Benefits of an Early Mobility Program for Hospitalized Patients With Cancer

PURPOSE Patients with cancer are often hospitalized with complications from cancer and cancer treatment. Many experience a decline in physical functioning, including loss of mobility, which likely contributes to increased length of stay (LOS) and increased readmissions. We aimed to determine whether a mobility program would improve quality of care and decrease health care utilization. METHODS We implemented a mobility aide program on an oncology unit in a large academic medical center for all patients without bedrest orders between October 1, 2018, and February 28, 2021. The program consisted of nursing evaluation using the Activity Measure for Post-Acute Care (AMPAC), an ordinal scale ranging from bed rest to ambulating ≥ 250 feet, to quantify mobility. Plan of care was determined in a multidisciplinary manner with physical therapy (PT), nursing, and a mobility aide, who is a medical assistant with enhanced rehabilitation training. Patients were then mobilized two times per day 7 days a week. Using descriptive statistics and mixed effects logistic regression, we evaluated the programs impact on LOS, readmissions, and changes in mobility during this time period compared with the 6-month interval before implementation. RESULTS A total of 1,496 hospitalized patients were identified. The odds of hospital readmission within 30 days of discharge was significantly less for those who received the intervention (OR, 0.53; 95% CI, 0.37 to 0.78; P = .001). The odds ratio (OR) of having a final AMPAC score at or above the median was significantly higher for those who received the intervention (OR, 1.60; 95% CI, 1.04 to 2.45; P < .05). There was no significant difference in LOS. CONCLUSION Use of this mobility program resulted in a significant decrease in readmissions and maintained or improved patients' mobility. This demonstrates that non-PT professionals can effectively mobilize hospitalized patients with cancer, thereby decreasing the burden on PT and nursing resources. Future work will evaluate the sustainability of the program and evaluate association with health care costs.

[1]  P. Vollenweider,et al.  Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients , 2020, JAMA network open.

[2]  H. Wald,et al.  The Case for Mobility Assessment in Hospitalized Older Adults: American Geriatrics Society White Paper Executive Summary , 2018, Journal of the American Geriatrics Society.

[3]  Daniel L. Young,et al.  Towards improving hospital workflows: An evaluation of resources to mobilize patients. , 2018, Journal of nursing management.

[4]  R. Haas,et al.  Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. , 2018, Journal of physiotherapy.

[5]  Peter C Austin,et al.  Assessing covariate balance when using the generalized propensity score with quantitative or continuous exposures , 2018, Statistical methods in medical research.

[6]  F. Fabbian,et al.  Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data. , 2017, Medical care.

[7]  W. Shi,et al.  A Descriptive Report of Early Mobilization for Critically Ill Ventilated Patients With Cancer , 2017, Rehabilitation oncology.

[8]  David Nerenz,et al.  Benefits of Early Active Mobility in the Medical Intensive Care Unit: A Pilot Study. , 2016, The American journal of medicine.

[9]  Elizabeth Colantuoni,et al.  Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project. , 2016, Journal of hospital medicine.

[10]  S. Kuys,et al.  Poor mobility in hospitalized adults of all ages. , 2016, Journal of hospital medicine.

[11]  Antonio Trogu,et al.  Hospital Admission of Cancer Patients: Avoidable Practice or Necessary Care? , 2015, PloS one.

[12]  David Ring,et al.  The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery , 2014, Clinical orthopaedics and related research.

[13]  A. Testa,et al.  Strengths of early physical rehabilitation programs in surgical breast cancer patients: results of a randomized control study , 2013, BMC Proceedings.

[14]  K. Covinsky,et al.  Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure". , 2011, JAMA.

[15]  A. Parker,et al.  A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol , 2011, BMC health services research.

[16]  P. Austin.  An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies , 2011, Multivariate behavioral research.

[17]  M. Kosinski,et al.  Score comparability of short forms and computerized adaptive testing: Simulation study with the activity measure for post-acute care. , 2004, Archives of physical medicine and rehabilitation.

[18]  Carol Porth,et al.  Essentials of Pathophysiology: Concepts of Altered Health States , 2003 .

[19]  Douglas G Altman,et al.  Basic statistical reporting for articles published in biomedical journals: the "Statistical Analyses and Methods in the Published Literature" or the SAMPL Guidelines. , 2015, International journal of nursing studies.

[20]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[21]  J. Morse,et al.  A prospective study to identify the fall-prone patient. , 1989, Social science & medicine.

[22]  Carol Porth,et al.  Pathophysiology: Concepts of Altered Health States , 1982 .