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Szeto K, Arnold J, Maher C. The Wearable Activity Tracker Checklist for Healthcare (WATCH): a 12-point guide for the implementation of wearable activity trackers in healthcare. Int J Behav Nutr Phys Act 2024; 21:30. [PMID: 38481238 PMCID: PMC10938760 DOI: 10.1186/s12966-024-01567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/27/2024] [Indexed: 03/17/2024] Open
Abstract
Increasing physical activity in patients offers dual benefits, fostering improved patient health and recovery, while also bolstering healthcare system efficiency by minimizing costs related to extended hospital stays, complications, and readmissions. Wearable activity trackers offer valuable opportunities to enhance physical activity across various healthcare settings and among different patient groups. However, their integration into healthcare faces multiple implementation challenges related to the devices themselves, patients, clinicians, and systemic factors. This article presents the Wearable Activity Tracker Checklist for Healthcare (WATCH), which was recently developed through an international Delphi study. The WATCH provides a comprehensive framework for implementation and evaluation of wearable activity trackers in healthcare. It covers the purpose and setting for usage; patient, provider, and support personnel roles; selection of relevant metrics; device specifications; procedural steps for issuance and maintenance; data management; timelines; necessary adaptations for specific scenarios; and essential resources (such as education and training) for effective implementation. The WATCH is designed to support the implementation of wearable activity trackers across a wide range of healthcare populations and settings, and in those with varied levels of experience. The overarching goal is to support broader, sustained, and systematic use of wearable activity trackers in healthcare, therefore fostering enhanced physical activity promotion and improved patient outcomes.
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Affiliation(s)
- Kimberley Szeto
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, North Terrace, GPO Box 2471, 5001, Adelaide, SA, Australia
| | - John Arnold
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, North Terrace, GPO Box 2471, 5001, Adelaide, SA, Australia
| | - Carol Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, North Terrace, GPO Box 2471, 5001, Adelaide, SA, Australia.
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Lynch DH, Mournighan K, Dale M, Spangler HB, Gotelli J, Davis R, Felton K, Lingley-Brown K, Busby-Whitehead J, Batsis JA, Hanson LC. Establishing and sustaining an acute care for elders unit: An incremental journey to success. J Am Geriatr Soc 2023; 71:3031-3039. [PMID: 37610294 DOI: 10.1111/jgs.18561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
Acute Care for Elders (ACE) units reduce hospital-associated delirium, functional decline, and lengths of stay. However, establishing and sustaining such units have proven difficult. There are only 43 ACE units among the >3500 hospitals in the United States. This study describes an iterative quality improvement process, which allowed us to establish and sustain an ACE unit care model in a modern academic hospital. This continuous process was centered on implementing the key principles of the ACE unit model of care: patient-centered care assessments, medical care review, specialized prepared environment, early mobilization, physical therapy, and early planning for discharge to home. Quality of care and patient outcomes data for older adults admitted to our ACE unit includes mortality index (observed/expected) consistently <1 (FY22 = 0.86), 30-day readmission rate of <10% (FY22 9.31%), and length of stay index of ~1 (FY22 1.07). We describe how work on our ACE unit has led to hospital-wide initiatives, including dementia-friendly hospital certification. Our hope is that others can use this process to enhance the dissemination of the ACE unit model of care.
