Can Mobility Technicians Provide Value to Hospitalized Patients?
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 试验地点
- 1
- 主要终点
- AM-PAC 6 Clicks score
研究概览
简要总结
The specific aim of this study is to determine the impact of the addition of a dedicated mobility technician to the care team on specialty specific outcomes for patients recovering from surgical treatment for a hip or lower extremity long bone fracture or a lung transplant.
The practice of post-operative early ambulation has been shown to improve outcomes by promoting enhanced recovery after surgery in a variety of patients. To that end, VUMC is establishing a "Culture of Mobility". To do so, additional personnel are being hired to help ambulate patients with traumatic hip and femur fractures, other fractures of the lower extremity long bones, as well as those post-lung transplant or readmitted post-lung transplant based upon the best available evidence supporting mobility programs. The added personnel are needed as the currently available resources have insufficient bandwidth to ensure complete early ambulation for all patients. The relative effectiveness of adding a dedicated resource is assumed. Although the literature suggests adding person-hours increases the amount of mobility achieved, there is an opportunity to evaluate whether this is really the case.
The goal of this study is to evaluate the impact of adding the mobility technician to the existing care team. The mobility technician will be assisting patients who could benefit from early ambulation after surgery. We hypothesize that by adding this staffing resource, more patients will get the appropriate level of usual care. Specifically, we expect that adding the resource increases the proportion of those patients who are receiving the prescribed amount of early ambulation post-surgery, with subsequent improvements in functional independence at discharge, and decreases length of stay since patients achieve readiness for discharge sooner.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All traumatic fractures of the hip or a lower extremity long bone
- •Post-lung transplant patient
- •Patient readmitted following a lung transplant
排除标准
- •Non-traumatic joint replacements
- •Patients with ankle fractures
- •Pre-lung transplant patients
- •Patients readmitted to the orthopedics unit following a traumatic injury
研究组 & 干预措施
10th floor south
The unit in this arm will be assigned physical therapists plus mobility technicians in the first month and only physical therapists in the following month.
During months where a unit has been assigned the mobility technicians, the mobility technician, along with nursing staff, will deliver additional prescribed mobility as well as standard-of-care prescribed therapy provided by physical therapy staff:
- On evaluation, a PT will assign a JH-HLM scale rating to the patient
- If the score is 4 or higher, the PT will add the patient to the mobility technician patient list
- The mobility technician will then see that patient daily, unless the score is <4
- Each PT session will involve a re-assessment by the PT of the JH-HLM scale rating as well as the Function Independence Measurement (FIM) score, and subsequently will update the recommended therapy if appropriate
- The mobility technician will work with PT and nursing to determine the best time to deliver mobility
干预措施: Patient Mobility (Behavioral)
6th floor Round Wing
The unit in this arm will be assigned only physical therapists in the first month and physical therapists plus mobility technicians in the following month.
During months where a unit has been assigned the mobility technicians, the mobility technician, along with nursing staff, will deliver additional prescribed mobility as well as standard-of-care prescribed therapy provided by physical therapy staff:
- On evaluation, a PT will assign a JH-HLM scale rating to the patient
- If the score is 4 or higher, the PT will add the patient to the mobility technician patient list
- The mobility technician will then see that patient daily, unless the score is <4
- Each PT session will involve a re-assessment by the PT of the JH-HLM scale rating as well as the Function Independence Measurement (FIM) score, and subsequently will update the recommended therapy if appropriate
- The mobility technician will work with PT and nursing to determine the best time to deliver mobility
干预措施: Patient Mobility (Behavioral)
结局指标
主要结局
AM-PAC 6 Clicks score
时间窗: 7 days post ICU discharge +/- 1 day for post-lung transplant patients and day 7 +/- 1 days for readmitted post-lung transplant patients. Raw scores range from 6-24, where a lower number suggests higher functional/mobile impairment.
The AM-PAC 6 clicks score will be the co-primary outcome for this study within the transplant population and is a measurement that helps describe patient basic mobility. This score will be obtained for this study from the Electronic Medical Record (EMR)
Length of Stay
时间窗: Admission to discharge (usually less than 1 week)
The primary outcome for this study will be length of stay (LOS), defined as time from admission to the unit to discharge from the unit in days. The LOS will be obtained for this study from the Electronic Medical Record (EMR).
次要结局
- Johns Hopkins Highest Level of Mobility (JH-HLM) score(At discharge (usually less than 1 week after admission))
- Total amount of mobility therapy(Admission to discharge (usually less than 1 week))
- Amount of ambulation(Admission to discharge (usually less than 1 week))
- Function Independence Measurement (FIM) score(At discharge (usually less than 1 week after admission))
研究者
Heather Skaar
Administrative Director, Physical Medicine & Rehabilitation Acute Care, Dayani Center, Orthopaedic Therapy
Vanderbilt University Medical Center