Improving Patient Walking During Hospitalization

Preventing Hospital-Acquired Disability: An Intervention to Improve Older Adult Patient Ambulation

The MOVIN (Mobilizing Older adult patients Via a systems-based Intervention) randomized controlled trial is designed to evaluate the impact of the MOVIN intervention on improving the functional ability of older adult hospital patients and reducing their healthcare utilization post-hospitalization. MOVIN is a program to increase patient ambulation while hospitalized. The study's hypothesis is that MOVIN will improve functional outcomes for hospitalized older adult patients by producing a change in nursing practice and culture of ambulation on inpatient units. MOVIN is a unit-based intervention. Therefore all patients on this unit are exposed to the intervention once it is implemented regardless of whether or not they participate in the trial. The study will enroll 360-420 total hospitalized participants 65 years and older for the duration of their stay. It will also enroll any nurses 18 years and older who worked on the units during the study and are willing to fill out surveys.

Study Overview

• Status: Completed
• Conditions: Older Adults; Hospital Acquired Condition; Early Mobility
• Intervention / Treatment: Other: MOVIN; Other: Surveys and Focus groups

Detailed Description

Up to 65% of hospitalized older adults will lose the ability to ambulate independently during their hospital stay. Loss of independent ambulation has been identified as a hospital-acquired disability and is a critical patient safety concern, resulting in permanent loss of function for 50% of older adults one-year post discharge. Functional loss is associated with multiple negative outcomes including a 33% increase in new nursing home placement, increase in length of hospital stay, need for home health services, falls, caregiver burden, decreased quality of life, and increased mortality. Given the rapid increase in the elderly population, loss of independent ambulation primarily due to the process of care in hospital settings may significantly increase future healthcare costs and further exacerbate concerns related to patient care quality.

Lack of walking during hospitalization has been directly linked to loss of independent ambulation in older adults. Nurses are responsible for promoting and maintaining patient independent mobility. However, the investigators research has identified multiple personal and organizational barriers that prevent nurses from walking patients. The investigators have developed and pilot tested a novel systems based multi-component intervention to improve ambulation of older adult patients, Mobilizing Older adult patients Via a systems-based INtervention (MOVIN).

MOVIN is comprised of five components: 1) psychomotor skills training; 2) communication tools; 3) ambulation pathways; 4) ambulation resources; and 5) unit ambulation culture. The Investigators pilot study of MOVIN demonstrated a statistically significant increase in frequency and weekly distance of patient ambulation as well as changes in nursing practice and unit culture. Notably, these changes have been sustained for greater than two years after completion of the study.

The investigators' goal is to eliminate loss of independent ambulation in hospitalized older adults. In pursuit of this goal, the specific aims are to:

• Specific Aim 1:Test the effectiveness of MOVIN to improve functional ability of older adult patients at discharge, and 1, 3 and 6 months post discharge

• Specific Aim 2: Test the effectiveness of MOVIN to reduce healthcare utilization of older adults at discharge, and 1, 3 and 6 months post discharge

  • 2.A. To analyze a return on investment of MOVIN based on program costs and health utilization measures across different hospitals
• Specific Aim 3: Measure change in nurse behaviors and unit culture and identify ongoing systems barriers that impact translation of MOVIN across inpatient units and different hospitals.

• Study Type: Interventional
• Enrollment (Actual): 765
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Wisconsin
    • Madison, Wisconsin, United States, 53705
      • UW School of Medicine and Public Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• age 65 years or older
• able to walk with or without assistance
• living in the community (not long term care) prior to admission
• have an ambulation order
• admitted to hospital's general adult medical unit
• able to consent
• able to speak and understand English
• at least 24h planned length of stay after initial study enrollment.