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Affiliation(s)
- David H Lynch
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly Mournighan
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maureen Dale
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hillary B Spangler
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Gotelli
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ronald Davis
- University of North Carolina Hospital at Chapel Hill, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kittra Felton
- University of North Carolina Hospital at Chapel Hill, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kara Lingley-Brown
- University of North Carolina Hospital at Chapel Hill, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John A Batsis
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura C Hanson
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
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Wang G, Zhang L, Ji T, Zhang W, Peng L, Shen S, Liu X, Shi Y, Chen X, Chen Q, Li Y, Ma L. A protocol for randomized controlled trial on multidisciplinary interventions for mobility limitation in the older adults (M-MobiLE). BMC Geriatr 2023; 23:476. [PMID: 37553604 PMCID: PMC10410791 DOI: 10.1186/s12877-023-04117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/16/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Mobility limitation-the loss of exercise capacity or independent living ability-is a common geriatric syndrome in older adults. As a potentially reversible precursor to disability, mobility limitation is influenced by various factors. Moreover, its complex physiological mechanism hinders good therapeutic outcomes with a single-factor intervention. Most hospitals have not incorporated the diagnosis and evaluation of mobility limitation into medical routines nor developed a multidisciplinary team (MDT) treatment plan. We aim to conduct a clinical trial titled "A Multidisciplinary-team approach for management of Mobility Limitation in Elderly (M-MobiLE)" to explore the effect of the MDT decision-making intervention for mobility limitation. METHODS The M-MobiLE study will be a multicenter, randomized, and controlled trial. We will recruit a minimum of 66 older inpatients with mobility limitation from at least five hospitals. Older patients with mobility limitation admitted to the geriatrics department will be included. Short-Physical Performance Battery (SPPB), Activities of Daily Living (ADL), Function Impairment Screening Tool (FIST), Geriatric Depression Scale (GDS-15), Short Form - 12 (SF-12), Fried frailty phenotype, social frailty, Morse Fall Risk Scale, SARC-CalF, Mini-Mental State Examination (MMSE), Mini-Nutritional Assessment Short-Form (MNA-SF), and intrinsic capacity will be assessed. The intervention group will receive an exercise-centered individualized MDT treatment, including exercise, educational, nutritional, medical, and comorbidity interventions; the control group will receive standard medical treatment. The primary outcome is the change in the SPPB score, and the secondary outcomes include increased SF-12, ADL, FIST, MMSE, MNA-SF, and intrinsic capacity scores and decreased GDS-15 and SARC-CalF scores. CONCLUSION Our results will help develop a multidisciplinary decision-making clinical pathway for inpatients with mobility limitation, which can be used to identify patients with mobility limitation more effectively, improve mobility, and reduce the risk of falls, frailty, and death in older inpatients. The implementation of this MDT strategy may standardize the treatment of mobility limitation, reduce adverse prognosis, and improve quality of life. TRIAL REGISTRATION ChiCTR, ChiCTR2200056756, Registered 19 February 2022.
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Affiliation(s)
- Guanzhen Wang
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Li Zhang
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tong Ji
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wanshu Zhang
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Linlin Peng
- Department of Geriatrics, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shanshan Shen
- Department of Geriatrics, Zhejiang hospital, Hangzhou, China
| | - Xiaolei Liu
- Department of Geriatrics, West China Hospital Sichuan University, Chengdu, China
| | - Yanqing Shi
- Department of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang hospital, Hangzhou, China
| | - Qiong Chen
- Department of Geriatrics, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yun Li
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Lina Ma
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China.
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Szeto K, Arnold J, Singh B, Gower B, Simpson CEM, Maher C. Interventions Using Wearable Activity Trackers to Improve Patient Physical Activity and Other Outcomes in Adults Who Are Hospitalized: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2318478. [PMID: 37318806 PMCID: PMC10273021 DOI: 10.1001/jamanetworkopen.2023.18478] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
Abstract
