title: Comparison of Posthospitalization Function and Community Mobility in Hospital Mobility Program and Usual Care Patients: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Low mobility is common during hospitalization and associated with loss or declines in ability to perform activities of daily living (ADL) and limitations in community mobility.
  
  
  OBJECTIVE
  To examine the effect of an in-hospital mobility program (MP) on posthospitalization function and community mobility.
  
  
  METHODS
  This single-blind randomized clinical trial used masked assessors to compare a MP with usual care (UC). Patients admitted to the medical wards of the Birmingham Veterans Affairs Medical Center from January 12, 2010, through June 29, 2011, were followed up throughout hospitalization with 1-month posthospitalization telephone follow-up. One hundred hospitalized patients 65 years or older were randomly assigned to the MP or UC groups. Patients were cognitively intact and able to walk 2 weeks before hospitalization. Data analysis was performed from November 21, 2012, to March 14, 2016.
  
  
  METHODS
  Patients in the MP group were assisted with ambulation up to twice daily, and a behavioral strategy was used to encourage mobility. Patients in the UC group received twice-daily visits.
  
  
  METHODS
  Changes in self-reported ADL and community mobility were assessed using the Katz ADL scale and the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), respectively. The LSA measures community mobility based on the distance through which a person reports moving during the preceding 4 weeks.
  
  
  RESULTS
  Of 100 patients, 8 did not complete the study (6 in the MP group and 2 in the UC group). Patients (mean age, 73.9 years; 97 male [97.0%]; and 19 black [19.0%]) had a median length of stay of 3 days. No significant differences were found between groups at baseline. For all periods, groups were similar in ability to perform ADL; however, at 1-month after hospitalization, the LSA score was significantly higher in the MP (LSA score, 52.5) compared with the UC group (LSA score, 41.6) (P = .02). For the MP group, the 1-month posthospitalization LSA score was similar to the LSA score measured at admission. For the UC group, the LSA score decreased by approximately 10 points.
  
  
  CONCLUSIONS
  A simple MP intervention had no effect on ADL function. However, the MP intervention enabled patients to maintain their prehospitalization community mobility, whereas those in the UC group experienced clinically significant declines. Lower life-space mobility is associated with increased risk of death, nursing home admission, and functional decline, suggesting that declines such as those observed in the UC group would be of great clinical importance.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00715962.
authors.affiliation: Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Care Center, Birmingham, Alabama2Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Brown
authors.affiliation: School of Occupational Therapy, College of Health Sciences, Brenau University, Atlanta, Georgia.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Foley
authors.affiliation: School of Health Professions, University of Alabama at Birmingham, Birmingham.
authors.forename: John D
authors.initials: JD
authors.lastname: Lowman
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Birmingham.
authors.forename: Paul A
authors.initials: PA
authors.lastname: MacLennan
authors.affiliation: College of Medicine, University of Arizona, Tucson7currently with Baylor College of Medicine, Houston, Texas.
authors.forename: Javad
authors.initials: J
authors.lastname: Razjouyan
authors.affiliation: College of Medicine, University of Arizona, Tucson7currently with Baylor College of Medicine, Houston, Texas.
authors.forename: Bijan
authors.initials: B
authors.lastname: Najafi
authors.affiliation: Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham.
authors.forename: Julie
authors.initials: J
authors.lastname: Locher
authors.affiliation: Geriatrics and Extended Care, Department of Veterans Affairs, Washington, DC.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D051346:Mobility Limitation; D010346:Patient Care Management / Q000379:methods; D010351:Patient Discharge; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D016896:Treatment Outcome