Use of robot technology in passive mobilization of acute hospitalized geriatric medicine patients: a pilot test and feasibility study

A S Bertelsen, A Storm, L Minet, J Ryg, A S Bertelsen, A Storm, L Minet, J Ryg

Abstract

Background: Along with an aging population, the field of robot technology in rehabilitation is expanding. As new technologies develop, it is important to test these clinically before implementation. To assess the possibilities of undertaking a future randomized controlled trial (RCT), the aim of this study was to pilot test and investigate the feasibility of a newly developed passive mobilization robot device in geriatric medicine patients.

Methods: We used a robot to perform passive mobilization for all recruited patients while they were lying in bed. Inclusion criteria include the following: ≥ 65 years of age, able to walk before hospitalization, and not capable of walking > 2 m at the first day of hospitalization. Exclusion criteria include the following: known moderate/severe dementia, unstable fractures (back, pelvis, or legs), high intracranial pressure, pressure ulcers/risk of developing pressure ulcers due to fragile skin, positive Confusion and Assessment Method (CAM) score, not able to understand Danish, and medical instability. A mixed-methods approach, including structured interviews for patients and relatives, questionnaires and semi-structured interviews for the staff, and observations in the clinic were used as data collection methods. A 6-week pilot test preceded the feasibility study to test study design, safety, interview guide, and setting, and to become familiar with the robot.

Results: The pilot test included 13 patients, made the staff confident in the use of the robot, and led to the correction of the interview guide. In the feasibility study, 177 patients were screened, 14 patients (four men, nine women) included, and 13 completed the intervention (median [IQR] age 86 [82-92] years). Overall, the robot was easy to use during passive mobilization and fully accepted by patients and relatives. Staff, however, found the robot difficult to maneuver. No adverse events were reported.

Conclusions: Use of robot technology in passive mobilization of older patients was feasible and well accepted by patients, relatives, and staff. Technical and workflow-related issues, as well as the robot not performing active mobilization, affects the launch of a RCT and thereby its implementation in geriatric medicine patients.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s). 2020.

Figures

Fig. 1
Fig. 1
Picture of the passive mobilization robot ROBERT®
Fig. 2
Fig. 2
Flowchart of study participants in the feasibility study period 06.11.2018 to 12.12.2018. Inspired by The CONSORT 2010 Flow Diagram

