Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities

Abstract

BackgroundAlmost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities.Methods/DesignThis longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer's Disease.DiscussionThere are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population.Trial RegistrationThis clinical trial is registered with ClinicalTrials.gov (trial registration number: NCT01474616).

The association between cognition and gait in a representative sample of very old people – the influence of dementia and walking aid use

“…Mobility limitations become more prevalent with age, and have been reported to approach 90% in some nursing home settings [25,26], which may subsequently impact ability to perform a gait speed test. One previous study of very old people showed that the ability to perform the gait speed test declined with age in women, with more than half of the female participants aged 95 years or older missing a gait speed value [27].…”

Knowledge translation interventions to sustain direct care provider behaviour change in long‐term care: A process evaluation

“…This mixed methods process evaluation was part of the Mobility of Vulnerable Elders (MOVE) clinical trial in which HCAs encouraged LTC residents to complete a simple sit-to-stand activity. 8,9 Knowledge translation interventions were used during this trial to promote the sustainability of the sit-to-stand activity and improve its documentation by HCAs. This process evaluation included interviews, focus groups and a ranking exercise to elicit perceptions of HCAs and facility leaders about the effectiveness and ease of implementation of those KT interventions.…”

Neuroimaging Assessment of Spasticity Developed after Acquired Brain Injuries and Multiple Sclerosis

“…Public health authorities and professional bodies have taken initiatives to develop various outcomes tools to evaluate neurorehabilitation services 8,9 , but there is a less obvious tendency to study the radiological features of the lesions leading to spasticity as they tend to be for more specific entities such as acute stroke 10 which -ideally-should be highlighted during or near admission time to expedite neurorehabilitation assessment and early implementation of treatment to improve outcome, decrease morbidity and length of stay aiming to improve post admission quality of life 11 .…”