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

Britt Stævnsbo Pedersen, Jeanette Wassar Kirk, Maren Kathrine Olesen, Birk Mygind Grønfeldt, Nina Thórný Stefánsdóttir, Rasmus Brødsgaard, Tine Tjørnhøj-Thomsen, Per Nilsen, Ove Andersen, Thomas Bandholm, Mette Merete Pedersen, Britt Stævnsbo Pedersen, Jeanette Wassar Kirk, Maren Kathrine Olesen, Birk Mygind Grønfeldt, Nina Thórný Stefánsdóttir, Rasmus Brødsgaard, Tine Tjørnhøj-Thomsen, Per Nilsen, Ove Andersen, Thomas Bandholm, Mette Merete Pedersen

Abstract

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.

Keywords: Accelerometers; Co-design; Feasibility and fidelity; Implementation; Mobility; Older medical patients.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow of patients in a feasibility cohort

References

    1. Pedersen MM, Bodilsen AC, Petersen J, Beyer N, Andersen O, Lawson-Smith L, et al. Twenty-four-hour mobility during acute hospitalization in older medical patients. J Gerontol A Biol Sci Med Sci. 2013;68:331–337. doi: 10.1093/gerona/gls165.
    1. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004;52:1263–1270. doi: 10.1111/j.1532-5415.2004.52354.x.
    1. Callen BL, Mahoney JE, Grieves CB, Wells TJ, Enloe M. Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatr Nurs N Y N. 2004;25:212–217. doi: 10.1016/j.gerinurse.2004.06.016.
    1. Brown CJ, Roth DL, Allman RM. Validation of use of wireless monitors to measure levels of mobility during hospitalization. J Rehabil Res Dev. 2008;45:551–558. doi: 10.1682/JRRD.2007.06.0086.
    1. Zisberg A, Shadmi E, Sinoff G, Gur-Yaish N, Srulovici E, Admi H. Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011;59:266–273. doi: 10.1111/j.1532-5415.2010.03276.x.
    1. Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008;56:2171–2179. doi: 10.1111/j.1532-5415.2008.02023.x.
    1. Loyd C, Markland AD, Zhang Y, Fowler M, Harper S, Wright NC, et al. Prevalence of hospital-associated disability in older adults: a meta-analysis. J Am Med Dir Assoc. 2020;21:455–461. doi: 10.1016/j.jamda.2019.09.015.
    1. Agmon M, Zisberg A, Gil E, Rand D, Gur-Yaish N, Azriel M. Association between 900 steps a day and functional decline in older hospitalized patients. JAMA Intern Med. 2017;177:272–274. doi: 10.1001/jamainternmed.2016.7266.
    1. Brown CJ. After three decades of study, hospital-associated disability remains a common problem. J Am Geriatr Soc. 2020;68:465–466. doi: 10.1111/jgs.16349.
    1. Dharmarajan K, Han L, Gahbauer EA, Leo-Summers LS, Gill TM. Disability and recovery after hospitalization for medical illness among community-living older persons: a prospective cohort study. J Am Geriatr Soc. 2020;68:486–495. doi: 10.1111/jgs.16350.
    1. Hastings S, Choate A, Mahanna E, Floegel T, Allen K, Van Houtven C, et al. Early mobility in the hospital: lessons learned from the STRIDE program. Geriatrics. 2018;3:61. doi: 10.3390/geriatrics3040061.
    1. Cohen Y, Zisberg A, Chayat Y, Gur-Yaish N, Gil E, Levin C, et al. Walking for better outcomes and recovery: the effect of WALK-FOR in preventing hospital-associated functional decline among older adults. J Gerontol A Biol Sci Med Sci. 2019;74:1664–1670. doi: 10.1093/gerona/glz025.
    1. Resnick B, Boltz M. Optimizing function and physical activity in hospitalized older adults to prevent functional decline and falls. Clin Geriatr Med. 2019;35:237–251. doi: 10.1016/j.cger.2019.01.003.