Importance Low levels of physical activity during hospitalization are thought to contribute to a range of poor outcomes for patients. Using wearable activity trackers during hospitalization may help improve patient activity, sedentary behavior, and other outcomes. Objective To evaluate the association of interventions that use wearable activity trackers during hospitalization with patient physical activity, sedentary behavior, clinical outcomes, and hospital efficiency outcomes. Data Sources OVID MEDLINE, CINAHL, Embase, EmCare, PEDro, SportDiscuss, and Scopus databases were searched from inception to March 2022. The Cochrane Central Register for Controlled trials, ClinicalTrials.gov, and World Health Organization Clinical Trials Registry were also searched for registered protocols. No language restrictions were imposed. Study Selection Randomized clinical trials and nonrandomized clinical trials of interventions that used wearable activity trackers to increase physical activity or reduce sedentary behavior in adults (aged 18 years or older) who were hospitalized were included. Data Extraction and Synthesis Study selection, data extraction, and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Main Outcomes and Measures The primary outcomes were objectively measured physical activity or sedentary behavior. Secondary outcomes included clinical outcomes (eg, physical function, pain, mental health), and hospital efficiency outcomes (eg, length of stay, readmission). Results Fifteen studies with a total of 1911 participants were included, representing various surgical cohorts (4 studies), stroke rehabilitation (3 studies), orthopedic rehabilitation (3 studies), mixed rehabilitation (3 studies), and mixed medical (2 studies). All studies were included in meta-analyses. There was a significant association between wearable activity tracker interventions with higher overall physical activity (standardized mean difference, 0.35; 95% CI, 0.15 to 0.54; I2 = 72%; P < .002) and less sedentary behavior (mean difference, -35.46 min/d; 95% CI, -57.43 to -13.48 min/d; I2 = 0; P = .002), and a significant association between wearable activity tracker interventions with improvements in physical function (standardized mean difference, 0.27; 95% CI, 0.08 to 0.46; I2 = 0; P = .006) compared with usual care. There was no significant association between wearable activity tracker interventions with pain, mental health, length of stay, or readmission risk. Conclusions and Relevance In this systematic review and meta-analysis, interventions that used wearable activity trackers with patients who are hospitalized were associated with higher physical activity levels, less sedentary behavior, and better physical functioning compared with usual care.
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Affiliation(s)
- Kimberley Szeto
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - John Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Ben Singh
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Bethany Gower
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Catherine E. M. Simpson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
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Bruening RA, Sperber N, Wang V, Mahanna E, Choate A, Tucker M, Zullig LL, Van Houtven CH, Allen KD, Hastings SN. Self-Organization of Interprofessional Staff to Improve Mobility of Hospitalized Patients with STRIDE: a Complexity Science-Informed Qualitative Study. J Gen Intern Med 2022; 37:4216-4222. [PMID: 35319083 PMCID: PMC9708971 DOI: 10.1007/s11606-022-07482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/03/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Inpatient mobility programs can help older adults maintain function during hospitalization. Changing hospital practice can be complex and require engagement of various staff levels and disciplines; however, we know little about how interprofessional teams organize around implementing such interventions. Complexity science can inform approaches to understanding and improving multidisciplinary collaboration to implement clinical programs. OBJECTIVE To examine, through a complexity science lens, how clinical staff's understanding about roles in promoting inpatient mobility evolved during implementation of the STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) hospital mobility program. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS Ninety-two clinical staff at eight Veterans Affairs hospitals. INTERVENTIONS STRIDE is a supervised walking program for hospitalized older adults designed to maintain patients' mobility and function. APPROACH We interviewed key staff involved in inpatient mobility efforts at each STRIDE site in pre- and post-implementation periods. Interviews elicited staff's perception of complexity-science aspects of inpatient mobility teams (e.g., roles over time, team composition). We analyzed data using complexity science-informed qualitative content analysis. KEY RESULTS We identified three key themes related to patterns of self-organization: (1) individuals outside of the "core" STRIDE team voluntarily assumed roles as STRIDE advocates, (2) leader-champions adapted their engagement level to match local implementation team needs during implementation, and (3) continued leadership support and physical therapy involvement were key factors for sustainment. CONCLUSIONS Staff self-organized around implementation of a new clinical program in ways that were responsive to changing program and contextual needs. These findings demonstrate the importance of effective self-organization for clinical program implementation. Researchers and practitioners implementing clinical programs should allow for, and encourage, flexibility in staff roles in planning for implementation of a new clinical program, encourage the development of advocates, and engage leaders in program planning and sustainment efforts.
