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Okita Y, Kawaguchi Y, Inoue Y, Ohno K, Sawada T, Levack W, Tomori K. Characteristics of goal-setting tools in adult rehabilitation: A scoping review. Clin Rehabil 2024; 38:234-250. [PMID: 37644842 PMCID: PMC10725121 DOI: 10.1177/02692155231197383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This scoping review aims to map the literature on goal-setting tools in adult rehabilitation, exploring their characteristics, target users and supporting evidence to inform practice and future research in this area. METHODS We completed a comprehensive search of four databases to identify relevant articles on tools for goal setting in rehabilitation. We followed Arkey and O'Malley's scoping review process to guide article selection, data extraction and data analysis. RESULTS We identified a total of 165 studies that reported on 55 different goal-setting tools, including tools for goal selection and goal documentation (n = 31), goal setting and intervention planning (n = 15), and for measuring the quality of the goal-setting process (n = 9). Over half of the tools were primarily designed for use in rehabilitation of physical disabilities (n = 32). Some tools fell under multiple sub-categories based on their characteristics as follows: 22 framework tools, 12 interview tools, 9 outcome measurement tools for goal achievement, 6 outcome measurement tools for goal quality and 25 documentation tools. The majority of goal-setting instruments targeted goals at the level of activity and participation (n = 51) and aimed to facilitate a client-centred or shared decision-making approach to rehabilitation planning (n = 46). CONCLUSIONS This study provides a comprehensive overview of existing goal-setting tools, highlighting their characteristics, target users and identified needs. These findings can enhance practitioners' awareness of the range of goal-setting tools available and can enable more effective utilization of these tools in clinical practice. Further research should investigate how clinicians can combine multiple tools to deliver goal setting.
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Affiliation(s)
- Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Yuko Kawaguchi
- Department of Rehabilitation, Kaikoukai Rehabilitation Hospital, Aichi, Japan
| | - Yuki Inoue
- Central Rehabilitation Department, Yokohama Rousai Hospital, Kanagawa, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsunori Sawada
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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Schafthuizen L, van Dijk M, van Rosmalen J, Ista E. Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms. BMC Nurs 2024; 23:11. [PMID: 38163905 PMCID: PMC10759502 DOI: 10.1186/s12912-023-01648-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Although stimulating patients' mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards. METHODS Mobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied. RESULTS Wearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9-93.6). The median total daily step count was 1326 (range 22-5362). CONCLUSION We found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Monique van Dijk
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
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3
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Fuchita M, Ridgeway KJ, Sandridge B, Kimzey C, Abraham A, Melanson EL, Fernandez-Bustamante A. Comparison of postoperative mobilization measurements by activPAL versus Johns Hopkins Highest Level of Mobility scale after major abdominal surgery. Surgery 2023; 174:851-857. [PMID: 37580218 PMCID: PMC10530478 DOI: 10.1016/j.surg.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The Johns Hopkins Highest Level of Mobility scale is a validated tool for assessing patient mobility in the hospital. It has excellent inter-rater and test-retest reliabilities, but it is unknown how accurately Johns Hopkins Highest Level of Mobility documentation reflects the patients' mobility performance in the immediate postoperative period compared to objective measures such as accelerometers. METHODS In this single-center observational study, consented adults undergoing open abdominal surgery wore a research-grade accelerometer, activPAL, starting immediately postoperatively until hospital discharge or up to 7 days. We collected the Johns Hopkins Highest Level of Mobility scores documented by hospital staff via retrospective chart review and evaluated their accuracy in describing the type, frequency, and volume of postoperative out-of-bed mobilization using the activPAL as the criterion. RESULTS We analyzed data from 56 participants. The activPAL showed that participants spent 97.7% of their time lying in bed or sitting in a chair. Meanwhile, the Johns Hopkins Highest Level of Mobility documentation of preambulatory activities (scores 1-5) was rare. The activPAL detected 4 times more out-of-bed mobilization than routine Johns Hopkins Highest Level of Mobility documentation. Whereas the frequency of activPAL-measured out-of-bed mobilization increased steadily to a median of 9 sessions by postoperative day 6, the number of Johns Hopkins Highest Level of Mobility documentation remained around twice daily. ActivPAL measurements demonstrated that Johns Hopkins Highest Level of Mobility documentation of ambulatory sessions (scores 6-8) was accurate. CONCLUSIONS We found that routine Johns Hopkins Highest Level of Mobility documentation did not accurately detect preambulatory activities or the overall frequency of out-of-bed mobility sessions, poorly reflecting the highly sedentary behaviors of the acute postoperative inpatients and highlighting the need to improve clinical documentation or use alternative methods to track postoperative mobilization.
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Affiliation(s)
- Mikita Fuchita
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Kyle J Ridgeway
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, University of Colorado Health, Aurora, CO; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO. http://www.twitter.com/Dr_Ridge_DPT
| | | | | | - Alison Abraham
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO
| | - Edward L Melanson
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Rocky Mountain Regional VA Medical Center, Aurora, CO
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Camilo Ferreira R, Moorhead SA, Zuchatti BV, Correia MDL, Montanari FL, Duran ECM. Nursing interventions and activities for patients with multiple traumas: An integrative review. Int J Nurs Knowl 2023; 34:254-275. [PMID: 36269059 DOI: 10.1111/2047-3095.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify nursing interventions and activities for patients with multiple traumas who have variations in physical mobility. METHODS We used integrative literature review following Whittemore and Knafl method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' guidelines and adopting the Oxford Center for Evidence-Based Classification Medicine - Levels of Evidence. The data collection was carried out between October and December 2019 and updated in May 2022, in the following databases: Virtual Health Library, Cochrane Library, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, PubMed®, SciVerse Scopus, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science. FINDINGS There were 103 articles to be fully read and evaluated. From these, 34 publications were selected. Most nursing interventions and activities identified were placed in the NIC class Activity and Exercise Management in the Physiological: Basic domain, which has interventions to organize or to assist with physical activity, energy conservation, and expenditure; followed by Elimination Management (interventions to establish and maintain regular bowel and urinary elimination patterns and manage complications due to altered patterns); Immobility Management (interventions to manage restricted body movement and the sequelae); Nutrition Support (interventions to modify or maintain nutritional status); Physical Comfort Promotion (interventions to promote comfort using physical techniques); and Self-Care Facilitation (interventions to provide or assist with routine activities of daily living). CONCLUSIONS The interventions and nursing activities found in this research were not only related to the change in mobility in victims of multiple traumas but also aimed to prevent the consequences of immobility and to take care of already established conditions. IMPLICATIONS FOR THE NURSING PRACTICE This research enables the taxonomy's development and the validation of interventions for selected groups of patients. This allows the contribution to the development of the NIC-an important resource to improve nursing practice in teaching, research, and care.
