AMP Step Wedge Trial (AMP SWT)

Activity and Mobility Promotion (AMP): Implementation and Impact of a Multifaceted Intervention to Increase Mobility in Hospital Patients

Annually, more than 35 million patients are hospitalized in the United States. Many of these will experience hospital-acquired loss of physical functioning due to a lack of mobility during their in-patient stay. Such loss includes difficulties performing basic activities, such as rising from a chair, toileting, or ambulating. This loss of function may increase hospital length of stay (LOS), nursing home placement, and decrease mobility and participation in community activities even years after hospitalization. Prevention of this hospital-acquired functional loss is critical. Even the sickest hospitalized patients (e.g., those in the intensive care unit [ICU]), can safely and feasibly benefit from early mobilization. In the non-ICU setting there is evidence that patient mobilization reduces LOS and hospital costs, while improving patient satisfaction and physical and psychological outcomes. The overall objective of this proposed project is to evaluate the implementation and impact of a transdisciplinary and multifaceted mobility program (Johns Hopkins Activity and Mobility Promotion - AMP) on clinical outcomes among hospitalized adults. In addition to clinical outcomes, we will identify barriers and facilitators to high-performance program adoption. Results of this project will provide critical new insights on the effectiveness of AMP and inform dissemination and implementation nationwide.

Study Overview

• Status: Completed
• Conditions: Disability; Immobility
• Intervention / Treatment: Other: AMP Implementation

• Study Type: Interventional
• Enrollment (Actual): 16676
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21287
      • Johns Hopkins Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• All adult patients admitted to study hospital unit
• Analysis will only include those with lengths of stay >=3 days

Exclusion Criteria:

• Patients with active do-not-resuscitate (DNR) order
• <18 years old

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: AMP Implementation

Other: AMP Implementation; Each study site will implement the Johns Hopkins AMP program at different times. The AMP program includes nursing staff training on the goals of AMP, how to complete mobility-focused outcome measures, set mobility goals, and to safely mobilize/ambulate patients. The AMP program also includes embedding these outcome measures and mobility goals into electronic medical records and producing weekly/monthly reports that show how often nursing staff score patient mobility and help patients meet daily activity goals.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
% of patients meeting daily mobility goal	Mobility goal is set and measured using the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale	39 months
% of patients with mobility measurements documented daily	Mobility documentation to include Activity Measure for Post-Acute Care (AM-PAC) and JH-HLM	39 months
% of patients receiving physical and/or occupational therapy consults	To be extracted from electronic medical record	39 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospital length of stay (days)	To be extracted from electronic medical record	39 months
Discharge disposition status	Count of where patients are discharged to (e.g,. home, inpatient rehab unit) assessed by extraction from electronic medical record.	39 months
Number of physical and occupational therapy visits received during inpatient stay	To be extracted from electronic medical record	39 months
Number of hospital-acquired morbidities	Includes falls, pressure injury, and venous thromboembolism. To be extracted from electronic medical record	39 months
Number of patients with 30-day readmissions	To be extracted from electronic medical record	39 months
Employee injuries resulting from patient mobilization	Number of employee injuries from facilitating patient mobility as assessed by medical record extraction	39 months

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Investigators: Principal Investigator: Sapna Kudchadkar, MD, Johns Hopkins University; Principal Investigator: Erik Hoyer, PhD, Johns Hopkins University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2021
• Primary Completion (Actual): April 1, 2024
• Study Completion (Actual): April 1, 2024

Study Registration Dates

• First Submitted: August 16, 2021
• First Submitted That Met QC Criteria: August 24, 2021
• First Posted (Actual): August 25, 2021

Study Record Updates

• Last Update Posted (Actual): April 25, 2024
• Last Update Submitted That Met QC Criteria: April 23, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Mobility; Activity; Hospital-acquired disability
• Other Study ID Numbers: IRB00270215

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No