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Affiliation(s)
- Rebecca A Bruening
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Nina Sperber
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA.
| | - Virginia Wang
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
- Department of Medicine, Duke University School of Medicine, Durham, USA
| | - Elizabeth Mahanna
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Ashley Choate
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Matthew Tucker
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Leah L Zullig
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
| | - Courtney Harold Van Houtven
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
| | - Kelli D Allen
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Susan N Hastings
- ADAPT Center of Innovation, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
- Department of Medicine, Duke University School of Medicine, Durham, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, USA
- Geriatrics Research, Education, and Clinical Center, Durham VA Health Care System, Durham, USA
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dos Santos Moraes TL, de Farias JMF, Rezende BS, de Carvalho FO, Santiago MS, Porto ES, Doria FM, Santana KCS, Gomes MV, Leite VS, Madruga RETTA, dos Santos Maciel LY, Andrade JD, de Farias Neto JP, Aidar FJ, da Silva Junior WM. Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU. Clin Pract 2021; 12:8-16. [PMID: 35076492 PMCID: PMC8788280 DOI: 10.3390/clinpract12010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Progressive mobility in the ICU has been recommended; however, the definitions of low, moderate, and high mobility in the ICU still diverge between studies. Therefore, our objective was to classify the mobility of the sample from verticalization and active withdrawal from the bed, and from that, to analyze the chances of discharge, death, and readmission to the ICU. MATERIALS AND METHODS This is an observational and retrospective study that consults the medical records of individuals admitted to the ICU of the University Hospital of Sergipe (HU/SE) between August 2017 and August 2018. Mobility level was classified based on the Intensive Care Unit Mobility Scale (IMS). RESULTS A total of 121 individuals were included. The mean age was 61.45 ± 16.45, being 53.7% female. Of these, 28 (23.1%) had low mobility, 33 (27.3%) had moderate mobility, and 60 (49.6%) had high mobility. Individuals with low mobility were 45 times more likely to die (OR = 45.3; 95% CI = 3.23-636.3) and 88 times less likely to be discharged from the ICU (OR = 0.22; 95% CI = 0.002-0.30). CONCLUSION Those who evolved with low mobility had a higher chance of death and a lower chance of discharge from the ICU. Moderate and high mobility were not associated with the investigated outcomes.
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Affiliation(s)
- Talita Leite dos Santos Moraes
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Joana Monteiro Fraga de Farias
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Brunielly Santana Rezende
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | | | - Michael Silveira Santiago
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Erick Sobral Porto
- Department of Medicine, Tiradentes University (UNIT), Aracaju 49032-490, SE, Brazil;
| | - Felipe Meireles Doria
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil;
| | | | - Marcel Vieira Gomes
- Program of Traumatology and Orthopaedics, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.V.G.); (V.S.L.)
| | - Victor Siqueira Leite
- Program of Traumatology and Orthopaedics, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.V.G.); (V.S.L.)
| | | | | | - Juliana Dantas Andrade
- University Hospital, Federal University of Sergipe (HU/UFS), Aracaju 49060-108, SE, Brazil; (F.O.d.C.); (J.D.A.)
| | | | - Felipe J. Aidar
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Walderi Monteiro da Silva Junior
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
- University Hospital, Federal University of Sergipe (HU/UFS), Aracaju 49060-108, SE, Brazil; (F.O.d.C.); (J.D.A.)
- Department of Physiotherapy, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil;
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Kok S, de Man-van Ginkel JM, Verstraten C, Resnick B, Metzelthin SF, Bleijenberg N, Schoonhoven L. Function focused care in hospital: A mixed-method feasibility study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Pereira DE, Welch SA, Montgomery CD, Hatcher JB, Duggan MC, Greysen SR. Low hospital mobility-resurgence of an old epidemic within a new pandemic and future solutions. Age Ageing 2021; 50:1439-1441. [PMID: 34077507 PMCID: PMC8195231 DOI: 10.1093/ageing/afab132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Low mobility during hospitalization poses risks of functional decline and other poor outcomes for older adults. Given the pervasiveness of this problem, low mobility during hospitalization was first described as ‘dangerous’ in 1947 and later described as an epidemic. Hospitals have made considerable progress over the last half-century and the last two decades in particular, however, the COVID-19 pandemic presents serious new challenges that threaten to undermine recent efforts and progress towards a culture of mobility. In this special article, we address the question of how to confront an epidemic of immobility within a pandemic. We identify 4 specific problems for creating and advancing a culture of mobility posed by COVID-19: social distancing and policies restricting patient movement, personnel constraints, PPE shortages, and increased patient hesitancy to ambulate. We also propose 4 specific solutions to address these problems. These approaches will help support a culture of healthy mobility during and after hospitalization and help patients to keep moving during the pandemic and beyond.