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Affiliation(s)
| | - Sue Ann Moorhead
- Emeritus professor and past Director for the Center for Nursing Classification & Clinical Effectiveness, College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Fabio Luis Montanari
- Specialist in oncology nursing, Master Student at Program at School of Nursing, State University of Campinas and Jaguariúna University Center - UniFAJ, Campinas, Brazil
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Lavezza A, Hoyer E, Friedman LA, Daley K, Steele A, Rosen S, Young D. Activities of Daily Living Assessment Early in Hospitalization Is Associated With Key Outcomes. Am J Occup Ther 2023; 77:7705205100. [PMID: 37812648 DOI: 10.5014/ajot.2023.050167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
IMPORTANCE Assessing patients' activities of daily living (ADLs) function early in hospitalization may help identify patients at risk for poor outcomes. OBJECTIVE To investigate the association between patients' ADL function at hospital admission and length of stay, inpatient falls, hospital-acquired pressure injuries, and discharge disposition. DESIGN Retrospective cohort study using scores collected on the Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF) in routine care at admission. SETTING Two inpatient units at the Johns Hopkins Hospital. PARTICIPANTS Hospitalized patients with various diagnoses, including neurosurgical, stroke, and general neurology (N = 1,899). RESULTS People with lower AM-PAC scores (every 10-point difference) had increased odds (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.4-1.8) of being in the highest length-of-stay quartile (≥8 days), having an injurious fall (OR = 1.7; 95% CI = 1.3-2.2), acquiring a pressure injury (OR = 2.7; 95% CI = 1.5-5.3), and being discharged to a postacute care facility (OR = 3.02; 95% CI = 2.1-2.7). CONCLUSIONS AND RELEVANCE Greater functional impairments in ADLs, measured with the AM-PACS IASF, were significantly associated with worse outcomes. AM-PAC IASF scores may be useful in identifying patients with ADL deficits and targeting occupational therapy services for patients who are at higher risk for negative outcomes. What This Article Adds: Early assessment of ADL function in routine care of hospitalized patients may aid in treatment and care plan decisions, particularly for inpatients who may be at higher risk for adverse outcomes.
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Affiliation(s)
- Annette Lavezza
- Annette Lavezza, OTR/L, is Director, Inpatient Rehabilitation Therapy Services, Johns Hopkins Hospital, Baltimore, MD, and Assistant Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD;
| | - Erik Hoyer
- Erik Hoyer, MD, is Associate Professor, Department of Physical Medicine and Rehabilitation and Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Lisa Aronson Friedman
- Lisa Aronson Friedman, ScM, is Senior Biostatistician, Division of Pulmonary and Critical Care Medicine, Outcomes After Critical Illness and Surgery (OACIS) Research Group, School of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Amber Steele
- Amber Steele, PT, DPT, CSCS, is Physical Therapist, Department of Physical Therapy, University of Nevada, Las Vegas
| | - Stephanie Rosen
- Stephanie Rosen, PT, DPT, is Physical Therapist, Department of Physical Therapy, University of Nevada, Las Vegas
| | - Daniel Young
- Daniel Young, PT, DPT, PhD, is Associate Professor, School of Integrated Health Sciences-Physical Therapy, University of Nevada, Las Vegas, and Adjunct Associate Professor, Department of Physical Medicine and Rehabilitation and Outcomes After Critical Illness and Surgery (OACIS) Research Group, School of Medicine, Johns Hopkins University, Baltimore, MD
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Johnson JK, Hamilton AC, Hu B, Pack QR, Lindenauer PK, Fox RJ, Hashmi A, Siegmund LA, Burchill CN, Taksler GB, Goto T, Stilphen M, Rothberg MB. Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial. Trials 2023; 24:471. [PMID: 37488588 PMCID: PMC10367239 DOI: 10.1186/s13063-023-07501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hospitalized older adults spend as much as 95% of their time in bed, which can result in adverse events and delay recovery while increasing costs. Observational studies have shown that general mobility interventions (e.g., ambulation) can mitigate adverse events and improve patients' functional status. Mobility technicians (MTs) may address the need for patients to engage in mobility interventions without overburdening nurses. There is no data, however, on the effect of MT-assisted ambulation on adverse events or functional status, or on the cost tradeoffs if a MT were employed. The AMBULATE study aims to determine whether MT-assisted ambulation improves mobility status and decreases adverse events for older medical inpatients. It will also include analyses to identify the patients that benefit most from MT-assisted mobility and assess the cost-effectiveness of employing a MT. METHODS The AMBULATE study is a multicenter, single-blind, parallel control design, individual-level randomized trial. It will include patients admitted to a medical service in five hospitals in two regions of the USA. Patients over age 65 with mild functional deficits will be randomized using a block randomization scheme. Those in the intervention group will ambulate with the MT up to three times daily, guided by the Johns Hopkins Mobility Goal Calculator. The intervention will conclude at hospital discharge, or after 10 days if the hospitalization is prolonged. The primary outcome is the Short Physical Performance Battery score at discharge. Secondary outcomes are discharge disposition, length of stay, hospital-acquired complications (falls, venous thromboembolism, pressure ulcers, and hospital-acquired pneumonia), and post-hospital functional status. DISCUSSION While functional decline in the hospital is multifactorial, ambulation is a modifiable factor for many patients. The AMBULATE study will be the largest randomized controlled trial to test the clinical effects of dedicating a single care team member to facilitating mobility for older hospitalized patients. It will also provide a useful estimation of cost implications to help hospital administrators assess the feasibility and utility of employing MTs. TRIAL REGISTRATION Registered in the United States National Library of Medicine clinicaltrials.gov (# NCT05725928). February 13, 2023.
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Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Aaron C Hamilton
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, USA
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, USA
| | - Robert J Fox
- Mellen Center for Treatment and Research in Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ardeshir Hashmi
- Center for Geriatric Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Lee Anne Siegmund
- Office of Nursing Research and Innovation, and Consultant Staff, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Glen B Taksler
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
- Population Health Research Institute, Case Western Reserve University at MetroHealth System, Cleveland, OH, USA
| | - Toyomi Goto
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
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Ehrlich AL, Owodunni OP, Mostales JC, Qin CX, Hadvani PJ, Sirisegaram L, Bettick D, Gearhart SL. Early Outcomes Following Implementation of a Multispecialty Geriatric Surgery Pathway. Ann Surg 2023; 277:e1254-e1261. [PMID: 35837966 DOI: 10.1097/sla.0000000000005567] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine geriatric-specific outcomes following implementation of a multispecialty geriatric surgical pathway (GSP). BACKGROUND In 2018, we implemented a GSP in accordance with the proposed 32 standards of American College of Surgeons' Geriatric Surgery Verification Program. METHODS This observational study combined data from the electronic health record system (EHR) and ACS-National Surgery Quality Improvement Program (NSQIP) to identify patients ≥65 years undergoing inpatient procedures from 2016 to 2020. GSP patients (2018-2020) were identified by preoperative high-risk screening. Frailty was measured with the modified frailty index. Surgical procedures were ranked according to the operative stress score (1-5). Loss of independence (LOI), length of stay, major complications (CD II-IV), and 30-day all-cause unplanned readmissions were measured in the pre/postpatient populations and by propensity score matching of patients by operative procedure and frailty. RESULTS A total of 533 (300 pre-GSP, 233 GSP) patients similar by demographics (age and race) and clinical profile (frailty) were included. On multivariable analysis, GSP patients showed decreased risk for LOI [odds ratio (OR) 0.26 (0.23, 0.29) P <0.001] and major complications [OR: 0.63 (0.50, 0.78) P <0.001]. Propensity matching demonstrated similar findings. Examining frail patients alone, GSP showed decreased risk for LOI [OR: 0.30 (0.25, 0.37) P <0.001], major complications [OR: 0.31 (0.24, 0.40) P <0.001], and was independently associated with a reduction in length of stay [incidence rate ratios: 0.97 (0.96, 0.98), P <0.001]. CONCLUSIONS In our diverse patient population, implementation of a GSP led to improved geriatric-specific surgical outcomes. Future studies to examine pathway compliance would promote the identification of further interventions.
