A Feasibility and Acceptability Study of a Virtual Multimodal Intervention Delivered by Volunteers to Improve Functional Outcomes of Frail Older Adults Discharged From Hospital

Study design A quasi-experimental mixed methods approach will be used to determine the feasibility and acceptability of implementing a volunteer-led multi-modal intervention for discharged older adults with frailty. This feasibility study will be conducted at the University Hospital Southampton NHS Foundation Trust (UHS), training hospital volunteers to deliver virtual group support for older adults discharged from UHS. The acceptability of the intervention will also be examined through qualitative interviews to explore the views and experiences of volunteers, trainers, carers and older adults involved in this study. The impact of the intervention on physical activity levels and functional outcomes will be measured.

Participants Older adults aged 65 years or above with frailty (clinical frailty score ≥5) who have been discharged from UHS will be invited to participate in this study. Participants must be able to walk at least a few steps upon hospital discharge and be cleared by their clinician as safe to exercise. Patients will be identified and approached by their clinical care team, if they are interested in participating in the research a member of the research team will obtain written informed consent. A sample size of 30 participants was chosen in line with previous sample size recommendations for feasibility studies of 24-50 participants. This sample size was considered an appropriate number that is pragmatic and achievable within the study timescale and resources available.

Recruitment and training of volunteers Volunteers from the UHS patient support hub will be invited to participate in the study and receive training to deliver the intervention. Volunteers aged 16 years or above who have completed the generic volunteer clearance and training at the hospital and who are safe to exercise will be identified by hospital voluntary services. Interested volunteers will be approached by a member of the research team to complete written informed consent. A sample size of 6 volunteers was chosen to provide sufficient cover to deliver the Frail2Fit intervention to small groups of older adults with 2 volunteers supporting each group.

The volunteer training programme will consist of a bespoke training package adapted from the SafeFit training guidance, supported, and delivered by an expert dietician (Prof Jane Murphy), psychologist (Judit Varkonyi-Sepp), and clinical exercise instructor, Dr Samantha Meredith (SM), and led by the PI, Dr Stephen Lim (SL). Training will be conducted at UHS for 2 days and 1 day of online training. The training sessions will include training on personal safety and safety of participants, and the exercise, nutrition and behaviour change protocols. As these are existing volunteers, they would have been recruited, and received the generic clearance and training provided by UHS. Throughout the study period, fidelity checks will be conducted by SM and SL to ensure that the volunteers are delivering high quality exercise sessions. Volunteers will also receive training on how to document adverse events that occur during the classes.

Intervention The intervention duration will be 3 months. Participants will receive three group sessions per week for 1 month (weeks 1-4), twice per week for the second month (weeks 5-8), and once weekly for the last month (weeks 9-12), with a maximum of 24 sessions. The tapered nature of the intervention was chosen to provide suitable support for older adults post-discharge with the aim to gradually encourage increased self-management to foster independence post-intervention. Components of the intervention, including exercise, nutrition support and behaviour change support, will be delivered from an online platform (Zoom). Each group session will last 40-60 minutes, including 20-30 minutes of exercise followed by 20-30 minutes of nutrition support. The components of the intervention and the training package have been adapted from the SafeFit trial and will be delivered in line with behaviour change principles to maximise participant uptake, adherence and lifestyle self-management.