    1. Brown CJ, Foley KT, Lowman JD, MacLennan PA, Razjouyan J, Najafi B, et al. Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients: a randomized clinical trial. JAMA Intern Med. 2016;176:921. doi: 10.1001/jamainternmed.2016.1870.
    1. McKelvie S, Hall AM, Richmond HR, Finnegan S, Lasserson D. Improving the rehabilitation of older people after emergency hospital admission. Maturitas. 2018;111:20–30. doi: 10.1016/j.maturitas.2018.02.011.
    1. Kirk JW, Bodilsen AC, Sivertsen DM, Husted RS, Nilsen P, Tjørnhøj-Thomsen T. Disentangling the complexity of mobility of older medical patients in routine practice: an ethnographic study in Denmark. PLoS One. 2019;14:e0214271. doi: 10.1371/journal.pone.0214271.
    1. Koorts H, Eakin E, Estabrooks P, Timperio A, Salmon J, Bauman A. Implementation and scale up of population physical activity interventions for clinical and community settings: the PRACTIS guide. Int J Behav Nutr Phys Act. 2018;15:51. doi: 10.1186/s12966-018-0678-0.
    1. Brown CJ, Williams BR, Woodby LL, Davis LL, Allman RM. Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians. J Hosp Med. 2007;2:305–313. doi: 10.1002/jhm.209.
    1. Boltz M, Capezuti E, Shabbat N. Nursing staff perceptions of physical function in hospitalized older adults. Appl Nurs Res. 2011;24:215–222. doi: 10.1016/j.apnr.2010.01.001.
    1. Doherty-King B, Bowers B. How nurses decide to ambulate hospitalized older adults: development of a conceptual model. Gerontologist. 2011;51:786–797. doi: 10.1093/geront/gnr044.
    1. Koenders N, van Oorsouw R, Seeger JPH, Nijhuis–van der Sanden MW, van de Glind I, Hoogeboom TJ. “I’m not going to walk, just for the sake of walking…”: a qualitative, phenomenological study on physical activity during hospital stay. Disabil Rehabil. 2018;2018:1–8.
    1. Pedersen MM, Brødsgaard R, Nilsen P, Kirk JW. Is promotion of mobility in older patients hospitalized for medical illness a physician’s job? An interview study with physicians in Denmark. Geriatrics. 2020;5:74. doi: 10.3390/geriatrics5040074.
    1. Camden C, Shikako-Thomas K, Nguyen T, Graham E, Thomas A, Sprung J, et al. Engaging stakeholders in rehabilitation research: a scoping review of strategies used in partnerships and evaluation of impacts. Disabil Rehabil. 2015;37:1390–1400. doi: 10.3109/09638288.2014.963705.
    1. Glasgow RE, Emmons KM. How can we increase translation of research into practice? Types of evidence needed. Annu Rev Public Health. 2007;28:413–433. doi: 10.1146/annurev.publhealth.28.021406.144145.
    1. Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to address determinants of practice. Cochrane Database Syst Rev. 2015;4:CD005470.
    1. Zisberg A, Agmon M, Gur-Yaish N, Rand D, Hayat Y, et al. No one size fits all—the development of a theory-driven intervention to increase in-hospital mobility: the “WALK-FOR” study. BMC Geriatr. 2018;18:91. doi: 10.1186/s12877-018-0778-3.
    1. Moore JE, Mascarenhas A, Marquez C, Almaawiy U, Chan W-H, et al. Mapping barriers and intervention activities to behaviour change theory for Mobilization of Vulnerable Elders in Ontario (MOVE ON), a multi-site implementation intervention in acute care hospitals. Implement Sci. 2014;9:160. doi: 10.1186/s13012-014-0160-6.
