An INtervention TO Improve MOBility of Older Hospitalized Patients

Impact of an INtervention TO Increase MOBility in Older Hospitalized Medical Patients (INTOMOB): a Cluster Randomized Controlled Trial

Low mobility during an acute care hospitalization is very frequent, particularly among older patients, and associated with adverse outcomes, such as persistent functional decline, institutionalization and death. However, increasing hospital mobility remains challenging because of the multiple existing barriers.

The goal of this clinical trial is to test the effect of a multilevel intervention to increase hospital mobility, which addresses modifiable barriers and facilitators and does not require unavailable additional resources.

This study aims to answer whether this intervention can improve mobility and patient-relevant outcomes such as life-space mobility and functional status.

The multilevel intervention will target:

1. The patients, who will receive an information booklet, a customizable diary, an exercise booklet and an iPad with access to the videos of the exercise booklet.
2. The healthcare professionals (nursing staff and physicians) who will complete an e-learning, receive an oral presentation on the intervention, and receive a "mobility checklist" that reminds them of what they should assess daily regarding mobility.
3. The hospital environment, where posters will be hung in the wards, including walking itineraries, on topics of interest to older adults.

In a first phase, the intervention will be pilot-tested in one ward of each hospital. The intervention will then be adapted based on patient and healthcare professional feedback.

In a second phase, the intervention will be tested in a cluster randomized controlled trial, and compared to standard of care.

Inclusion criteria:

• Admission to a general internal medicine (GIM) ward of a participating hospital
• Age ≥60 years
• Being ambulatory during the 2 weeks before admission (self-report)
• Living in the community (not in a nursing home or another institution) for at least the last 30 days prior to admission
• Ability to understand French or German
• Planned length of stay at least 3 days after enrollment
• For the pilot-study only: Possibility to start the study within 48 hours after admission to the GIM ward

Exclusion criteria:

• Medical contraindication to walk (e.g., wound not allowing loading weight)
• Wheelchair-bound
• End-of-life
• Severe psychiatric disorder (severe depression, schizophrenia, psychosis)
• Delirium (according to the Confusion Assessment Method [CAM])

Additional exclusion criterion for the pilot-study only:

- Dementia (defined as Mini-Cog <3)

Additional exclusion criteria for the RCT only:

• Cognitive impairment making impossible to use study material (=implement the intervention) and to understand and sign informed consent, based on clinical judgement, except if a proxy can be actively involved in the study and provides consent
• Severe visual impairment