achieve increased mobility in hospitalized older medical patients and suggest that targeting multiple levels is necessary to influence physicians’ propensity to promote mobility.

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“…by motivating and providing practical assistance. Despite the increased attention on PA in the last decade [ 92 – 94 ], there seems to be little focus on involving caregivers within the mobilization of older patients. In the intensive care setting, the concept of family involvement in inpatient mobilization is already gaining interest.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review

Dijkstra

Sluis

Jager‐Wittenaar

et al. 2022

Int J Behav Nutr Phys Act

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Background To improve older patients’ physical activity (PA) behavior, it is important to identify facilitators and barriers to enhancing PA in older patients (≥ 65 years) during hospitalization from the perspectives of patients, caregivers, and healthcare professionals (HCPs). Methods In this systematic review, a search of PubMed, CINAHL, PsycINFO, EMBASE, and Web of Science (January 2000–May 2021) was performed, and quantitative, qualitative, and mixed-methods studies were included. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Identified facilitators and barriers were categorized using the social ecological model at the intrapersonal, interpersonal, and institutional levels. Results The 48 included articles identified 230 facilitators and 342 barriers. The main facilitators at the intrapersonal level included: knowledge, awareness, and attitudes; interpersonal level: social support, including encouragement and interdisciplinary collaboration; and institutional level: stimulating physical environment, patient activities and schedules, and PA protocols. The main barriers at the intrapersonal level included: physical health status, having lines or drains, patients’ fear, and HCPs’ safety concerns; interpersonal level: patient-HCP relation and HCPs’ unclear roles; and institutional level: lack of space and resources, including time and equipment. Best evidence synthesis provided moderate level of evidence for three barriers: patients’ unwillingness or refusal to move, patients having symptoms, and patients having lines or drains. No moderate level of evidence was found for facilitators. Conclusion The PA behavior of older adults during hospitalization is multidimensional. Our overview highlights facilitators and barriers on multilevel scale (intrapersonal, interpersonal, and institutional levels) that guides patients, caregivers, HCPs, and researchers in future clinical practice, and intervention development and implementation.

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

Abstract: This editorial comments on the article by https://doi.org/10.1111/jgs.16350. in this issue.

Cited by 23 publications

References 13 publications

Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients—the WALK-Copenhagen project (WALK-Cph)

Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients—the WALK-Copenhagen project (WALK-Cph)

Is Promotion of Mobility in Older Patients Hospitalized for Medical Illness a Physician’s Job?—An Interview Study with Physicians in Denmark

Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review

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