Mobility Promotion for Frailty

Overseen By Myles W O'Brien, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Université de Sherbrooke

Disqualifiers: Other clinical trials, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 2 weeks

60 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Mobility promotion for frailty?

Research shows that exercise and nutrition programs, like MoveStrong, can improve physical function and protein intake in frail older adults, suggesting that mobility promotion treatments may help maintain independence and health in this population. ^{1 2 3 4 5}

Is the mobility promotion treatment safe for humans?

The research does not provide specific safety data for the mobility promotion treatment, but it suggests that physical activity interventions are generally supported for older adults to help with frailty, which implies a level of safety in these types of interventions. ^{3 5 6 7 8}

How is the Mobility Promotion treatment for frailty different from other treatments?

Mobility Promotion for frailty is unique because it focuses on increasing physical activity to improve mobility and independence in older adults, rather than relying on medication. This approach emphasizes the importance of physical movement and may include exercises or activities tailored to enhance mobility, which is crucial for maintaining health and well-being in frail individuals. ^{1 3 4 5 9}

What is the purpose of this trial?

Frailty describes the variability in aging and explains why two people of the same chronological age may look very different. Higher frailty leads to poor quality of life, disability, and death. Hospitalized patients living with frailty have a higher risk for functional decline, new impairments in activities of daily living, a longer hospital stay, hospital readmission, and death. A previous study from our team has reported that 60% of inpatients have more difficulty with 1+ basic activity of daily living (i.e., eating, getting out of bed, using the toilet, etc.) after hospitalization compared to pre-admission, with 1-in-4 patients having difficulty with 3+ basic tasks. Patients with few health deficits can recover to their pre-admission level, but those with higher frailty levels cannot, priming them for readmissions. Physical activity and reducing time spent sitting or lying postures prevent and improve frailty. Older patients who walk at least once/day outside their room during hospitalization have \~1.7 days shorter length of hospital stay compared with those who stayed in their room. Although multiple barriers exist to promoting upright time in a hospital, strategies that help address patients' excessive time spent in bed are often not implemented but could attenuate the development of frailty in the hospital. Few exercise interventions in hospital studies have considered frailty. The investigators have conducted a clinical trial within the Halifax Infirmary (Nova Scotia Health) that focused on mobilizing patients (average age: \~75 years) via regular visits by a Kinesiologist and observed that the intervention groups reduced their frailty level from preadmission and admission versus discharge. While preliminary findings from this model were promising, its reach was limited to acute geriatric care and dependent upon researchers to conduct the intervention. At the Georges-L. Dumont hospital, a patient mobilization program has been introduced in General and Internal Medicine (floor 4C) that embedded Kinesiologists within care to visit patients daily. Preliminary findings indicate that patients and staff are enjoying the program via self-report questionnaire. However, evaluations of the program's effectiveness in changing objectively measured activity and frailty levels and whether multiple patient visits would be more effective (e.g., refining the program) are unclear. The investigators propose to evaluate the effectiveness of the existing patient mobilization program and if more patient contact improves outcomes. Our study integrates activity monitoring technology and frailty assessments to help patients leave the hospital healthier and decrease the risk of readmission. Study Objectives: The proposed study will test the hypothesis that, compared to usual care (Kinesiology visit once/day), patients who receive multiple check-ins will, 1) increase their step counts and upright time, 2) decrease their frailty level, and 3) have a less length of stay and less readmission rates.

Eligibility Criteria

This trial is for hospitalized patients living with frailty, who are at risk of functional decline and longer hospital stays. It aims to help them recover better by promoting physical activity during their stay. The study will include those willing to be monitored and assessed for frailty levels.

Inclusion Criteria

I am 50 years old or older.

I will be in the hospital for at least 4 days.

Patients not in a shared room with another study participant

Exclusion Criteria

Patients enrolled in other clinical trials or interventions that might confound the results of the study

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

Treatment

Kinesiologists visit patients daily to promote movement and help them mobilize to the best of their capabilities

2 weeks

Daily visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Mobility promotion

Trial Overview The trial tests if a patient mobilization program with daily visits from Kinesiologists can improve health outcomes in frail patients. It compares usual care (one visit/day) against multiple check-ins, measuring step counts, upright time, frailty level changes, length of stay, and readmission rates.

Participant Groups

Group I: Males Experimental Treatment 1 Intervention

A team of Kinesiologists visit the patients daily from admission to discharge to promote movement and help them mobilize to the best of their capabilities (e.g., walking, standing, or sitting on the edge of the bed).

Group II: Females Experimental Treatment 1 Intervention

A team of Kinesiologists visit the patients daily from admission to discharge to promote movement and help them mobilize to the best of their capabilities (e.g., walking, standing, or sitting on the edge of the bed).

Who Is Running the Clinical Trial?

Université de Sherbrooke

Lead Sponsor

Trials

317

Recruited

79,300+

Vitalite Health Network

Collaborator

Trials

3

Recruited

130+

Findings from Research

A 12-month multifactorial intervention significantly improved mobility-related disability in 241 frail older adults, as evidenced by better scores on the Goal Attainment Scale and Life Space Assessment compared to the control group.

