Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial
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 patie...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Trials |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13063-023-07501-y |
| _version_ | 1827890229375139840 |
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| author | Joshua K. Johnson Aaron C. Hamilton Bo Hu Quinn R. Pack Peter K. Lindenauer Robert J. Fox Ardeshir Hashmi Lee Anne Siegmund Christian N. Burchill Glen B. Taksler Toyomi Goto Mary Stilphen Michael B. Rothberg |
| author_facet | Joshua K. Johnson Aaron C. Hamilton Bo Hu Quinn R. Pack Peter K. Lindenauer Robert J. Fox Ardeshir Hashmi Lee Anne Siegmund Christian N. Burchill Glen B. Taksler Toyomi Goto Mary Stilphen Michael B. Rothberg |
| author_sort | Joshua K. Johnson |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T21:06:42Z |
| format | Article |
| id | doaj.art-2466358fb9164a9caf330b534bafc236 |
| institution | Directory Open Access Journal |
| issn | 1745-6215 |
| language | English |
| last_indexed | 2024-03-12T21:06:42Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Trials |
| spelling | doaj.art-2466358fb9164a9caf330b534bafc2362023-07-30T11:24:06ZengBMCTrials1745-62152023-07-0124111410.1186/s13063-023-07501-yAssisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trialJoshua K. Johnson0Aaron C. Hamilton1Bo Hu2Quinn R. Pack3Peter K. Lindenauer4Robert J. Fox5Ardeshir Hashmi6Lee Anne Siegmund7Christian N. Burchill8Glen B. Taksler9Toyomi Goto10Mary Stilphen11Michael B. Rothberg12Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland ClinicDepartment of Hospital Medicine, Cleveland ClinicDepartment of Quantitative Health Sciences, Cleveland ClinicDepartment of Healthcare Delivery and Population Science, University of Massachusetts Medical School-BaystateDepartment of Healthcare Delivery and Population Science, University of Massachusetts Medical School-BaystateMellen Center for Treatment and Research in Multiple Sclerosis, Neurological Institute, Cleveland ClinicCenter for Geriatric Medicine, Cleveland ClinicOffice of Nursing Research and Innovation, and Consultant Staff, Lerner Research Institute, Cleveland ClinicPenn Medicine Lancaster General HospitalCenter for Value-Based Care Research, Cleveland ClinicCenter for Value-Based Care Research, Cleveland ClinicRehabilitation and Sports Therapy, Neurological Institute, Cleveland ClinicCenter for Value-Based Care Research, Cleveland ClinicAbstract 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.https://doi.org/10.1186/s13063-023-07501-yAmbulationActivityMobilityOlder adultsGeriatricsHospital |
| spellingShingle | Joshua K. Johnson Aaron C. Hamilton Bo Hu Quinn R. Pack Peter K. Lindenauer Robert J. Fox Ardeshir Hashmi Lee Anne Siegmund Christian N. Burchill Glen B. Taksler Toyomi Goto Mary Stilphen Michael B. Rothberg Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial Trials Ambulation Activity Mobility Older adults Geriatrics Hospital |
| title | Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial |
| title_full | Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial |
| title_fullStr | Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial |
| title_full_unstemmed | Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial |
| title_short | Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial |
| title_sort | assisted ambulation to improve health outcomes for older medical inpatients ambulate study protocol for a randomized controlled trial |
| topic | Ambulation Activity Mobility Older adults Geriatrics Hospital |
| url | https://doi.org/10.1186/s13063-023-07501-y |
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