    1. Koenders N, Potkamp-Kloppers S, Geurts Y, Akkermans R, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Ban Bedcentricity: a multifaceted innovation to reduce sedentary behavior of patients during the hospital stay. Phys Ther. 2021;101(7):pzab054. doi: 10.1093/ptj/pzab054.
    1. Quested E, Ntoumanis N, Thøgersen-Ntoumani C, Hagger MS, Hancox JE. Evaluating quality of implementation in physical activity interventions based on theories of motivation: current challenges and future directions. Int Rev Sport Exerc Psychol. 2017;10:252–269. doi: 10.1080/1750984X.2016.1217342.
    1. Craig P, Dieppe P, Macintyre S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: new guidance. London: Miedical Research Council; 2019.
    1. Fisher R, Smith K, Finney S, Pinder K. The importance of implementation fidelity data for evaluating program effectiveness. Campus. 2014;19:28–32. doi: 10.1002/abc.21171.
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. 10.1136/bmj.a1655. Published 29 September 2008.
    1. Sanders EB-N, Stappers PJ. Co-creation and the new landscapes of design. CoDesign. 2008;4:5–18. doi: 10.1080/15710880701875068.
    1. Abbott JH. The distinction between randomized clinical trials (RCTs) and preliminary feasibility and pilot studies: what they are and are not. J Orthop Sports Phys Ther. 2014;44:555–558. doi: 10.2519/jospt.2014.0110.
    1. Dusenbury L, Brannigan R, Falco M, Hansen WB. A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Educ Res. 2003;18:237–256. doi: 10.1093/her/18.2.237.
    1. Kirk JW, Bodilsen AC, Tjørnhøj-Thomsen T, Pedersen MM, Bandholm T, Husted RS, et al. A tailored strategy for designing the Walk-Copenhagen (WALK-Cph) intervention to increase mobility in hospitalised older medical patients: a protocol for the qualitative part of the WALK-Cph project. BMJ Open. 2018;8:e020272. doi: 10.1136/bmjopen-2017-020272.
    1. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50:217–226. doi: 10.1097/MLR.0b013e3182408812.
    1. Landes SJ, McBain SA, Curran GM. An introduction to effectiveness-implementation hybrid designs. Psychiatry Res. 2019;280:112513. doi: 10.1016/j.psychres.2019.112513.
    1. Arain M, Campbell MJ, Cooper CL, Lancaster GA. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol. 2010;10:67. doi: 10.1186/1471-2288-10-67.
    1. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. Am J Prev Med. 2009;36:452–457. doi: 10.1016/j.amepre.2009.02.002.
    1. Pedersen MM, Petersen J, Bean JF, Damkjaer L, Juul-Larsen HG, Andersen O, et al. Feasibility of progressive sit-to-stand training among older hospitalized patients. PeerJ. 2015;3:e1500. doi: 10.7717/peerj.1500.
    1. Grimby G, Börjesson M, Jonsdottir IH, Schnohr P, Thelle DS, Saltin B. The “Saltin-Grimby Physical Activity Level Scale” and its application to health research. Scand J Med Sci Sports. 2015;25(Suppl 4):119–125. doi: 10.1111/sms.12611.
    1. Schnohr P, Scharling H, Jensen JS. Changes in leisure-time physical activity and risk of death: an observational study of 7,000 men and women. Am J Epidemiol. 2003;158:639–644. doi: 10.1093/aje/kwg207.
    1. Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation. 1968;38:1104–1115. doi: 10.1161/01.CIR.38.6.1104.
    1. De Morton NA, Davidson M, Keating JL. The de Morton Mobility Index (DEMMI): an essential health index for an ageing world. Health Qual Life Outcomes. 2008;6:63. doi: 10.1186/1477-7525-6-63.
    1. De Morton NA, Lane K. Validity and reliability of the de Morton Mobility Index in the subacute hospital setting in a geriatric evaluation and management population. J Rehabil Med. 2010;42:956–961. doi: 10.2340/16501977-0626.