Participants in the intervention group also demonstrated a slight increase in walking speed and higher scores on activity measures, indicating enhanced mobility and participation in daily life activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial. Fairhall, N., Sherrington, C., Kurrle, SE., et al.[2022]

The MoveStrong program, an 8-week exercise and nutrition intervention delivered via telephone and virtual sessions, was feasible and well-accepted by older adults, with a high retention rate of 93% and adherence to sessions exceeding 80%.

Participants showed significant improvements in physical function, as evidenced by increased chair stand test scores and enhanced dietary protein intake, indicating the program's effectiveness in addressing frailty in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

MoveStrong at home: a feasibility study of a model for remote delivery of functional strength and balance training combined with nutrition education for older pre-frail and frail adults. Wang, E., Keller, H., Mourtzakis, M., et al.[2022]

A 12-month multidisciplinary intervention targeting frailty in 241 older adults significantly reduced frailty by 1.0 criterion and improved mobility by 3.2 points for those who complied with the treatment, indicating a strong efficacy for compliant participants.

The overall effect of the intervention was much greater for those who adhered to the treatment compared to the average effect across all participants, highlighting the importance of compliance in achieving better health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial. Fairhall, N., Sherrington, C., Cameron, ID., et al.[2019]

Increasing physical activity through mobility training can significantly reduce frailty in older adults, leading to better health outcomes.

Mobility is crucial for maintaining independence and well-being in older adults, highlighting the importance of targeted interventions in community settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of mobility training for frail older adults living in the community. Harrison, J., Phoong, KY., Mansoor, M., et al.[2023]

In a study of 754 older adults over 5 years, transitions between mobility disability states were common, with higher rates of moving from no disability to intermittent disability and from intermittent to continuous disability.

Older age, female sex, and physical frailty increased the likelihood of worsening mobility, highlighting the need for programs that not only prevent disability but also help restore and maintain mobility in older individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The dynamic nature of mobility disability in older persons. Gill, TM., Allore, HG., Hardy, SE., et al.[2022]

In a study of 119 community-dwelling older adults, balance deficits and physical activity measures were identified as independent predictors of future falls, particularly in pre-frail and frail individuals, but not in non-frail participants.

Gait performance declined with increasing frailty, yet it did not serve as a reliable predictor of falls when considering frailty status, highlighting the importance of balance and activity levels over gait in assessing fall risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor Performance and Physical Activity as Predictors of Prospective Falls in Community-Dwelling Older Adults by Frailty Level: Application of Wearable Technology. Mohler, MJ., Wendel, CS., Taylor-Piliae, RE., et al.[2018]

Researchers at the University of Manchester are developing a behavior change intervention aimed at pre-frail older adults to encourage participation in group-based physical activity classes, which have been shown to effectively slow the progression of frailty.

There is strong support from stakeholders for proactively addressing pre-frailty, as a significant number of older adults are affected, suggesting that such interventions could enhance healthy aging and improve overall health outcomes in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability of physical activity signposting for pre-frail older adults: a qualitative study to inform intervention development. Money, A., Harris, D., Hawley-Hague, H., et al.[2023]

In a study of 8533 older adults with an average age of 72, frailty and not driving were both linked to a higher risk of disability, with 5.3% of frail individuals becoming disabled compared to only 1.3% of non-frail individuals.

Frail individuals who do not drive had a significantly higher risk of disability (HR: 2.28) compared to those who are not frail and drive, indicating that both frailty and driving status are important factors in assessing disability risk in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Frailty and driving status associated with disability: a 24-month follow-up longitudinal study. Doi, T., Tsutsumimoto, K., Ishii, H., et al.[2021]

In a study of 1,814 older adults in Ireland, 7.7% were classified as frail and 44.0% as prefrail, highlighting the prevalence of frailty in this population.

The Timed Up-and-Go (TUG) test effectively identifies frail individuals (AUC = 0.87) but is less effective at distinguishing between nonfrail and prefrail individuals (AUC = 0.73), indicating that while TUG is a useful tool, it cannot replace the comprehensive assessment of frailty components.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using timed up-and-go to identify frail members of the older population. Savva, GM., Donoghue, OA., Horgan, F., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial. [2022]

2. Canada pubmed.ncbi.nlm.nih.gov

MoveStrong at home: a feasibility study of a model for remote delivery of functional strength and balance training combined with nutrition education for older pre-frail and frail adults. [2022]

3. Netherlands pubmed.ncbi.nlm.nih.gov

A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Effectiveness of mobility training for frail older adults living in the community. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

The dynamic nature of mobility disability in older persons. [2022]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Motor Performance and Physical Activity as Predictors of Prospective Falls in Community-Dwelling Older Adults by Frailty Level: Application of Wearable Technology. [2018]

7. England pubmed.ncbi.nlm.nih.gov

Acceptability of physical activity signposting for pre-frail older adults: a qualitative study to inform intervention development. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Frailty and driving status associated with disability: a 24-month follow-up longitudinal study. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Using timed up-and-go to identify frail members of the older population. [2022]