References

    1. Christensen Kaare, Doblhammer Gabriele, Rau Roland, Vaupel James W. Ageing populations: the challenges ahead. The Lancet. 2009;374(9696):1196–1208. doi: 10.1016/S0140-6736(09)61460-4.
    1. Buurman BM, Frenkel WJ, Abu-Hanna A, Parlevliet JL, de Rooij SE. Acute and chronic diseases as part of multimorbidity in acutely hospitalized older patients. European journal of internal medicine. 2016;27:68–75. doi: 10.1016/j.ejim.2015.09.021.
    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(3):331–337. doi: 10.1093/gerona/gls165.
    1. Oestergaard AS, Mathiesen MH, Karlsen A, Turtumoeygaard IF, Vahlgren J, Kjaer M, et al. In acutely admitted geriatric patients, offering increased physical activity during hospitalization decreases length of stay and can improve mobility. 2018;1(1):46-53.
    1. Callen Bonnie L, Mahoney Jane E, Grieves Carey B, Wells Thelma J, Enloe Myra. Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatric Nursing. 2004;25(4):212–217. doi: 10.1016/j.gerinurse.2004.06.016.
    1. Karlsen A, Loeb MR, Andersen KB, Joergensen KJ, Scheel FU, Turtumoeygard IF, et al. Improved functional performance in geriatric patients during hospital stay. Am J Phys Med Rehabil. 2017;96(5):e78–e84. doi: 10.1097/PHM.0000000000000671.
    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. 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(2):266–273. doi: 10.1111/j.1532-5415.2010.03276.x.
    1. Yakub F, Md Khudzari AZ, Mori Y. Recent trends for practical rehabilitation robotics, current challenges and the future. International journal of rehabilitation research Internationale Zeitschrift fur Rehabilitationsforschung Revue internationale de recherches de readaptation. 2014;37(1):9–21. doi: 10.1097/MRR.0000000000000035.
    1. Cooper RA, Dicianno BE, Brewer B, LoPresti E, Ding D, Simpson R, et al. A perspective on intelligent devices and environments in medical rehabilitation. Med Eng Phys. 2008;30(10):1387–1398. doi: 10.1016/j.medengphy.2008.09.003.
    1. Walters SJ, Bonacho Dos Anjos Henriques-cadby I, Bortolami O, Flight L, Hind D, Jacques RM, et al. Recruitment and retention of participants in randomised controlled trials: a review of trials funded and published by the United Kingdom Health Technology Assessment Programme. BMJ Open. 2017;7(3):e015276. doi: 10.1136/bmjopen-2016-015276.
    1. Bracken K, Askie L, Keech AC, Hague W, Wittert G. Recruitment strategies in randomised controlled trials of men aged 50 years and older: a systematic review. BMJ Open. 2019;9(4):e025580. doi: 10.1136/bmjopen-2018-025580.
    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(5):452–457. doi: 10.1016/j.amepre.2009.02.002.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot and feasibility studies. 2016;2:64. doi: 10.1186/s40814-016-0105-8.
    1. Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. 4. ed. Thousand Oaks: SAGE Publications; 2014.
    1. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941–948. doi: 10.7326/0003-4819-113-12-941.
    1. Han JH, Wilson A, Graves AJ, Shintani A, Schnelle JF, Dittus RS, et al. Validation of the confusion assessment method for the intensive care unit in older emergency department patients. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. 2014;21(2):180–187. doi: 10.1111/acem.12309.
    1. Holloway I, Wheeler S. Qualitative research in nursing and healthcare. 3.;3. Aufl.;3rd; ed. Chichester, West Sussex: Wiley-Blackwell; 2010.
    1. Doyle S. Member checking with older women: a framework for negotiating meaning. Health Care for Women International. 2007;28(10):888–908. doi: 10.1080/07399330701615325.
    1. Harper M, Cole P. Member checking: can benefits be gained similar to group therapy? 2012.
    1. Green J, Thorogood N. Qualitative methods for health research. 4th ed. ed. London: Sage; 2018. xviii, 420 s. p.
    1. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2015;26(13):1753–1760. doi: 10.1177/1049732315617444.
    1. Braun Virginia, Clarke Victoria. APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological. Washington: American Psychological Association; 2012. Thematic analysis; pp. 57–71.
    1. Takahashi T, Takeshima N, Rogers NL, Rogers ME, Islam MM. Passive and active exercises are similarly effective in elderly nursing home residents. J Phys Ther Sci. 2015;27(9):2895–2900. doi: 10.1589/jpts.27.2895.
    1. Cumming TB, Collier J, Thrift AG, Bernhardt J. The effect of very early mobilisation after stroke on psychological well-being. J Rehabil Med. 2008;40(8):609–614. doi: 10.2340/16501977-0226.
    1. Jigjid E, Kawashima N, Ogata H, Nakazawa K, Akai M, Eto F, et al. Effects of passive leg movement on the oxygenation level of lower limb muscle in chronic stroke patients. Neurorehabil Neural Repair. 2008;22(1):40–49. doi: 10.1177/1545968307302927.
    1. Witham MD, Stott DJ. Conducting and reporting trials for older people. Age Ageing. 2017;46(6):889–894. doi: 10.1093/ageing/afx153.
    1. Witham MD, George J. Clinical trial design for older people--time for a rethink. QJM : monthly journal of the Association of Physicians. 2014;107(1):15–16. doi: 10.1093/qjmed/hct178.
    1. Zulman DM, Sussman JB, Chen X, Cigolle CT, Blaum CS, Hayward RA. Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med. 2011;26(7):783–790. doi: 10.1007/s11606-010-1629-x.
    1. McMurdo ME, Witham MD, Gillespie ND. Including older people in clinical research. Bmj. 2005;331(7524):1036–1037. doi: 10.1136/bmj.331.7524.1036.

Source: PubMed

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