    1. Pedersen MM, Kjær-Sørensen P, Midtgaard J, Brown CJ, Bodilsen AC. A Danish version of the life-space assessment (LSA-DK) - translation, content validity and cultural adaptation using cognitive interviewing in older mobility limited adults. BMC Geriatr. 2019;19:312. doi: 10.1186/s12877-019-1347-0.
    1. Baker PS, Bodner EV, Allman RM. Measuring life-space mobility in community-dwelling older adults. J Am Geriatr Soc. 2003;51:1610–1614. doi: 10.1046/j.1532-5415.2003.51512.x.
    1. Peel C, Sawyer Baker P, Roth DL, Brown CJ, Brodner EV, Allman RM. Assessing mobility in older adults: the UAB Study of Aging Life-Space Assessment. Phys Ther. 2005;85:1008–1119. doi: 10.1093/ptj/85.10.1008.
    1. Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud. 1988;10:64–67. doi: 10.3109/09638288809164105.
    1. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry. 1983;140:734–739. doi: 10.1176/ajp.140.6.734.
    1. Taraldsen K, Askim T, Sletvold O, Einarsen EK, Grüner Bjåstad K, Indredavik B, et al. Evaluation of a body-worn sensor system to measure physical activity in older people with impaired function. Phys Ther. 2011;91:277–285. doi: 10.2522/ptj.20100159.
    1. Grant PM, Ryan CG, Tigbe WW, Granat MH. The validation of a novel activity monitor in the measurement of posture and motion during everyday activities. Br J Sports Med. 2006;40:992–997. doi: 10.1136/bjsm.2006.030262.
    1. Ryan CG, Grant PM, Tigbe WW, Granat MH. The validity and reliability of a novel activity monitor as a measure of walking. Br J Sports Med. 2006;40:779–784. doi: 10.1136/bjsm.2006.027276.
    1. Grant PM, Dall PM, Mitchell SL, Granat MH. Activity-monitor accuracy in measuring step number and cadence in community-dwelling older adults. J Aging Phys Act. 2008;16:201–214. doi: 10.1123/japa.16.2.201.
    1. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005;4:287–291. doi: 10.1002/pst.185.
    1. Lancaster GA, Thabane L. Guidelines for reporting non-randomised pilot and feasibility studies. Pilot Feasibility Stud. 2019;5:114. doi: 10.1186/s40814-019-0499-1.
    1. Kirk JW, Haines E. Ethnography. In: Handbook on implementation science. Northampton: Edward Elgar Publishing. 2020. p. 480–7.
    1. Hammersley M, Atkinson P. Ethnography: principles in practice. 2. London and New York: Routledge; 1995.
    1. Tjørnhøj-Thomsen T, Reynolds Whyte S. Fieldwork and partipant observation. In: Research methods in public health. Copenhagen: Gyldendal Akademisk; 2008. p. 298.
    1. Hasson H, Blomberg S, Dunér A. Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care. Implement Sci. 2012;7:23. doi: 10.1186/1748-5908-7-23.
    1. Hasson H. Systematic evaluation of implementation fidelity of complex interventions in health and social care. Implement Sci. 2010;5:67. doi: 10.1186/1748-5908-5-67.
    1. Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007;2:40. doi: 10.1186/1748-5908-2-40.
    1. Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014;41:545–547. doi: 10.1188/14.ONF.545-547.
    1. Linstone HA, Turoff M. The delphi method: techniques and applications. 2002nd edition: Murray Turoff and Harold Linstone; 2002. . Accessed 17 Mar 2021
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–1327. doi: 10.2105/AJPH.89.9.1322.
    1. Baldwin CE, Phillips AC, Edney SM, Lewis LK. Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study. Int J Behav Nutr Phys Act. 2020;17:69. doi: 10.1186/s12966-020-00970-3.
