Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): a multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation

Barbara Liu, Julia E Moore, Ummukulthum Almaawiy, Wai-Hin Chan, Sobia Khan, Joycelyne Ewusie, Jemila S Hamid, Sharon E Straus, MOVE ON Collaboration, Barbara Liu, Julia E Moore, Ummukulthum Almaawiy, Wai-Hin Chan, Sobia Khan, Joycelyne Ewusie, Jemila S Hamid, Sharon E Straus, MOVE ON Collaboration

Abstract

Background: older patients admitted to hospitals are at risk for hospital-acquired morbidity related to immobility. The aim of this study was to implement and evaluate an evidence-based intervention targeting staff to promote early mobilisation in older patients admitted to general medical inpatient units.

Methods: the early mobilisation implementation intervention for staff was multi-component and tailored to local context at 14 academic hospitals in Ontario, Canada. The primary outcome was patient mobilisation. Secondary outcomes included length of stay (LOS), discharge destination, falls and functional status. The targeted patients were aged ≥ 65 years and admitted between January 2012 and December 2013. The intervention was evaluated over three time periods-pre-intervention, during and post-intervention using an interrupted time series design.

Results: in total, 12,490 patients (mean age 80.0 years [standard deviation 8.36]) were included in the overall analysis. An increase in mobilisation was observed post-intervention, where significantly more patients were out of bed daily (intercept difference = 10.56%, 95% CI: [4.94, 16.18]; P < 0.001) post-intervention compared to pre-intervention. Hospital median LOS was significantly shorter during the intervention period (intercept difference = -3.45 days, 95% CI: [-6.67,-0.23], P = 0.0356) compared to pre-intervention. It continued to decrease post-intervention with significantly fewer days in hospital (intercept difference= -6.1, 95% CI: [-11,-1.2]; P = 0.015) in the post-intervention period compared to pre-intervention.

Conclusions: this is a large-scale study evaluating an implementation strategy for early mobilisation in older, general medical inpatients. The positive outcome of this simple intervention on an important functional goal of getting more patients out of bed is a striking success for improving care for hospitalised older patients.

Keywords: acute care hospital; frail; implementation; mobilisation; older people.

© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.

Figures

Figure 1.
Figure 1.
Overall weekly visual audit results for proportion of patients out of bed.
Figure 2.
Figure 2.
Change in length of stay.

References

    1. Gillick MR, Serrell NA, Gillick LS. Adverse consequences of hospitalization in the elderly. Soc Sci Med 1982; 16: 1033–8.
    1. Asher RA. The dangers of going to bed. Br Med J 1947; 2: 967.
    1. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118: 219–23.
    1. Cumming TB, Collier J, Thrift A, Bernhardt J. The effect of very early mobilization after stroke on psychological well-being. J Rehabil Med 2008; 40: 609–14.
    1. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg 2006; 76: 607–11.
    1. Mundy LM, Leet TL, Darst K, Schnitzler MA, Dunagan WC. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest 2003; 124: 883–9.
    1. Chippala P, Sharma R. Effect of very early mobilisation on functional status in patients with acute stroke: a single-blind, randomized controlled trail. Clin Rehabil 2016; 30: 669–75.
    1. Schweickert WD, Pohlman MC, Pohlman AS et al. . Early physical and occupational therapy in mechanically ventilated critically ill patients: a randomized controlled trial. Lancet 2009; 373: 1874–82.
    1. Fisher SR, Kuo YF, Graham JE, Ottenbacher KJ, Ostir GV. Early ambulation and length of stay in older adults hospitalized for acute illness. Arch Intern Med 2010; 170: 1942–3.
    1. Chandrasekaran S, Ariaretnam SK, Tsung J, Dickison D. Early mobilization after total knee replacement reduces the incidence of deep venous thrombosis. ANZ J Surg 2009; 79: 526–9.
    1. Greening NJ, Williams JE, Hussain SF et al. . An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ 2014; 349: g4315.
    1. Bernhardt J, Langhorne P, Lindley RI et al. . Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 2015; 386: 46–55.
    1. Schaller SJ, Anstey M, Blobner M et al. . Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388: 1377–88.
    1. Brown CJ, Foley KT, Lowman JD Jr 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: 921–7.
    1. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc 2009; 57: 1660–5.
    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 2004; 25: 212–7.
    1. Ettinger WH. Can hospitalization-associated disability be prevented? JAMA 2011; 306: 1800–1.
    1. Ogrinc G, Mooney SE, Estrada C et al. . The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care 2008; 17(Suppl 1):i13–32.
    1. Hoffmann TC, Glasziou PP, Boutron I et al. . Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Br Med J 2014; 348: g1687.
    1. Graham ID, Logan J, Harrison MB et al. . Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006; 26: 13–24.
    1. Liu B, Almaawiy U, Moore JE, Chan WH, Straus SE. MOVE ON Team Evaluation of a multisite educational intervention to improve mobilization of older patients in hospital: protocol for mobilization of vulnerable elders in Ontario (MOVE ON). Implement Sci 2013; 3: 76–83.
    1. Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G. A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility. Stroke 2008; 39: 390–6.
    1. Moore JE, Mascarenhas A, Marquez C et al. . MOVE ON Team 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.
    1. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002; 27: 299–309.
    1. Durbin J. Testing for serial correlation in least-squares regressions when some of the regressors are lagged dependent variables. Econometrica 1970; 38: 410–21.
    1. Cochrane D, Orcutt G. Application of least squares regression to relationships containing auto correlated error terms. J Am Stat Assoc 1949; 44: 32–61.
    1. R Core Team R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2013.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009; 4: 50.
    1. Baker R, Camosso-Stefinovic J, Gillies C et al. . Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2015; (4): CD005470.
    1. Reisinger HS, Yin J, Radonovich L et al. . Comprehensive survey of hand hygiene measurement and improvement practices in the Veterans Health Administration. Am J Infect Control 2013; 41: 989–93.
    1. Oliver D. Prevention of falls in hospital inpatients: agendas for research and practice. Age Ageing 2004; 33: 328–30.

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