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Affiliation(s)
- April L Ehrlich
- Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Oluwafemi P Owodunni
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Joshua C Mostales
- Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Caroline Xu Qin
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Priyanka J Hadvani
- Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Susan L Gearhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bayview Medical Center, Baltimore, MD
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Capo-Lugo CE, Young DL, Farley H, Aquino C, McLaughlin K, Calantuoni E, Friedman LA, Kumble S, Hoyer EH. Revealing the tension: The relationship between high fall risk categorization and low patient mobility. J Am Geriatr Soc 2023; 71:1536-1546. [PMID: 36637798 PMCID: PMC10175187 DOI: 10.1111/jgs.18221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Using an inpatient fall risk assessment tool helps categorize patients into risk groups which can then be targeted with fall prevention strategies. While potentially important in preventing patient injury, fall risk assessment may unintentionally lead to reduced mobility among hospitalized patients. Here we examined the relationship between fall risk assessment and ambulatory status among hospitalized patients. METHODS We conducted a retrospective cohort study of consecutively admitted adult patients (n = 48,271) to a quaternary urban hospital that provides care for patients of broad socioeconomic and demographic backgrounds. Non-ambulatory status, the primary outcome, was defined as a median Johns Hopkins Highest Level of Mobility <6 (i.e., patient walks less than 10 steps) throughout hospitalization. The primary exposure variable was the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) category (Low, Moderate, High). The capacity to ambulate was assessed using the Activity Measure for Post-Acute Care (AM-PAC). Multivariable regression analysis controlled for clinical demographics, JHFRAT items, AM-PAC, comorbidity count, and length of stay. RESULTS 8% of patients at low risk for falls were non-ambulatory, compared to 25% and 54% of patients at moderate and high risk for falls, respectively. Patients categorized as high risk and moderate risk for falls were 4.6 (95% CI: 3.9-5.5) and 2.6 (95% CI: 2.4-2.9) times more likely to be non-ambulatory compared to patients categorized as low risk, respectively. For patients with high ambulatory potential (AM-PAC 18-24), those categorized as high risk for falls were 4.3 (95% CI: 3.5-5.3) times more likely to be non-ambulatory compared to patients categorized as low risk. CONCLUSIONS Patients categorized into higher fall risk groups had decreased mobility throughout their hospitalization, even when they had the functional capacity to ambulate.
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Affiliation(s)
- Carmen E. Capo-Lugo
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham; Birmingham, AL
- Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University; Baltimore, MD
| | - Daniel L. Young
- Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University; Baltimore, MD
- Department of Physical Therapy, University of Nevada, Las Vegas; Las Vegas, NV
| | - Holley Farley
- Department of Nursing, Johns Hopkins Hospital; Baltimore, MD
| | - Carla Aquino
- Department of Nursing, Johns Hopkins Hospital; Baltimore, MD
| | - Kevin McLaughlin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; Baltimore, MD
| | - Elizabeth Calantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; Baltimore, MD
| | - Erik H. Hoyer
- Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University; Baltimore, MD
- Department of Nursing, Johns Hopkins Hospital; Baltimore, MD
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McLaughlin KH, Friedman M, Hoyer EH, Kudchadkar S, Flanagan E, Klein L, Daley K, Lavezza A, Schechter N, Young D. The Johns Hopkins Activity and Mobility Promotion Program: A Framework to Increase Activity and Mobility Among Hospitalized Patients. J Nurs Care Qual 2023; 38:164-170. [PMID: 36729980 PMCID: PMC9944180 DOI: 10.1097/ncq.0000000000000678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Kevin H. McLaughlin
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Michael Friedman
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Erik H. Hoyer
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Sapna Kudchadkar
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Eleni Flanagan
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Lisa Klein
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Kelly Daley
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Annette Lavezza
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Nicole Schechter
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Daniel Young
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
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Hoyer EH, Friedman M, Lavezza A, Flanagan E, Kumble S, D'Alessandro M, Gutierrez M, Colantuoni E, Brotman DJ, Young DL. A unit-based, multi-center evaluation of adopting mobility measures and daily mobility goals in the hospital setting. Appl Nurs Res 2023; 70:151655. [PMID: 36933900 DOI: 10.1016/j.apnr.2022.151655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/10/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Promoting patient mobility helps improve patient outcomes, but mobility status is not widely tracked nor do patients have specific individualized mobility goals. PURPOSE We evaluated nursing adoption of mobility measures and daily mobility goal achievement using the Johns Hopkins Mobility Goal Calculator (JH-MGC), a tool to guide an individualized patient mobility goal based on the level of mobility capacity. METHOD Built on a translating research into practice framework, the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program was the vehicle to promote use of the mobility measures and the JH-MGC. We evaluated a large-scale implementation effort of this program on 23 units across two medical centers. FINDINGS Units significantly improved documentation compliance to mobility measures and achieving daily mobility goals. Units with the highest documentation compliance rates had higher rates of daily mobility goal achievement, especially for longer distance ambulation goals. DISCUSSION The JH-AMP program improved adoption of mobility status tracking and higher nursing inpatient mobility levels.
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Affiliation(s)
- Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eleni Flanagan
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Morning Gutierrez
- Department of Nursing, The Johns Hopkins Bayview Medical Campus, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel L Young
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
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11
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Rauzi MR, Ridgeway KJ, Wilson MP, Jolley SE, Nordon-Craft A, Stevens-Lapsley JE, Erlandson KM. Rehabilitation Therapy Allocation and Changes in Physical Function Among Patients Hospitalized Due to COVID-19: A Retrospective Cohort Analysis. Phys Ther 2023; 103:pzad007. [PMID: 37172130 PMCID: PMC10071586 DOI: 10.1093/ptj/pzad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/03/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Limited staffing and initial transmission concerns have limited rehabilitation services during the COVID-19 pandemic. The purpose of this analysis was to determine the associations between Activity Measure for Post-Acute Care (AM-PAC) mobility categories and allocation of rehabilitation, and in-hospital AM-PAC score change and receipt of rehabilitation services for patients with COVID-19. METHODS This was a retrospective cohort study of electronic health record data from 1 urban hospital, including adults with a COVID-19 diagnosis, admitted August 2020 to April 2021. Patients were stratified by level of medical care (intensive care unit [ICU] and floor). Therapy allocation (referral for rehabilitation, receipt of rehabilitation, and visit frequency) was the primary outcome; change in AM-PAC score was secondary. AM-PAC Basic Mobility categories (None [21-24], Minimum [18-21], Moderate [10-17], and Maximum [6-9]) were the main predictor variable. Primary analysis included logistic and linear regression, adjusted for covariates. RESULTS A total of 1397 patients (ICU: n = 360; floor: n = 1037) were included. AM-PAC mobility category was associated with therapy allocation outcomes for floor but not patients in the ICU: the Moderate category had greater adjusted odds of referral (adjusted odds ratio [aOR] = 10.88; 95% CI = 5.71-21.91), receipt of at least 1 visit (aOR = 3.45; 95% CI = 1.51-8.55), and visit frequency (percentage mean difference) (aOR = 42.14; 95% CI = 12.45-79.67). The secondary outcome of AM-PAC score improvement was highest for patients in the ICU who were given at least 1 rehabilitation therapy visit (aOR = 5.31; 95% CI = 1.90-15.52). CONCLUSION AM-PAC mobility categories were associated with rehabilitation allocation outcomes for floor patients. AM-PAC score improvement was highest among patients requiring ICU-level care with at least 1 rehabilitation therapy visit. IMPACT Use of AM-PAC Basic Mobility categories may help improve decisions for rehabilitation therapy allocation among patients who do not require critical care, particularly during times of limited resources.
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Affiliation(s)
- Michelle R Rauzi
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
| | - Kyle J Ridgeway
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, University of Colorado Health, Aurora, Colorado, USA
| | - Melissa P Wilson
- Department of Biomedical Informatics, University of Colorado, Aurora, Colorado, USA
| | - Sarah E Jolley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Amy Nordon-Craft
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
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12
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Olson LM, Zonsius MC, Rodriguez-Morales G, Emery-Tiburcio EE. Promoting Safe Mobility Strategies for partnering with caregivers to maximize older adults' functional ability. Home Healthc Now 2023; 41:105-111. [PMID: 36867484 DOI: 10.1097/nhh.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Olson,L.M., et al. Promote Safe Mobility. Am J Nurs 2022; 122(7): 46-52.
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Affiliation(s)
- Linda M Olson
- Linda M. Olson is a chairperson and program director in the Department of Occupational Therapy in the College of Health Sciences at Rush University Medical Center in Chicago, where Mary C. Zonsius is an associate professor in the College of Nursing, Grisel Rodriguez-Morales is a manager and assistant professor in the Department of Social Work and Community Health, and Erin E. Emery-Tiburcio is an associate professor in the Department of Psychiatry and Behavioral Sciences. Contact author: Linda M. Olson, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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13
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Utility of the transversus abdominis plane and rectus sheath blocks in patients undergoing anterior lumbar interbody fusions. Spine J 2022; 22:1660-1665. [PMID: 35533987 DOI: 10.1016/j.spinee.2022.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior lumbar interbody fusion (ALIF) is a well-established technique to address numerous pathological conditions of the spine and to restore sagittal spine balance. Improving patient comfort and reducing opioid consumption following lumbar fusions is a significant goal for spine surgeons. Therefore, there is a growing need to explore multimodal options for pain management post-surgery. PURPOSE Determine the effectiveness of combined transversus abdominis plane (TAP) and rectus sheath (RS) blocks in those undergoing (ALIF) as compared to a historical control. STUDY DESIGN/SETTING Retrospective comparative cohort performed at a tertiary referral orthopedic specialty hospital. PATIENT SAMPLE Of the 175 patients (88 patients received a combined regional block) who underwent an ALIF between January 1, 2018 and August 1, 2021. OUTCOME MEASURES Pain scores both during activity and at rest, opioid consumption during the first 72 hours postoperatively, total postoperative anesthesia care unit length of stay (PACU LOS), 30-day emergency department visits, 30-day readmissions, and unplanned returns to the operating room. METHODS Charts of patients undergoing an ALIF during the open period for this study were placed into two groups: those that received combined regional anesthesia and those that did not. A t test assuming unequal variances was used to determine if there were differences in outcome variables between the two groups. RESULTS The study group, those receiving the combine block, demonstrated a statistically significant reduction in opioid pain medicine (24.8%), reported pain (10-13%), and PACU LOS (18.7%). There were no differences in complication rates between the two groups. CONCLUSIONS The combined use of TAP and RS blocks appears to be a well-tolerated and effective means of pain management in this patient cohort.
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14
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Pain and Mobilization after Surgery: Comment. Anesthesiology 2022; 137:265-266. [PMID: 35588465 PMCID: PMC9869927 DOI: 10.1097/aln.0000000000004248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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15
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Mclaughlin KH, Young D, Friedman LA, Peters J, Vickery G, Hoyer EH. An Interprofessional Examination of the Johns Hopkins Mobility Goal Calculator among Hospitalized Post-Surgical Patients. Nurs Health Sci 2022; 24:735-741. [PMID: 35780301 DOI: 10.1111/nhs.12972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
Individualized mobility goals created using a goal calculator have been shown to increase patient mobility on medical nursing units, but have not been studied among postoperative populations. This study aimed to examine the feasibility of an automated mobility goal calculator on a postoperative nursing unit. To examine this, we utilized the goal calculator to create goals for patients (N=128) following surgery and mobilized each patient with either a nurse or physical therapist. Each patient's highest level of mobility was recorded and providers completed surveys on the appropriateness of calculated goals. Overall, 94% of patients achieved calculated goals. Patients with more pain achieved goals significantly less often than those with less pain. Those with higher mobility achieved their goals similarly with either provider. Providers reported 47% of goals were appropriate, with goals being set too low as the primary reason for goals being inappropriate. We conclude that the automated goal calculator can be used on postoperative nursing units to set realistic goals for patients after surgery. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kevin H Mclaughlin
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Daniel Young
- University of Nevada, Las Vegas, Department of Physical Therapy
| | - Lisa A Friedman
- Johns Hopkins University, School of Medicine, Department of Medicine
| | | | | | - Erik H Hoyer
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation
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16
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Promoting Safe Mobility. Am J Nurs 2022; 122:46-52. [DOI: 10.1097/01.naj.0000842256.48499.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Heinzmann J, Baumgartner C, Liechti FD. Goal-Directed Mobility of Medical Inpatients-A Mini Review of the Literature. Front Med (Lausanne) 2022; 9:878031. [PMID: 35665320 PMCID: PMC9158316 DOI: 10.3389/fmed.2022.878031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Inpatients spend most of their hospitalization in bed, which can lead to negative physical, social, and psychological outcomes, especially in the geriatric population. Goal-directed mobilization involves setting mobility goals with patients and care teams working together toward achieving these goals. Methods Three different platforms (SCOPUS, Ovid Medline, PubMed) were searched. Search terms included "goal-directed," "goal-attainment" or "goal-setting," and "inpatient" or "hospitalization" and "mobility" or "mobilization." Articles were included if mobility goals were set in acutely hospitalized adults. Studies were excluded if only covering specific illness or surgery. Results One Hundred Seventy three articles were screened for inclusion by two independent reviewers. In the final analysis, 13 articles (5 randomized controlled trials, 2 Post-hoc analyses, 3 quality-improvement projects, 1 pre-post two group analysis, 1 comment and 1 study protocol) were assessed. Goal-directed mobilization improved mobility-related outcomes, i.e., level of mobilization, activity, daily walking time and functional independence. Readmissions, quality of life, discharge disposition and muscle weakness were not significantly altered and there was conflicting evidence regarding length of stay and activities of daily living. Conclusion There is a lack of evidence of goal-directed mobilization on relevant outcomes due to the low number of studies in the field and the study design used. Further research on goal-directed mobility should use standardized mobility protocols and measurements to assess mobility and the effects of goal-directed mobility more accurately and include broader patient populations.