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Affiliation(s)
| | - Sarah A Welch
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Mariu C Duggan
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - S Ryan Greysen
- Section of Hospital Medicine, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Hannan M, Collins EG, Phillips SA, Quinn L, Steffen AD, Bronas UG. Sedentary Behavior in Older Adults With Preclinical Cognitive Impairment With and Without Chronic Kidney Disease. J Gerontol Nurs 2021; 47:35-42. [PMID: 34044686 PMCID: PMC8670529 DOI: 10.3928/00989134-20210510-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Older adults with preclinical cognitive impairment can have chronic conditions and lifestyle factors that influence health. Sedentary behavior is common in older adults with and without chronic kidney disease (CKD). The objective of the current study was to determine the differences in sedentary behavior for older adults with preclinical cognitive impairment with and without CKD. Our study evaluated 48 older adults with preclinical cognitive impairment with and without CKD who underwent assessment of sedentary behavior via accelerometry. We found that older adults with preclinical cognitive impairment with and without CKD were sedentary, but there were no significant differences between groups. Fragmentation index was different (p < 0.05), with a lower fragmentation index found in those with CKD. Sedentary behavior should be assessed and evaluated as a potential target for interventions to improve health in these at-risk older adults; however, further investigation is needed. [Journal of Gerontological Nursing, 47(6), 35-42.].
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Affiliation(s)
- Mary Hannan
- Postdoctoral Research Fellow; University of Illinois Chicago, College of Medicine, Department of Medicine, Chicago, IL
| | - Eileen G. Collins
- Associate Dean for Research, Professor; University of Illinois Chicago, College of Nursing, Department of Biobehavioral Nursing Science, Chicago, IL
| | - Shane A. Phillips
- Professor, Senior Associate Dean for Clinical Affairs; University of Illinois Chicago, College of Applied Health Sciences, Department of Physical Therapy, Chicago, IL
| | - Lauretta Quinn
- Clinical Professor; University of Illinois Chicago, College of Nursing, Department of Biobehavioral Nursing Science, Chicago, IL
| | - Alana D. Steffen
- Research Assistant Professor; University of Illinois Chicago, College of Nursing, Department of Population Health Nursing Science, Chicago, IL
| | - Ulf G. Bronas
- Associate Professor; University of Illinois Chicago, College of Nursing, Department of Biobehavioral Nursing Science, Chicago, IL
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10
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Kennedy M, Webb M, Gartaganis S, Hwang U, Biese K, Stuck A, Lesser A, Hshieh T, Inouye SK. ED-DEL: Development of a change package and toolkit for delirium in the emergency department. J Am Coll Emerg Physicians Open 2021; 2:e12421. [PMID: 33969341 PMCID: PMC8082702 DOI: 10.1002/emp2.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/05/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022] Open
Abstract
Delirium is a common and deadly problem in the emergency department affecting up to 30% of older adult patients. The 2013 Geriatric Emergency Department guidelines were developed to address the unique needs of the growing older population and identified delirium as a high priority area. The emergency department (ED) environment presents unique challenges for the identification and management of delirium, including patient crowding, time pressures, competing priorities, variable patient acuity, and limitations in available patient information. Accordingly, protocols developed for inpatient units may not be appropriate for use in the ED setting. We created a Delirium Change Package and Toolkit in the Emergency Department (ED-DEL) to provide protocols and guidance for implementing a delirium program in the ED setting. This article describes the multistep process by which the ED-DEL program was created and the key components of the program. Our ultimate goal is to create a resource that can be disseminated widely and used to improve delirium identification, prevention, and management in older adults in the ED.