Exclusion Criteria:

• activated Power of Attorney
• lower extremity amputation
• on hospice
• bed rest order or activity restriction
• wheelchair bound

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Pre-intervention/control; 160-200 older adult patients (age 65 or older) will be recruited on four units across two hospitals (two units per hospital) over 6-8 months prior to implementation of the unit-based MOVIN intervention.
Experimental: Post-intervention; 160-200 older adult patients (age 65 or older) will be recruited on four units across two hospitals (two units per hospital) over 6-8 months after MOVIN has been implemented on the unit.	Other: MOVIN; MOVIN is a multi-component unit-based intervention comprised of five components that are implemented simultaneously in a hospital unit. The five components are: 1) psychomotor skills training, 2) unit ambulation culture, 3) communication, 4) resources, 5) ambulation environment.
Other: Nurses; Nurses will complete surveys and provide qualitative data to assess barriers to implementation. Nurses will be invited to enroll in the survey/qualitative data arm during both Pre-intervention and Post-intervention phases.	Other: Surveys and Focus groups; Nurses will answer surveys about nurse behavior, changes in self-efficacy, frequency and distance of patient ambulation, documentation of ambulation, qualitative data collected to determine barriers to implementation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Aim 3: Barriers to Ambulation Survey	Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Barriers to Patient Ambulation Survey assesses the nurses opinions regarding ambulation of hospitalized patients within the past 2 weeks. It is scored from 0-100 with higher scores indicating increased barriers to ambulation.	pre-intervention, post-intervention (up to about 20 weeks)
Aim 1: Change in Gait Speed	Gait Speed is a physical performance measure identified as a sensitive clinical indicator of health, mortality, healthcare utilization, and independence in ambulation, and is feasible to test in hospitalized older adults. A 4 meter walk test will be conducted on admission to the study, discharge from the hospital and at 3 months post discharge in the subjects home or the hospital or clinic. A trained member of the research team will conduct the gait speed test. Interrater reliability for the 4 meter walk test will be conducted between all members of the research team prior to collecting gait speed data on study participants. Change scores will be calculated as the difference among gait speeds measured at each time points.	Within 24 hours of hospital admission, Within 8 hours of hospital discharge, 3 months post-discharge; Up to 4 months total
Aim 1: Change in Self-report on Activities of Daily Living (ADL)	A trained member of the research team collected patients self-report of ADLs on admission to the study, discharge from the hospital, by phone at 1 month post intervention and 6 months post intervention, and in person at the 3 month post intervention visit using the Katz ADL Index. The Katz ADL Index is a self-report scale that measures six ADL on two levels (independent or requiring assistance of another). A score of 0-6 is possible, with higher scores indicating higher independence with ADLs and lower scores indicating higher dependence on others to perform ADLs. The scale demonstrates excellent reliability and predictive validity, and is sensitive to change in hospital settings. For the primary analysis, patients with a score of 6 were converted to a binary score of 1=Independent; all others were scored as 0=Dependent.	Within 24 hours of hospital admission, Within 8 hours of hospital discharge, 1 month post-discharge, 3 months post-discharge; 6 months post-discharge
Aim 1: Change in Life Space Assessment	The University of Alabama at Birmingham (UAB) Life Space Assessment (LSA) is a self-report scale of ambulation that measures spaces patients' move in, the frequency of moving into those spaces, and dependency in moving into those spaces. This scale has demonstrated reliability and predictive validity and sensitivity to change after hospital stay. Level scores are calculated by multiplying the life-space level (higher numbers indicate farther distances moved, e.g., 1-inside the home to 5-places outside of the person's town), degree of independence (higher scores indicate greater independence), and frequency of movement (higher scores equal greater frequency). Total scores range from 0 (totally bed-bound) to 120 (moved out of town every day without assistance). A trained member of the research team will collect patients self-report on Life Space. Change scores will be calculated as the difference among LSA ambulation measured at each time point.	Within 24 hours of hospital admission, 1 month post-discharge, 3 months post-discharge; 6 months post-discharge
Aim 2: Hospital Readmissions	Hospital readmissions were collected via patient self-report and via medical record review by a trained researcher from the study team. Patient readmission was coded as 0=not readmitted, 1=readmitted. Reported value for each cell reflects a model-based estimate of the probability of readmission, a type of least squares mean appropriate for a binary variable.	1 month post-discharge; 3 months post-discharge; 6 months post-discharge; Up to 7 months total
Aim 2: Emergency Department Visits	Emergency department (ED) visits will be collected via patient self report. Patient ED usage was coded as 0=no ED visit, 1=any ED visit. Reported value for each cell reflects a model-based estimate of the probability of an ED visit, a type of least squares mean appropriate for a binary variable.	1 month post-discharge; 3 months post-discharge; 6 months post-discharge; Up to 7 months total
Aim 2: Length of Hospital Stay	Length of hospital stay will be collected via patient medical record review by a nurse researcher from the study team.	During hospital stay in the Pre-Intervention and Post-Intervention periods
Aim 2: Discharge Destination	Discharge destination (home, skilled nursing facility) was collected via patient medical record review by a nurse researcher from the study team. Patient discharge destination was coded as 1=discharged to home, 0=discharged to a skilled nursing facility. Reported value for each cell reflects a model-based estimate of the probability of discharge to home, a type of least squares mean appropriate for a binary variable.	Within 3 months post-discharge; Up to 4 months total
Aim 3: Distance of Patient Ambulation	Unit level data on ambulation. Each week, the total distance walked on that unit by all patients on the unit was recorded. We report the average total weekly distance walked, using a model-based least squares mean. The number of participants analyzed is large because this measure is unit-level and includes all patients observed on the unit during the study period, not only those enrolled in the full study, and will double count patients who were observed during more than one week.	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Aim 3: Ambulation Culture Survey	Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Ambulation Culture Survey asks for opinions on ambulation culture. We report responses to the item, "How would you rate your unit/work area on patient care related to ambulation?" This item has a minimum score of 1 (Poor) and a maximum score of 5 (Excellent). Higher values represent a better outcome.	pre-intervention, post-intervention (up to about 20 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Aim 3: Frequency of Patient Ambulation (Percent of Patients Ambulated by Nursing Staff)	Unit-level data on the percent of patients ambulated by nursing staff (as recorded in the electronic health record) out of the total number of ambulatory patients on the unit.	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Aim 3: Nurse Fatigue Survey: Chronic Fatigue Subscale	Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue.	pre-intervention, post-intervention (up to about 20 weeks)
Aim 3: Nurse Fatigue Survey: Acute Fatigue Subscale	Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue.	pre-intervention, post-intervention (up to about 20 weeks)
Aim 3: Nurse Fatigue Survey: Intershift Recovery Subscale	Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue.	pre-intervention, post-intervention (up to about 20 weeks)
Aim 3: Professional Quality of Life Survey: Compassion Satisfaction	Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). The Compassion Satisfaction subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction. Please note that for this subscale, scores were transformed before analysis using a Box-Cox (squared) transformation in order to meet the assumption of normally distributed model residuals; in effect the square-scale score has a range from 100-2500, where higher scores are still better. This results in reported least squares means that are very large compared to the original scale.	pre-intervention, post-intervention (up to about 20 weeks)
Aim 3: Professional Quality of Life Survey: Burnout	Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). There are 3 subscales: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, each subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction, higher burnout, and higher secondary traumatic stress.	pre-intervention, post-intervention (up to about 20 weeks)
Aim 3: Professional Quality of Life Survey: Secondary Traumatic Stress	Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). There are 3 subscales: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, each subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction, higher burnout, and higher secondary traumatic stress.	pre-intervention, post-intervention (up to about 20 weeks)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Aim 3: Qualitative Assessment of Intervention Implementation	Enrolled nursing staff will be interviewed and interviews will be coded for themes. Themes will be summarized to report by participant count.	post-intervention (approximately 3-5 months after active intervention launch)