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Affiliation(s)
- Jeannelle Heinzmann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian D Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Johnson JK, Lapin B, Bethoux F, Skolaris A, Katzan I, Stilphen M. Patient Versus Clinician Proxy Reliability of the AM-PAC "6-Clicks" Basic Mobility and Daily Activity Short Forms. Phys Ther 2022; 102:6563497. [PMID: 35385119 DOI: 10.1093/ptj/pzac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to test the reliability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" mobility and activity short forms between patients and therapist proxies. As a secondary aim, reliability was examined when patients completed their self-report before versus after the therapist evaluation. METHODS Patients being seen for an initial physical therapist (N = 70) or occupational therapist (N = 71) evaluation in the acute care hospital completed the "6-Clicks" mobility short form (if a physical therapist evaluation) or activity short form (if an occupational therapist evaluation). Whether patients completed their self-assessment before or after the evaluation was randomized. Patient- and therapist-rated "6-Clicks" raw scores were converted to AM-PAC T-scores for comparison. Reliability was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and agreement was assessed with weighted kappa values. RESULTS The ICCs for the "6-Clicks" mobility and daily activity short forms were 0.57 (95% CI = 0.42-0.69) and 0.45 (95% CI = 0.28-0.59), respectively. For both short forms, reliability was higher when the patient completed the self-assessment after versus before the therapist evaluation (ICC = 0.67, 95% CI = 0.47-0.80 vs ICC = 0.50, 95% CI = 0.26-0.67 for the mobility short form; and ICC = 0.52, 95% CI = 0.29-0.70 vs ICC = 0.34, 95% CI = 0.06-0.56 for the activity short form). CONCLUSION Reliability of the "6-Clicks" total scores was moderate for both the mobility and activity short forms, though higher for the mobility short form and when patients' self-report occurred after the therapist evaluation. IMPACT Reliability of the AM-PAC "6-Clicks" short forms is moderate when comparing scores from patients with those of therapists responding as proxies. The short forms are useful for measuring participants' function in the acute care hospital; however, it is critical to recognize limitations in reliability between clinician- and patient-reported AM-PAC scores when evaluating longitudinal change and recovery.
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Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alexis Skolaris
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Irene Katzan
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mary Stilphen
- Department of Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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19
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Liechti FD, Heinzmann J, Schmidt Leuenberger JM, Limacher A, Wertli MM, Verra ML. Effect of goal-directed mobilisation intervention compared with standard care on physical activity among medical inpatients: protocol for the GoMob-in randomised controlled trial. BMJ Open 2022; 12:e058509. [PMID: 35551091 PMCID: PMC9109085 DOI: 10.1136/bmjopen-2021-058509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite the fact that immobilisation is a major contributor to morbidity and mortality, patients hospitalised in general internal medicine (GIM) wards spend up to 50% of time in bed. Previous studies in selected patient populations showed increased mobility after implementation of goal-directed mobilisation (GDM). Due to the study design used so far, the degree of evidence is generally low. The effect of GDM on clinical outcomes and economically relevant indicators in patients hospitalised in GIM wards is currently unknown. This study aims to evaluate a GDM intervention compared to standard care on physical activity (de Morton Mobility Index, DEMMI) in medical inpatients. METHODS AND ANALYSIS GoMob-in is a randomised, controlled, open-label study with blinded outcome assessment. We plan to enrol 160 inpatients with indication for physiotherapy on GIM wards of a tertiary hospital in Bern, Switzerland. Adult patients newly hospitalised on GIM wards will be included in the study. The primary outcome will be the change in the DEMMI score between baseline and 5 days. Secondary outcomes are change of DEMMI (inclusion to hospital discharge), mobilisation time (inclusion to day 5, inclusion to discharge), in-hospital delirium episodes, number of in-hospital falls, length of stay, number of falls within 3 months, number of re-hospitalisations and all-cause mortality within 3 months, change in independence during activities of daily living, concerns of falling, and quality of life within 3 months and destination after 3 months. Patients in the intervention group will be attributed a regularly updated individual mobility goal level made visible for all stakeholders and get a short educational intervention on GDM. ETHICS AND DISSEMINATION This study has been approved by the responsible Ethics Board (Ethikkommission Bern/2020-02305). Written informed consent will be obtained from participants before study inclusion. Results will be published in open access policy peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04760392.
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Affiliation(s)
- Fabian D Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jeannelle Heinzmann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Maria M Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Kantonsspital Baden, Baden, Switzerland
| | - Martin L Verra
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
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20
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Young DL, Fritz JM, Kean J, Thackeray A, Johnson JK, Dummer D, Passek S, Stilphen M, Beck D, Havrilla S, Hoyer EH, Friedman M, Daley K, Marcus RL. Key Data Elements for Longitudinal Tracking of Physical Function: A Modified Delphi Consensus Study. Phys Ther 2022; 102:6497841. [PMID: 35079819 DOI: 10.1093/ptj/pzab279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/02/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Physical function is associated with important outcomes, yet there is often a lack of continuity in routine assessment. The purpose of this study was to determine data elements and instruments for longitudinal measurement of physical function in routine care among patients transitioning from acute care hospital setting to home with home health care. METHODS A 4-round modified Delphi process was conducted with 13 participants with expertise in physical therapy, health care administration, health services research, physiatry/medicine, and health informatics. Three anonymous rounds identified important and feasible data elements. A fourth in-person round finalized the recommended list of individual data elements. Next, 2 focus groups independently provided additional perspectives from other stakeholders. RESULTS Response rates were 100% for online rounds 1, 3, and 4 and 92% for round 2. In round 1, 9 domains were identified: physical function, participation, adverse events, behavioral/emotional health, social support, cognition, complexity of illness/disease burden, health care utilization, and demographics. Following the fourth round, 27 individual data elements were recommended. Of these, 20 (74%) are "administrative" and available from most hospital electronic medical records. Additional focus groups confirmed these selections and provided input on standardizing collection methods. A website has been developed to share these results and invite other health care systems to participate in future data sharing of these identified data elements. CONCLUSION A modified Delphi consensus process was used to identify critical data elements to track changes in patient physical function in routine care as they transition from acute hospital to home with home health. IMPACT Expert consensus on comprehensive and feasible measurement of physical function in routine care provides health care professionals and institutions with guidance in establishing discrete medical records data that can improve patient care, discharge decisions, and future research.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA.,Department of Population Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Danica Dummer
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Sandra Passek
- Cleveland Clinic Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mary Stilphen
- Cleveland Clinic Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donna Beck
- Johns Hopkins Home Health Services, Baltimore, Maryland, USA
| | | | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kelly Daley
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Robin L Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
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21
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Boerrigter JL, Geelen SJG, van Berge Henegouwen MI, Bemelman WA, van Dieren S, de Man-van Ginkel JM, van der Schaaf M, Eskes AM, Besselink MG. Extended mobility scale (AMEXO) for assessing mobilization and setting goals after gastrointestinal and oncological surgery: a before-after study. BMC Surg 2022; 22:38. [PMID: 35109840 PMCID: PMC8812167 DOI: 10.1186/s12893-021-01445-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/10/2021] [Indexed: 01/31/2023] Open
Abstract
Background Early structured mobilization has become a key element of Enhanced Recovery After Surgery programs to improve patient outcomes and decrease length of hospital stay. With the intention to assess and improve early mobilization levels, the 8-point ordinal John Hopkins Highest Level of Mobility (JH-HLM) scale was implemented at two gastrointestinal and oncological surgery wards in the Netherlands. After the implementation, however, healthcare professionals perceived a ceiling effect in assessing mobilization after gastrointestinal and oncological surgery. This study aimed to quantify this perceived ceiling effect, and aimed to determine if extending the JH-HLM scale with four additional response categories into the AMsterdam UMC EXtension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale reduced this ceiling effect. Methods All patients who underwent gastrointestinal and oncological surgery and had a mobility score on the first postoperative day before (July–December 2018) or after (July–December 2019) extending the JH-HLM into the AMEXO scale were included. The primary outcome was the before-after difference in the percentage of ceiling effects on the first three postoperative days. Furthermore, the before-after changes and distributions in mobility scores were evaluated. Univariable and multivariable logistic regression analysis were used to assess these differences. Results Overall, 373 patients were included (JH-HLM n = 135; AMEXO n = 238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score before extending the JH-HLM into the AMEXO as compared to 4 (1.7%) patients after (OR = 0.021, CI = 0.007–0.059, p < 0.001). During the first three postoperative days, 118 (87.4%) patients scored the highest possible mobility score before compared to 40 (16.8%) patients after (OR = 0.028, CI = 0.013–0.060, p < 0.001). A change in mobility was observed in 88 (65.2%) patients before as compared to 225 (94.5%) patients after (OR = 9.101, CI = 4.046–20.476, p < 0.001). Of these 225 patients, the four additional response categories were used in 165 (73.3%) patients. Conclusions A substantial ceiling effect was present in assessing early mobilization in patients after gastrointestinal and oncological surgery using the JH-HLM. Extending the JH-HLM into the AMEXO scale decreased the ceiling effect significantly, making the tool more appropriate to assess early mobilization and set daily mobilization goals after gastrointestinal and oncological surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01445-3.