    1. Smart DA, Dermody G, Coronado ME, Wilson M. Mobility programs for the hospitalized older adult: a scoping review. Gerontol Geriatr Med. 2018;4:2333721418808146. doi: 10.1177/2333721418808146.
    1. Stutzbach J, Jones J, Taber A, Recicar J, Burke RE, Stevens-Lapsley J. Systems approach is needed for in-hospital mobility: a qualitative metasynthesis of patient and clinician perspectives. Arch Phys Med Rehabil. 2021;102(5):984–98.
    1. Birken S, Clary A, Tabriz AA, Turner K, Meza R, Zizzi A, et al. Middle managers’ role in implementing evidence-based practices in healthcare: a systematic review. Implement Sci. 2018;13:149. doi: 10.1186/s13012-018-0843-5.
    1. Rogers E. Diffusion of innovations. 5. New York: Free Press; 2003.
    1. Dearing JW, Cox JG. Diffusion of innovations theory, principles, and practice. Health Aff Proj Hope. 2018;37:183–190. doi: 10.1377/hlthaff.2017.1104.
    1. Berwick DM. Disseminating innovations in health care. JAMA. 2003;289:1969–1975. doi: 10.1001/jama.289.15.1969.
    1. Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, et al. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet Lond Engl. 2008;371:725–735. doi: 10.1016/S0140-6736(08)60342-6.
    1. Escoffery C, Lebow-Skelley E, Haardoerfer R, Boing E, Udelson H, Wood R, et al. A systematic review of adaptations of evidence-based public health interventions globally. Implement Sci. 2018;13:125. doi: 10.1186/s13012-018-0815-9.
    1. Chen EK, Reid MC, Parker SJ, Pillemer K. Tailoring evidence-based interventions for new populations: a method for program adaptation through community engagement. Eval Health Prof. 2013;36:73–92. doi: 10.1177/0163278712442536.
    1. Boyd H, McKernon S, Mullin B, Old A. Improving healthcare through the use of co-design. N Z Med J. 2012;125:12.
    1. Coetsee L. From resistance to commitment. Public Adm Q. 1999;23:204–222.
    1. Benjamin K, Edwards NC, Bharti VK. Attitudinal, perceptual, and normative beliefs influencing the exercise decisions of community-dwelling physically frail seniors. J Aging Phys Act. 2005;13:276–293. doi: 10.1123/japa.13.3.276.
    1. Schutzer KA, Graves BS. Barriers and motivations to exercise in older adults. Prev Med. 2004;39:1056–1061. doi: 10.1016/j.ypmed.2004.04.003.
    1. Balde A, Figueras J, Hawking DA, Miller JR. Physician advice to the elderly about physical activity. J Aging Phys Act. 2003;11:90–97. doi: 10.1123/japa.11.1.90.
    1. Schofield G, Croteau K, McLean G. Trust levels of physical activity information sources: a population study. Health Promot J Austr. 2005;16:221–224. doi: 10.1071/HE05221.
    1. House S, Havens D. Nurses’ and physicians’ perceptions of nurse-physician collaboration: a systematic review. J Nurs Adm. 2017;47:165–171. doi: 10.1097/NNA.0000000000000460.
    1. Casanova J, Day K, Dorpat D, Hendricks B, Theis L, Wiesman S. Nurse-physician work relations and role expectations. J Nurs Adm. 2007;37:68–70. doi: 10.1097/00005110-200702000-00007.
    1. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629. doi: 10.1111/j.0887-378X.2004.00325.x.
    1. Pedersen MM, Petersen J, Beyer N, Larsen HG-J, Jensen PS, Andersen O, et al. A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial. Trials. 2019;20(1):655. doi: 10.1186/s13063-019-3720-x.
    1. Tracy SJ. Qualitative quality: eight “big-tent” criteria for excellent qualitative research. Qual Inq. 2010;16:837–851. doi: 10.1177/1077800410383121.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner