Walking for Better Outcomes and Recovery: The Effect of WALK-FOR in Preventing Hospital-Associated Functional Decline Among Older Adults

Abstract

Background In-hospital immobility of older adults is associated with hospital-associated functional decline (HAFD). This study examined the WALK-FOR program’s effects on HAFD prevention. Methods A quasi-experimental pre-post two-group (intervention group [IG] n = 188, control group [CG] n = 189) design was applied in two hospital internal medical units. On admission, patients reported pre-hospitalization functional status, which was assessed again at discharge and 1-month follow-up. Primary outcome was decline in basic activities of daily living (BADL), using the Modified Barthel Index. Secondary outcomes were decline in instrumental ADL (Lawton’s IADL scale) and community mobility (Yale Physical Activity Survey). All participants (75.1 ± 7 years old) were cognitively intact and ambulatory at admission. The WALK-FOR included a unit-tailored mobility program utilizing patient-and-staff education with a specific mobility goal (900 steps per day), measured by accelerometer. Results Decline in BADL occurred among 33% of the CG versus 23% of the IG (p = .02) at discharge, and among 43% of the CG versus 30% in the IG (p = .01) at 1-month follow-up. Similarly, 26% of the CG versus 15% of the IG declined in community mobility at 1-month follow-up (p = .01). Adjusted for major covariates, the intervention reduced the odds of decline in BADL by 41% (p = .05) at discharge and by 49% at 1-month follow-up (p = .01), and in community mobility by 63% (p = .02). There was no significant effect of the intervention on IADL decline (p = .19). Conclusions The WALK-FOR intervention is effective in reducing HAFD.

A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalization

“…Intervention group participants reportedly achieved higher daily step counts and/or more time spent active with individualized physiotherapy (for people undergoing thoracic surgery for lung cancer), 42 and with an early mobility bundle 26 or a system change approach (for older adults). 43 In the self-monitoring randomized-trials, feedback by either accelerometry or an activity whiteboard reportedly increased steps/day as compared to control group care, 21,36,39 although this was only for people who underwent laparoscopic (rather than open) abdominal surgery in one study. 38 Time spent in light and/ or moderate intensity physical activity reportedly improved over hospitalization in patients recovering from ischaemic stroke using self-monitoring, 36 and this was similar to reported improvements in steps/day and time spent in moderate physical activity with provision of an activity booklet.…”

“…28 These studies were similar to those that implemented complex system changes which sought to re-work practises and culture, rather than delivering individualized or intensive therapy. The implementation projects educated staff 22,43 and patients, 43 sought to understand staff roles and developed staff competence through guidance, motivation, role-modelling and supervision. 22,43 Change was supported by addressing barriers relating to the environment (walking aid availability 26,43 ) and policy (mandatory reporting 43 ).…”

“…Data were collected on patient satisfaction in two studies, 29,41 self-efficacy for physical activity in two studies, 35,36 fear of falling in one study 22 and beliefs about mobility in one study. 43 Studies suggested that future interventions could be improved by personalization for patient preference (such as the number of days/ week or times of day for exercise), adaptations for people with different levels of cognitive and physical capability (e.g. lower intensity for participants with severe limitations, higher intensity physical activity options for participants with functional ability, or programs for low risk groups with short lengths of stay), selection of outcome measures (that cover psychological outcomes, self-assessment of recovery, pre-morbid physical activity and discharge disposition) and have either a post-discharge component to intervention delivery or longer follow up.…”

“…Guinan et al 32 Time spent in light, moderate and vigorous intensity activity (min/day and total accumulated); total active min/day; steps/day (and total accumulated) Cohen et al 43 Ave. steps/day; participants who walked >900 steps/day recovering from traumatic fractures. 22 Of the studies in surgical patient groups that expressed physical activity as a rate of recovery compared to pre-operative values, the less invasive laparoscopic/mini procedures were reported to result in faster recovery than open repair, 27,44 while there was no difference reported in recovery as a result of wearing plain clothes instead of a hospital gown.…”

Scaling-up implementation in community hospitals: a multisite interrupted time series design of the Mobilization of Vulnerable Elders (MOVE) program in Alberta

“…Functional decline in hospital can be prevented by early mobilization [8–11]. However, currently hospitalized older adults spend most of their stay in bed [12, 13].…”