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Affiliation(s)
- José L Boerrigter
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Nursing Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Janneke M de Man-van Ginkel
- Nursing Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Anne M Eskes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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22
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Lesser S, Zakharkin S, Louie C, Escobedo MR, Whyte J, Fulmer T. Clinician knowledge and behaviors related to the 4Ms framework of Age-Friendly Health Systems. J Am Geriatr Soc 2021; 70:789-800. [PMID: 34837381 PMCID: PMC9299469 DOI: 10.1111/jgs.17571] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/15/2022]
Abstract
Background The Age‐Friendly Health Systems (AFHS) aims to improve the experience of care for adults aged 65 years and older through the 4Ms framework, an evidence‐based approach to care planning that emphasizes what matters most to the older person, mentation, mobility, and medication. The aim of this study was to examine clinicians' attitudes, knowledge, and practices concerning AFHS and the 4Ms. Methods We surveyed U.S.‐based health care providers randomly identified from the Medscape database. The sample was weighted based on sex, U.S. Census region, and ethnic diversity of health occupations. We examined the differences between cohorts using proportions tests and logistic regression models. Results More than 90% of clinicians (n = 1684) agreed that “older patients require a different approach to care than younger patients.” Fifty percent of clinicians “always” take the age of their patient into consideration when determining care. A majority of clinicians said they discuss each of the 4Ms with older patients and/or their family caregivers. Screening for depression and review of high‐risk medication use are among the leading types of age‐friendly care that clinicians provide to older patients. A minority of clinicians are asking older adults about and aligning the care plan with What Matters. Conclusions A majority of clinicians acknowledged the benefits of providing care via AFHS but reported limited knowledge of the specificities of the 4Ms framework and are not necessarily taking the age of their patients into consideration when determining the best form of care. Health care settings that have implemented the 4Ms framework appear to be doing so in an incomplete way. Our study reinforces the case for training primary care providers on how to adopt the evidence‐based 4Ms framework in clinical practice effectively and consistently.
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Affiliation(s)
| | | | | | | | - John Whyte
- Market Research, WebMD, New York, New York, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, New York, USA
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23
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Geelen SJG, van Dijk-Huisman HC, de Bie RA, Veenhof C, Engelbert R, van der Schaaf M, Lenssen AF. Barriers and enablers to physical activity in patients during hospital stay: a scoping review. Syst Rev 2021; 10:293. [PMID: 34736531 PMCID: PMC8569983 DOI: 10.1186/s13643-021-01843-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low levels of physical activity are common during the hospital stay and have been associated with negative health outcomes. Understanding barriers and enablers to physical activity during a hospital stay can improve the development and implementation of tailored interventions aimed at improving physical activity. Previous studies have identified many barriers and enablers, but a comprehensive overview is lacking. This study aimed to identify and categorize all published patient- and healthcare professional-reported barriers and enablers to physical activity during a hospital stay for acute care, using the Theoretical Domains Framework (TDF). METHODS We conducted a scoping review of Dutch and English articles using MEDLINE, CINAHL Plus, EMBASE, PsycINFO, and Cochrane Library (inception to September 2020), which included quantitative, qualitative, and mixed-methods studies reporting barriers and enablers to physical activity during a hospital stay for acute care, as perceived by patients or healthcare professionals. Two reviewers systematically extracted, coded, and categorized all barriers and enablers into TDF domains. RESULTS Fifty-six articles were included in this review (32 qualitative, 7 quantitative, and 17 mixed-methods). In total, 264 barriers and 228 enablers were reported by patients, and 415 barriers and 409 enablers by healthcare professionals. Patient-reported barriers were most frequently assigned to the TDF domains Environmental Context & Resources (ECR, n = 148), Social Influences (n = 32), and Beliefs about Consequences (n = 25), while most enablers were assigned to ECR (n = 67), Social Influences (n = 54), and Goals (n = 32). Barriers reported by healthcare professionals were most frequently assigned to ECR (n = 210), Memory, Attention and Decision Process (n = 45), and Social/Professional Role & Identity (n = 31), while most healthcare professional-reported enablers were assigned to the TDF domains ECR (n = 143), Social Influences (n = 76), and Behavioural Regulation (n = 54). CONCLUSIONS Our scoping review presents a comprehensive overview of all barriers and enablers to physical activity during a hospital stay and highlights the prominent role of the TDF domains ECR and Social Influences in hospitalized patients' physical activity behavior. This TDF-based overview provides a theoretical foundation to guide clinicians and researchers in future intervention development and implementation. SCOPING REVIEW REGISTRATION No protocol was registered for this review.
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Affiliation(s)
- Sven Jacobus Gertruda Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands.
| | - Hanneke Corine van Dijk-Huisman
- Department of Physical Therapy, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6229HX, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
| | - Robert Adriaan de Bie
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & Sports, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Raoul Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Antoine François Lenssen
- Department of Physical Therapy, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6229HX, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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24
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de Foubert M, Cummins H, McCullagh R, Brueton V, Naughton C. Systematic review of interventions targeting fundamental care to reduce hospital-associated decline in older patients. J Adv Nurs 2021; 77:4661-4678. [PMID: 34240755 DOI: 10.1111/jan.14954] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/29/2021] [Accepted: 06/10/2021] [Indexed: 01/07/2023]
Abstract
AIMS To examine the effectiveness of targeted nursing interventions on mobilization, nutrition and cognitive engagement to reduce functional and hospital-associated decline (HAD) in older patients. DESIGN Systematic review of experimental studies using randomized and quasi-experimental designs. DATA SOURCES We searched electronic databases CINAHL, MEDLINE, EMBASE, Cochrane library, google scholar and BMJ quality reports from January 2009 to February 2020. REVIEW METHODS We reviewed intervention studies that targeted ward nursing teams to increase mobilization, nutrition or cognitive engagement of older adults. Inclusion criteria included older patients, acute care (medical, surgical and older adult wards) and reporting patient level outcomes. Quality appraisal included the Joanna Briggs Critical Appraisal Checklist for Quasi-Experimental Studies. RESULTS From 1729 papers, 18 studies using quasi-experimental and pre-post designs were selected. Study heterogeneity necessitated a narrative synthesis. The quality of evidence was low to moderate. All studies used multicomponent strategies, and 10 studies used evidence translation frameworks to align interventions to local barriers. Overall, 74% (n = 14) of studies reported a significant improvement in the stated primary outcome. Eight studies reported a significant increase in mobilization (e.g., sitting in a chair or walking), and four reported improved functional outcomes. Five studies improved nutrition outcomes (e.g., protein or energy intake), and three studies reported a significant reduction in delirium. CONCLUSION Acknowledging methodological limitations, the evidence indicates that nursing teams using evidence-translation frameworks can improve mobilization, nutrition and cognitive engagement in acute care settings. Future research requires higher-quality pragmatic trial designs, standardized outcomes, staff co-designed interventions, evidence-translation frameworks and patient engagement to make more confident inference about effectiveness. IMPACT Nursing teams with the support of hospital management have to address ward and system barriers to prioritize fundamental care to improve patient outcomes. There is sufficient evidence on multicomponent interventions and implementation strategies to inform nurse-led quality improvement.
