The Johns Hopkins Activity and Mobility Promotion Program: A Framework to Increase Activity and Mobility Among Hospitalized Patients

Kevin H McLaughlin, Michael Friedman, Erik H Hoyer, Sapna Kudchadkar, Eleni Flanagan, Lisa Klein, Kelly Daley, Annette Lavezza, Nicole Schechter, Daniel Young, JH-AMP Group, Kevin H McLaughlin, Michael Friedman, Erik H Hoyer, Sapna Kudchadkar, Eleni Flanagan, Lisa Klein, Kelly Daley, Annette Lavezza, Nicole Schechter, Daniel Young, JH-AMP Group

Abstract

Background: Greater mobility and activity among hospitalized patients has been linked to key outcomes, including decreased length of stay, increased odds of home discharge, and fewer hospital-acquired morbidities. Systematic approaches to increasing patient mobility and activity are needed to improve patient outcomes during and following hospitalization.

Problem: While studies have found the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program improves patient mobility and associated outcomes, program details and implementation methods are not published.

Approach: JH-AMP is a systematic approach that includes 8 steps, described in this article: (1) organizational prioritization; (2) systematic measurement and daily mobility goal; (3) barrier mitigation; (4) local interdisciplinary roles; (5) sustainable education and training; (6) workflow integration; (7) data feedback; and (8) promotion and awareness.

Conclusions: Hospitals and health care systems can use this information to guide implementation of JH-AMP at their institutions.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.

References

    1. Freeman WJ, Heslin KC. Overview of U.S. Hospital Stays in 2016: Variation by Geographic Region. Agency for Healthcare Research and Quality; 2016.
    1. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004;52(8):1263–1270. doi:10.1111/j.1532-5415.2004.52354.x
    1. Mudge AM, McRae P, McHugh K, et al. Poor mobility in hospitalized adults of all ages. J Hosp Med. 2016;11(4):289–291. doi:10.1002/jhm.2536
    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(9):1660–1665. doi:10.1111/j.1532-5415.2009.02393.x
    1. Olson EV, Johnson BJ, Thompson LF. The hazards of immobility. 1967. Am J Nurs. 1990;90(3):43–48.
    1. Scharf AC, Gronewold J, Dahlmann C, et al. Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline. BMC Geriatr. 2020;20(1):75. doi:10.1186/s12877-020-1443-1
    1. Young DL, Colantuoni E, Friedman LA, et al. Prediction of disposition within 48-hours of hospital admission using patient mobility scores. J Hosp Med. 2019;14:E1–E4. doi:10.12788/jhm.3332
    1. Wu X, Li Z, Cao J, et al. The association between major complications of immobility during hospitalization and quality of life among bedridden patients: a 3-month prospective multi-center study. PLoS One. 2018;13(10):e0205729. doi:10.1371/journal.pone.0205729
    1. Graf C. Functional decline in hospitalized older adults. Am J Nurs. 2006;106(1):58–67, quiz 67-68. doi:10.1097/00000446-200601000-00032
    1. Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536–542. doi:10.1016/j.apmr.2010.01.002
    1. Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271–281. doi:10.1310/tsr1704-271
    1. Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ. 2008;337:a1714. doi:10.1136/bmj.a1714
    1. Pandullo SM, Spilman SK, Smith JA, et al. Time for critically ill patients to regain mobility after early mobilization in the intensive care unit and transition to a general inpatient floor. J Crit Care. 2015;30(6):1238–1242. doi:10.1016/j.jcrc.2015.08.007
    1. Gustafson OD, Vollam S, Morgan L, Watkinson P. A human factors analysis of missed mobilisation after discharge from intensive care: a competition for care? Physiotherapy. 2021;113:131–137. doi:10.1016/j.physio.2021.03.013
    1. Baldwin CE, Rowlands AV, Fraysse F, Johnston KN. The sedentary behaviour and physical activity patterns of survivors of a critical illness over their acute hospitalisation: an observational study. Aust Crit Care. 2020;33(3):272–280. doi:10.1016/j.aucc.2019.10.006
    1. Gandotra S, Files DC, Shields KL, Berry M, Bakhru RN. Activity levels in survivors of the intensive care unit. Phys Ther. 2021;101(9):pzab135. doi:10.1093/ptj/pzab135
    1. Walsh TS, Salisbury LG, Merriweather JL, et al. Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: the RECOVER randomized clinical trial. JAMA Intern Med. 2015;175(6):901–910. doi:10.1001/jamainternmed.2015.0822
    1. Hoyer EH, Friedman M, Lavezza A, et al. Promoting mobility and reducing length of stay in hospitalized general medicine patients: a quality-improvement project. J Hosp Med. 2016;11(5):341–347. doi:10.1002/jhm.2546
    1. Jette D, Stilphen M, Ranganathan VK, Passek S, Frost FS, Jette AM. Interrater reliability of AM-PAC “6-clicks” basic mobility and daily activity short forms. Phys Ther. 2015;95(5):758–766. doi:10.2522/ptj.20140174
    1. Hiser S, Chung CR, Toonstra A, et al. Inter-rater reliability of the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) in the intensive care unit. Braz J Phys Ther. 2021;25(3):352–355. doi:10.1016/j.bjpt.2020.07.010
    1. Klein LM, Young D, Feng D, et al. Increasing patient mobility through an individualized goal-centered hospital mobility program: a quasi-experimental quality improvement project. Nurs Outlook. 2018;66(3):254–262. doi:10.1016/j.outlook.2018.02.006
    1. Hoyer EH, Brotman DJ, Chan KS, Needham DM. Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil. 2015;94(4):304–312. doi:10.1097/PHM.0000000000000185
    1. Probasco JC, Lavezza A, Cassell A, et al. Choosing wisely together: physical and occupational therapy consultation for acute neurology inpatients. Neurohospitalist. 2018;8(2):53–59. doi:10.1177/1941874417729981
    1. Hoyer EH, Young DL, Friedman LA, et al. Routine inpatient mobility assessment and hospital discharge planning. JAMA Intern Med. 2019;179(1):118–120. doi:10.1001/jamainternmed.2018.5145
    1. Meadowcroft E. #everyBODYmoves campaign and resources. Activity and mobility promotion. Accessed January 5, 2022.
    1. Boockvar KS, Judon KM, Eimicke JP, Teresi JA, Inouye SK. Hospital elder life program in long-term care (HELP-LTC): a cluster randomized controlled trial. J Am Geriatr Soc. 2020;68(10):2329–2335. doi:10.1111/jgs.16695
    1. Hastings SN, Sloane R, Morey MC, Pavon JM, Hoenig H. Assisted early mobility for hospitalized older veterans: preliminary data from the STRIDE program. J Am Geriatr Soc. 2014;62(11):2180–2184. doi:10.1111/jgs.13095
    1. Hastings SN, Stechuchak KM, Choate A, et al. Implementation of a stepped wedge cluster randomized trial to evaluate a hospital mobility program. Trials. 2020;21(1):863. doi:10.1186/s13063-020-04764-7
    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. MOVEs Canada. The MOVE program. Accessed March 21, 2022.

Source: PubMed

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