Perceived acceptability and preferences for low-intensity early activity interventions of older hospitalized medical patients exposed to bed rest: a cross sectional study

Abstract

BackgroundHospitalized older patients spend most of their time in bed, putting them at risk of experiencing orthostatic intolerance. Returning persons to their usual upright activity level is the most effective way to prevent orthostatic intolerance but some older patients have limited activity tolerance, supporting the need for low-intensity activity interventions. Consistent with current emphasis on patient engagement in intervention design and evaluation, this study explored older hospitalized patients’ perceived acceptability of, and preference for, two low-intensity early activity interventions (bed-to-sitting and sitting-to-walking), and characteristics (gender, illness severity, comorbidity, illnesses and medications with orthostatic effects, and baseline functional capacity) associated with perceived acceptability and preference.MethodsA convenience sample was recruited from in-patient medical units of two hospitals in Ontario, Canada and included 60 cognitively intact adults aged 65+ who were admitted for a medical condition within the past 72 h, spent ≥ 24 consecutive hours on a stretcher or in bed, presented with ≥ 2 chronic diseases, understood English, and were able to ambulate before admission. A cross-sectional observational design was used. Participants were presented written and oral descriptions and a 2-min video of each intervention. The sequence of the interventions’ presention was randomized. Following the presentation, a research nurse administered measures of perceived acceptability and preference, and collected health and demographic data. Perceived acceptability and preference for the interventions were measured using the Treatment Acceptability and Preferences Scale. Illness severity was measured using the Modified Early Warning Score. Comorbidity was assessed with the Age Adjusted Charlson Comorbidity Scale and the Cumulative Illness Rating Scale – for Geriatrics. Baseline functional capacity was measured using the Duke Activity Status Index.ResultsParticipants’ perceived acceptability of both interventions clustered above the scale midpoint. Most preferred the sitting-to-walking intervention (n = 26; 43.3%). While none of the patient characteristics were associated with intervention acceptability, illness severity (odds ratio = 1.9, p = 0.04) and medications with orthostatic effects (odds ratio = 9.9, p = 0.03) were significantly associated with intervention preference.ConclusionsThe interventions examined in this study were found to be acceptable to older adults, supporting future research examining their feasibility and effectiveness.

Health-related preferences of older patients with multimorbidity: an evidence map

“…Thirty-two studies (22 %) investigated a variety of treatment preferences concerning (1) medication (13/32),37 41–43 47 49 53 54 105–108 perhaps for a specific blood pressure-lowering drug due to its characteristics (eg, effects and dose schedule),106 (2) dialysis as a treatment option in end-stage renal disease (6/32),48 109–113 (3) surgery (4/32),114–117 such as a decision in favour of implantable cardioverter-defibrillators or joint replacement, (4) chemotherapy (5/32),35 57 118–120 for which studies may have examined preferences in adjuvant cancer treatments and (5) non-pharmacological/conservative interventions (3/32),121–123 such as studies exploring preferences for activity interventions 121…”

The Role of Treatment Perceptions in Intervention Evaluation: A Review

“…It denotes the appraisal of an intervention relative to four attributes: appropriateness in addressing the health problem, anticipated effectiveness in improving the health problem, potential risks or discomforts, and convenience or ease with which participants can implement an intervention and its respective treatment recommendations in daily life (Diller et al, 2013;Lengel & Mullins-Sweat, 2017;Miner et al, 2016). Acceptability reflects the desirability of an intervention to potential participants; it is commonly assessed independently of exposure to the intervention (Elliott, 1988) as illustrated in a large number of descriptive studies (e.g., Bluestein et al, 2011;Elliott & Hunsley, 2015;Fox et al, 2018;Sidani et al, 2018a).…”

“…The description: states the intervention's name; clarifies its goals; delineates its main components and activities, and the treatment recommendations that participants are to carry out; specifies the mode and dose at which the intervention is delivered; and identifies the benefits and risks associated with the intervention. In step 2, participants rate the intervention relative to four attributes: perceived appropriateness, effectiveness, risks and convenience (Fox et al, 2018;Sidani et al, 2018a). This rating helps participants recognize what they value most about the intervention that makes it more or less desirable (Harrison et al, 2014).…”

“…Participants review the description of each treatment under consideration and rate its acceptability. Once they have rated all treatments, they indicate the one they prefer (Fox et al, 2018;Sidani et al, 2018a). Having participants rate all interventions prior to indicating their preference helps them to clarify the attributes they value most, and compare and contrast the different interventions relative to the most valued attributes.…”

155Home Visits: A New Screening Tool For Frailty? A Retrospective Study

“…This is the definition of frailty. Furthermore, there are studies demonstrating outcomes of hospitalization, institutionalization, morbidity, and mortality in older people with falls,[789] delirium,[1011] incontinence[12] immobility,[1314] and adverse drug reactions. [15]…”