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Affiliation(s)
- Marguerite de Foubert
- South Infirmary Victoria University Hospital, Cork, Ireland.,Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Cummins
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Valerie Brueton
- Formerly Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, United Kingdom
| | - Corina Naughton
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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25
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Johnson AM, Kuperstein J, Graham RH, Talari P, Kelly A, Dupont-Versteegden EE. BOOSTing patient mobility and function on a general medical unit by enhancing interprofessional care. Sci Rep 2021; 11:4307. [PMID: 33619329 PMCID: PMC7900133 DOI: 10.1038/s41598-021-83444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 02/02/2021] [Indexed: 11/09/2022] Open
Abstract
Low mobility during hospitalization remains prevalent despite associated negative consequences. The goal of this quality improvement (QI) project was to increase patient mobility and function by adding a physical therapist (PT) to an existing interprofessional care team. A mobility technician assisted treatment group patients with mobility during hospitalization based on physical therapist recommendations. Change in functional status and highest level of mobility achieved by treatment group patients was measured from admission to discharge. Observed hospital length of stay (LOS), LOS index, and 30-day all cause hospital readmission comparisons between treatment group and a comparison group on the same unit, and between cross-sectional comparison groups one year prior were used for Difference in Difference analysis. Bivariate comparisons between the treatment and a cross-sectional comparison group from one year prior showed a statistically significant change in LOS Index. No other bivariate comparisons were statistically significant. Difference in Difference methods showed no statistically significant change in observed LOS, LOS Index, or 30-day readmission. Patients in the treatment group had statistically significant improvements in functional status and highest level of mobility achieved. Physical function and mobility improved for patients who participated in mobility sessions. Mobility technicians may contribute to improved care quality and patient safety in the hospital.
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Affiliation(s)
- A M Johnson
- Department of Rehabilitation Science, College of Health Sciences, University of Kentucky, 900 S. Limestone Street, Lexington, KY 40536, USA.
| | - J Kuperstein
- Department of Rehabilitation Science, College of Health Sciences, University of Kentucky, 900 S. Limestone Street, Lexington, KY 40536, USA
| | - R Hogg Graham
- Department of Health and Clinical Sciences, College of Health Sciences, University of Kentucky, Lexington, USA
| | - P Talari
- Division of Hospital Medicine, University of Kentucky HealthCare, Lexington, USA
| | - A Kelly
- Department of Medicine, Center for Health Services Research, University of Kentucky, Lexington, USA
| | - E E Dupont-Versteegden
- Department of Rehabilitation Science, College of Health Sciences, University of Kentucky, 900 S. Limestone Street, Lexington, KY 40536, USA
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26
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Young D, Kudchadkar SR, Friedman M, Lavezza A, Kumble S, Daley K, Flanagan E, Hoyer E. Using Systematic Functional Measurements in the Acute Hospital Setting to Combat the Immobility Harm. Arch Phys Med Rehabil 2020; 103:S162-S167. [PMID: 33373600 DOI: 10.1016/j.apmr.2020.10.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
Abstract
Hospitalized patients often experience unnecessary immobility and inactivity leading to direct harms and poor outcomes. Despite growing evidence that early and regular mobility and activity are safe and helpful for patients in the hospital, there remains substantial room for improvement in clinical practice. Key to improvement is establishing an interdisciplinary approach to measurement and communication using a common language of function. Here we provide a framework for systematic functional measurement in the hospital. We also provide 3 specific examples of how this framework has been used to improve care: (1) targeting specialized rehabilitation providers to the patients most likely to need their services, (2) generating a daily mobility goal for all patients, and (3) identifying patients early who are likely to require postacute care.
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Affiliation(s)
- Daniel Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
| | - Sapna R Kudchadkar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kelly Daley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Eleni Flanagan
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Erik Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
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27
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Abstract
OBJECTIVE The aim of this study was to examine the effect of nurses' mobility plan use on patients' length of stay, discharge destination, falls, physical therapy consults, and nurses' knowledge, attitudes, and beliefs regarding patient mobility. BACKGROUND Functional decline due to decreased mobility during hospitalization results in diminished quality of life. Sixty-five percent of older inpatients lose the ability to ambulate during hospitalization and 30% do not regain that capability. METHODS Using a quasi-experimental design, nurses' use of a mobility assessment on 4 patient outcome variables was examined before (n = 2,259) and after (n = 3,649) use. Nurses' attitudes, knowledge, and beliefs regarding mobility were also examined. RESULTS Positive changes in patient variables occurred. Limited change occurred relative to nurses' knowledge, attitudes, and beliefs. CONCLUSIONS Implementing a nurse-led mobility plan enhances therapy resource utilization through identification of appropriate consults and improves patients' discharge home. In addition, nurses' knowledge, attitudes, and beliefs toward patient mobility planning can be positively influenced.
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28
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Johnson JK, Lapin B, Green K, Stilphen M. Frequency of Physical Therapist Intervention Is Associated With Mobility Status and Disposition at Hospital Discharge for Patients With COVID-19. Phys Ther 2020; 101:5912500. [PMID: 32986836 PMCID: PMC7543647 DOI: 10.1093/ptj/pzaa181] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/05/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE For patients diagnosed with the novel coronavirus, COVID-19, evidence is needed to understand the effect of treatment by physical therapists in the acute hospital on patient outcomes. The primary aims of this study were to examine the relationship of physical therapy visit frequency and duration in the hospital with patients' mobility status at discharge and probability of discharging home. METHODS This retrospective study included patients with COVID-19 admitted to any of 11 hospitals in 1 health system. The primary outcome was mobility status at discharge, measured using the Activity Measure for Post-Acute Care 6-Clicks basic mobility (6-Clicks mobility) and the Johns Hopkins Highest Level of Mobility scales. Discharge to home versus to a facility was a secondary outcome. Associations between these outcomes and physical therapy visit frequency or mean duration were tested using multiple linear or modified Poisson regression. Potential moderation of these relationships by particular patient characteristics was examined using interaction terms in subsequent regression models. RESULTS For the 312 patients included, increased physical therapy visit frequency was associated with higher 6-Clicks mobility (b = 3.63; 95% CI, 1.54-5.71) and Johns Hopkins Highest Level of Mobility scores (b = 1.15; 95% CI, 0.37-1.93) at hospital discharge and with increased probability of discharging home (adjusted relative risk = 1.82; 95% CI, 1.25-2.63). Longer mean visit duration was also associated with improved mobility at discharge and the probability of discharging home, though the effects were less pronounced. Few moderation effects were observed. CONCLUSION Patients with COVID-19 demonstrated improved mobility at hospital discharge and higher probability of discharging home with increased frequency and longer mean duration of physical therapy visits. These associations were not generally moderated by patient characteristics. IMPACT Physical therapy should be an integral component of care for patients hospitalized due to COVID-19. Providing sufficient physical therapist interventions to improve outcomes must be balanced against protection from viral spread. LAY SUMMARY Patients with COVID-19 can benefit from more frequent and longer physical therapy visits in the hospital.