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Affiliation(s)
- Maura Kennedy
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Margaret Webb
- Aging Brain CenterMarcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
| | - Sarah Gartaganis
- Aging Brain CenterMarcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
| | - Ula Hwang
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Geriatric Research, Education and Clinical CenterJames J. Peters VA Medical CenterBronxNew YorkUSA
| | - Kevin Biese
- Department of Emergency MedicineDivision of Geriatric Emergency MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Amy Stuck
- Strategy DepartmentWest Health InstituteSan DiegoCaliforniaUSA
| | - Adriane Lesser
- Clinical Research DepartmentWest Health InstituteSan DiegoCaliforniaUSA
| | - Tammy Hshieh
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineDivision of AgingBrigham and Women's HospitalBostonMassachusettsUSA
| | - Sharon K. Inouye
- Aging Brain CenterMarcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineDivision of Gerontology, Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
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11
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Optimization and Validation of a Classification Algorithm for Assessment of Physical Activity in Hospitalized Patients. SENSORS 2021; 21:s21051652. [PMID: 33673447 PMCID: PMC7956397 DOI: 10.3390/s21051652] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
Low amounts of physical activity (PA) and prolonged periods of sedentary activity are common in hospitalized patients. Objective PA monitoring is needed to prevent the negative effects of inactivity, but a suitable algorithm is lacking. The aim of this study is to optimize and validate a classification algorithm that discriminates between sedentary, standing, and dynamic activities, and records postural transitions in hospitalized patients under free-living conditions. Optimization and validation in comparison to video analysis were performed in orthopedic and acutely hospitalized elderly patients with an accelerometer worn on the upper leg. Data segmentation window size (WS), amount of PA threshold (PA Th) and sensor orientation threshold (SO Th) were optimized in 25 patients, validation was performed in another 25. Sensitivity, specificity, accuracy, and (absolute) percentage error were used to assess the algorithm’s performance. Optimization resulted in the best performance with parameter settings: WS 4 s, PA Th 4.3 counts per second, SO Th 0.8 g. Validation showed that all activities were classified within acceptable limits (>80% sensitivity, specificity and accuracy, ±10% error), except for the classification of standing activity. As patients need to increase their PA and interrupt sedentary behavior, the algorithm is suitable for classifying PA in hospitalized patients.
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12
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Montgomery CD, Pereira DE, Hatcher JB, Kilbury D, Ballance S, Bradham T, Duggan MC, Welch SA. Improving the assessment and documentation of patient mobility using a quality improvement framework. Geriatr Nurs 2021; 42:325-330. [PMID: 33561614 DOI: 10.1016/j.gerinurse.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To implement a system for assessing and documenting patient mobility in an inpatient geriatric unit using a quality improvement framework. METHODS Whiteboards incorporating the Johns Hopkins Highest Level of Mobility scale were placed on each door of the unit. Staff were trained to assess and document patient mobility, and documentation compliance was measured. Nurses were surveyed to assess perceived burden of the system. Fall rates were calculated and analyzed for change from baseline. RESULTS Median daily documentation rates reached 79% by the end of the project. Surveys indicated a low perceived burden of the system. Fall rates did not increase when compared to the previous year baseline (p = 0.80) and the analogous time frames during the previous two years (p = 0.84). CONCLUSION A quality improvement framework may be used to improve mobility assessment and documentation in a geriatric unit without increasing patient falls or nursing burden.
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Affiliation(s)
- Chandler D Montgomery
- Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, USA 37240-0002.
| | - Daniel E Pereira
- Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, USA 37240-0002
| | - Jeremy B Hatcher
- Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, USA 37240-0002
| | - Darlene Kilbury
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, TN, USA 37232
| | - Stephanie Ballance
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, TN, USA 37232
| | - Tamala Bradham
- Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, USA 37240-0002
| | - Maria C Duggan
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, TN, USA 37232; Department of Veteran Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Ave S, Nashville, TN, USA 37212
| | - Sarah A Welch
- Department of Veteran Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Ave S, Nashville, TN, USA 37212; Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, 2201 Children's Way, Suite 1318, Nashville, TN, USA 37212
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13
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Mobilizing Hospitals to Mobilize Patients. J Am Geriatr Soc 2020; 68:2202-2204. [DOI: 10.1111/jgs.16698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/11/2023]
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