Impact of an INtervention TO increase MOBility in older hospitalised medical patients (INTOMOB): a cluster randomised controlled trial

• Patient confinement to bed is one of the top 5 low-value practices to avoid in hospital according to smartermedicine (Choosing Wisely Switzerland), but the practice continues. One study showed that 80% of hospitalised patients could walk independently, but 83% of their hospital stay was spent in bed; they ambulated or stood only 3% of the time. Low mobility of hospitalised patients is associated with cascading problems, including persistent functional decline, institutionalisation, and death. Higher hospital mobility is associated with better outcomes, but interventions to increase mobility have not succeeded. Most studies did not actively involve the patients, required resources that are unavailable, or did not systematically address barriers to increase mobility. A workable intervention must help healthcare providers (HCPs) and patients change their behaviours and implement necessary changes in hospitals and healthcare systems.

The overall objective of the INTOMOB project is to develop and test a multilevel patient-empowering intervention that helps patients and HCPs overcome barriers to increase hospital mobility, and thus improve outcomes of older adults. Our specific aims are to 1) characterise patient and HCP barriers and needs to increase hospital mobility; 2) develop and pilot test a multilevel intervention addressing these barriers and needs to increase hospital mobility; 3) test the efficacy of the intervention in a cluster randomised controlled trial (RCT) in 3 hospitals; and 4) develop a toolkit to implement and disseminate the intervention if it is successful.

The study includes

1. a survey, focus groups, and interviews with older recently hospitalised patients, patient representatives, and hospital HCPs to assess barriers and needs to increase hospital mobility.
2. the development of a multilevel (patient, HCP, environment, system) intervention to increase hospital mobility by overcoming barriers and meeting needs we identify.
3. a pilot study of the intervention to assess acceptability and feasibility
4. a cluster RCT in three hospitals to test the effect of the intervention