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Affiliation(s)
- Joshua K Johnson
- Address all correspondence to Dr Johnson at: Rehabilitation and Sports Therapy. Cleveland Clinic, 9500 Euclid Ave, Cleveland, Ohio 44195-5243 (USA); ; @joshkj_dpt
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic
| | - Karen Green
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
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29
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Johnson JK, Fritz JM, Brooke BS, LaStayo PC, Thackeray A, Stoddard G, Marcus RL. Physical Function in the Hospital Is Associated With Patient-Centered Outcomes in an Inpatient Rehabilitation Facility. Phys Ther 2020; 100:1237-1248. [PMID: 32313956 DOI: 10.1093/ptj/pzaa073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 12/11/2019] [Accepted: 02/11/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Poor knowledge of the relationships between physical function (PF) in the hospital and patient outcomes in an inpatient rehabilitation facility (IRF) limits the identification of patients most appropriate for discharge to an IRF. This study aimed to test for independent associations between PF measured via the AM-PAC "6-clicks" basic mobility short form in the hospital and outcomes in an IRF. METHODS This was a retrospective cohort study. Primary data were collected from an acute hospital and IRF at 1 academic medical center. Associations were tested between PF at hospital admission or discharge and PF improvement in the IRF, discharge from the IRF to the community, and 30-day hospital events by estimating adjusted relative risk (aRR) using modified Poisson regression and the relative difference in IRF length of stay (LOS) using Gamma regression. RESULTS A total of 1323 patients were included. Patients with moderately low, (aRR = 1.50; 95% CI = 1.15-1.93), moderately high (aRR = 1.52; 95% CI = 1.16-2.01), or high (aRR = 1.37; 95% CI = 1.02-1.85) PF at hospital discharge were more likely than those with very low PF to improve their PF while in the IRF. These same patients were more likely to discharge from IRF to the community and had significantly shorter IRF LOS. Hospital-measured PF did not differentiate risk for 30-day hospital events. CONCLUSION Patients with moderate-but not very low or very high-PF measured near the time of acute hospital discharge were likely to achieve meaningful PF improvement in an IRF. They also had a shorter IRF LOS so may be ideal candidates for discharge to IRF. Prospective studies with larger samples are necessary to test this assertion. IMPACT Providers in the hospital should identify patients with moderate PF near the time of hospital discharge as those who may benefit most from post-acute rehabilitation in an IRF.
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Affiliation(s)
- Joshua K Johnson
- Cleveland Clinic Rehabilitation and Sports Therapy, 9500 Euclid Avenue, Cleveland, OH 44195 (USA); Cleveland Clinic Center for Value-Based Care Research; and Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah
| | - Benjamin S Brooke
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Paul C LaStayo
- Department of Physical Therapy and Athletic Training, University of Utah
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah
| | - Gregory Stoddard
- Department of Internal Medicine, University of Utah School of Medicine
| | - Robin L Marcus
- Department of Physical Therapy and Athletic Training, University of Utah
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30
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Abstract
The older adult population is growing in number and diversity, and this population has unique care needs that the current healthcare system is ill prepared to meet. In order to ensure older adults receive safe, person-centered care that supports their goals, the John A. Hartford Foundation has developed and, with their partners at the Institute for Healthcare Improvement, the American Hospital Association, and Catholic Health Association of the United States, is implementing across the United States the Age-Friendly Health Systems Initiative. This article provides an overview of the Age-Friendly Health Systems Initiative and how within it nurses can serve as leaders in ensuring age-friendly care for older adults.
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31
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Young DL, Kumble S, Capo-Lugo C, Littier H, Lavezza A, Hoyer E, Friedman M, Needham DM, Rogers D, Martin SC, Minnier T, Matcho BA, Euloth T, Ni P, Jette A. Measuring Mobility in Low Functioning Hospital Patients: An AM-PAC Replenishment Project. Arch Phys Med Rehabil 2020; 101:1144-1151. [PMID: 32173327 DOI: 10.1016/j.apmr.2020.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/11/2019] [Accepted: 01/23/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To expand an existing validated measure of basic mobility (Activity Measure for Post-Acute Care [AM-PAC]) for patients at the lowest levels of function. DESIGN Item replenishment for existing item response theory (IRT) derived measure via (1) idea generation and creation of potential new items, (2) item calibration and field testing, and (3) longitudinal pilot test. SETTING Two tertiary acute care hospitals. PARTICIPANTS Consecutive inpatients (N=502) ≥18 years old, with an AM-PAC Inpatient Mobility Short Form (IMSF) raw score ≤15. For the longitudinal pilot test, 8 inpatients were evaluated. RESULTS Fifteen new AM-PAC items were developed, 2 of which improved mobility measurement at the lower levels of functioning. Specifically, with the 2 new items, the floor effect of the AM-PAC IMSF was reduced by 19%, statistical power and measurement breadth were greater, and there was greater measurement sensitivity in longitudinal pilot testing. CONCLUSION Adding 2 new items to the AM-PAC IMSF lowered the floor and increased statistical power, measurement breadth, and sensitivity.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Carmen Capo-Lugo
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Heather Littier
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Annette Lavezza
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Erik Hoyer
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Michael Friedman
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Debra Rogers
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan C Martin
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tami Minnier
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Beth A Matcho
- Centers for Rehab Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tracey Euloth
- Centers for Rehab Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pengsheng Ni
- School of Public Health, Boston University, Boston, Massachusetts
| | - Alan Jette
- Department of Physical Therapy, MGH Institute, Boston, Massachusetts
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32
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Capo‐Lugo CE, Shumock K, Young DL, Klein L, Cassell A, Cvach M, Lavezza A, Friedman M, Bhatia E, Brotman DJ, Hoyer EH. Association between ambulatory status and call bell use in hospitalized patients—A retrospective cohort study. J Nurs Manag 2019; 28:54-62. [DOI: 10.1111/jonm.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Carmen E. Capo‐Lugo
- Department of Physical Therapy School of Health Professions University of Alabama at Birmingham Birmingham Alabama
- Department of Physical Medicine and Rehabilitation School of Medicine Johns Hopkins University Baltimore Maryland
| | | | - Daniel L. Young
- Department of Physical Medicine and Rehabilitation School of Medicine Johns Hopkins University Baltimore Maryland
- Department of Physical Therapy University of Nevada, Las Vegas Las Vegas Nevada
| | - Lisa Klein
- Johns Hopkins Hospital Baltimore Maryland
| | - Andre Cassell
- Department of Physical Medicine and Rehabilitation Johns Hopkins Hospital Baltimore Maryland
| | - Maria Cvach
- Johns Hopkins Health System Baltimore Maryland
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation Johns Hopkins Hospital Baltimore Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation Johns Hopkins Hospital Baltimore Maryland
| | - Elys Bhatia
- Johns Hopkins Health System Baltimore Maryland
| | | | - Erik H. Hoyer
- Department of Physical Medicine and Rehabilitation School of Medicine Johns Hopkins University Baltimore Maryland
- Department of Physical Medicine and Rehabilitation Johns Hopkins Hospital Baltimore Maryland
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