Help Optimise and Mobilise Elders (H.O.M.E)

Not Applicable

• Conditions: Functional Disturbance; Mobility Limitation
• Interventions: Other: Multicomponent, mobility-focused intervention

• Registration Number: NCT05484063
• Lead Sponsor: JurongHealth

Brief Summary

During hospitalisations, older inpatients commonly face issues such as immobility, loss of independence, and functional decline. This leads them down the cascade of dependency with consequent increased risk of adverse outcomes, institutionalisation as well as higher post-acute care costs. The investigators hypothesize that by implementing a mobility intervention in the inpatient setting, patients would be able to maintain their function upon discharge and avoid the cascade of dependency. As such, the investigators aim to do this by implementing and evaluating a mobility intervention, while optimising reversible factors affecting mobility among inpatients admitted to a geriatric unit in Singapore. The investigators will also examine the cost impact of a mobility focused model of care and also adopt the effectiveness-implementation hybrid Type 2 design where both effectiveness and implementation spheres are tested simultaneously.

Detailed Description

Aim 1: To examine the effectiveness of multicomponent, mobility-focused model of care in reducing iatrogenic complications and improving patient outcomes. Adopting the Institute for Healthcare Improvement's (IHI) 4Ms framework ("Mobility", "Mentation, "Medication", and "What Matters"), the investigators will examine the effectiveness of timely and individually catered mobility interventions which not only increase mobilization but also optimize factors inhibiting mobility for elderly inpatients. It is hypothesized that the mobility outcomes, such as maximum distance walked and mobilization frequency will be significantly improved for patients who receive the intervention compared to those who receive standard care.

Aim 2: To examine the cost impact of a mobility-focused model of care. The investigators will examine whether the cost of these multicomponent, mobility-focused interventions can be offset from cost savings from early mobilisation benefits, by comparing healthcare utilization costs between-groups. Further to that, a cost effectiveness analysis will be performed should functional effectiveness be observed. For the primary cost impact objective, it is hypothesized that the cost savings arising from reduction in bed days of hospitalization and other medical costs incurred during study period will outweigh the cost of implementing this model of care. In addition, it is also hypothesized that the proposed intervention will be cost-effective through achieving better functional outcomes for patients, with lower costs required.

Aim 3: To evaluate the implementation outcomes of multicomponent, mobility-focused model of care in the process of this intervention. It is hypothesized that this intervention will have good acceptability, feasibility, penetration, implementation costs and sustainability.

Study Timeline

• Status Verified: 2022-06
• Study First Submitted: 2022-06-25
• Study Start: 2022-07-25
• Study First Submitted QC: 2022-08-01
• Last Update Submitted: 2022-08-01
• Study First Posted: 2022-08-02
• Last Update Posted: 2022-08-02
• Primary Completion: 2023-01-31
• Study Completion: 2023-09-30

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 90

Inclusion Criteria

• Newly admitted patients to the geriatric service
• Aged 75 years and above
• Mobile with or without the use of a walking aid

Exclusion Criteria

• Vancomycin-resistant enterococcus (VRE) status
• Requires droplet or airborne precautions
• Critically ill
• Haemodynamically instability
• Requires more than 4-hourly parameters
• Systolic blood pressure <90 mmHg
• Heart rate >100beats/min
• Non-ambulant patients
• With advanced dementia (Functional Assessment Staging Scale [FAST] 7 dementia)
• Fulfills direct admission to another subspecialty unit

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Multicomponent, mobility-focused intervention	Intervention group will receive a multicomponent, mobility-focused intervention during the course of inpatient admission.

Primary Outcome Measures

Name	Time	Method
Change in maximum distance walked	Upon admission and at the point of discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)	The total distance covered by the research participant (in meter)
Mobilisation frequency	Through the duration of admission	Number of times mobilised. The average mobilisation frequency will be calculated by dividing the sum by the number of admission days.

Secondary Outcome Measures

Name	Time	Method
Change in modified barthel score	Upon admission, at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay), and one-month post discharge	The score ranges from 0 to 100 with 0 as the worst outcome
Change in gait speed	Upon admission and at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)	4 meter gait speed test (meter/second)
Inpatient length of stay and discharge location	The duration of admission and upon discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)	The duration of admission (days) and the location the respective participant is discharged to
Presence of common iatrogenic complications such as delirium, injurious falls, pressure ulcers, and venous thromboembolisms	At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)	Each of the complication will be measured in nominal scale; 0 denotes the absence of the complication while 1 denotes the presence of the complications. The total number of complications arise will be calculated. The greater the number indicates poorer outcome
Gross amount of patient's bill during index admission, considering subsidy level	At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)	The total gross amount of participant's bill during index admission. The subsidy level will be documented
The intervention related costs for group therapy	At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)	The number of group therapy sessions attended by the participant multiply by the cost for one group therapy session. The subsidy level will be documented.

Trial Locations

Locations (2)

Geriatrics Education and Research Institute; 🇸🇬 Singapore, Singapore

Ng Teng Fong Hospital; 🇸🇬 Singapore, Singapore