Aim 2: Physical Therapy (PT) Utilization	Billing data will be used retrospectively to understand use of PT services on the intervention units at pre-intervention, intervention, and post-intervention data collection periods	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Patient Satisfaction: Participant Experience Scores From 1-5 on HCAHPS	The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Participants rank their hospital experience from 1-5, where 5 is the best possible experience.	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Patient Satisfaction: Count of Participants With Responses to Strongly Disagree/Disagree/Agree/Strongly Agree Questions on HCAHPS	The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of Responses to Strongly disagree/Disagree/Agree/Strongly agree to the following questions: During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left When I left the hospital, I had a good understanding of the things I was responsible for in managing my health When I left the hospital, I clearly understood the purpose for taking each of my medications Analysis will include shifts in the distribution of responses across response options, as well as changes in frequency/percentage of top-box responses (responses of "Strongly agree") relative to all responses.	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Patient Satisfaction: Count of Participants With Satisfaction Responses to Definitely no/Probably no/Probably Yes/Definitely Yes to the Following Question: Would You Recommend This Hospital to Your Friends and Family?	The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts With Satisfaction Responses to Definitely no/Probably no/Probably yes/Definitely yes to the following question: Would you recommend this hospital to your friends and family? Analysis will include shifts in the distribution of responses across response options, as well as changes in frequency/percentage of top-box responses (responses of "Definitely Yes") relative to all responses.	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Patient Satisfaction: Hospital Experience Scores From 0-10 on HCAPHS	The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Participants rank their hospital experience from 0-10, where 10 is the best possible hospital.	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Patient Satisfaction: Where Participants Went After Hospitalization	The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of whether they went home, to someone else's home, or another facility after discharge.	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Patient Satisfaction: Count of Participants With Satisfaction Responses to Never, Sometimes, Usually, Always Questions on HCAHPS	Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are Participant Counts to questions with response options: Never, Sometimes, Usually, Always. Analysis will include shifts of distribution across response options and changes in frequency/percentage of top-box responses ("Always") relative to all responses. Questions include: During this hospital stay, how often did nurses treat you with courtesy and respect? how often did nurses listen carefully to you? how often did nurses explain things in a way you could understand? after you pressed the call button, how often did you get help as soon as you wanted it? how often were your room and bathroom kept clean? how often was the area around your room quiet at night? How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total
Patient Satisfaction: Count of Participants Answering Yes to Items on the HCAPHS	The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of those who answered "Yes" to the following Yes or No questions: During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?; During this hospital stay, were you given any medicine that you had not taken before?; During this hospital stay, did doctors, nurses, or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?; During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?; During this hospital stay, were you admitted to this hospital through the Emergency Room?; Were you visited by a member of our nursing leadership team during your stay?	6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total

Collaborators and Investigators

• Sponsor: University of Wisconsin, Madison
• Collaborators: Agency for Healthcare Research and Quality (AHRQ)
• Investigators: Principal Investigator: Linsey M Steege, PhD, University of Wisconsin, Madison

Study record dates

Study Major Dates

• Study Start (Actual): March 2, 2021
• Primary Completion (Actual): January 27, 2025
• Study Completion (Actual): January 27, 2025

Study Registration Dates

• First Submitted: July 14, 2020
• First Submitted That Met QC Criteria: July 16, 2020
• First Posted (Actual): July 21, 2020

Study Record Updates

• Last Update Posted (Actual): March 27, 2026
• Last Update Submitted That Met QC Criteria: March 5, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: walking; hospitalization; aged; nursing care
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Pathological Conditions, Signs and Symptoms; Iatrogenic Disease; Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Surveys and Questionnaires; Focus Groups
• Other Study ID Numbers: 2020-0010; A549000 (Other Identifier: UW Madison); NUR/FACULTY AFFAIRS/ADMIN (Other Identifier: UW Madison); 1R01HS026733-01A1 (U.S. AHRQ Grant/Contract); Protocol Version 08/19/2024 (Other Identifier: UW Madison)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No