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Comparison of Posthospitalization Function and Community Mobility in Hospital Mobility Program and Usual Care Patients: A Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. INTERVENTIONS: 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. MAIN OUTCOMES AND MEASURES: 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 AND RELEVANCE: 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00715962.
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“This finding contrasts with an earlier RCT that did not report significant benefits of a single in-hospital mobility program and behavioral strategy designed to promote mobility in older patients, particularly in their ability to perform ADLs following acute hospitalization [524].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [524]
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Clarifying Confusion: The Confusion Assessment Method: A New Method for Detection of Delirium
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International exercise recommendations in older adults (ICFSR): Expert consensus guidelines
Izquierdo, M., Merchant, R. A., Morley, J. E., Anker, S. D., Aprahamian, I., Arai, H., Aubertin-Leheudre, M., Bernabei, R., Cadore, E. L., Cesari, M., et al. (2021) · The Journal of nutrition, health and aging · doi:10.1007/s12603-021-1665-8 · Cited by 1,247
Martínez-Velilla, N., Casas-Herrero, A., Zambom-Ferraresi, F., Sáez de Asteasu, M. L., Lucia, A., Galbete, A., García-Baztán, A., Alonso-Renedo, J., González-Glaría, B., Gonzalo-Lázaro, M., et al. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.4869 · Cited by 481
Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis
Loyd, C., Markland, A. D., Zhang, Y., Fowler, M. E., Harper, S. A., Wright, N. C., Carter, C. S., Buford, T. W., Smith, C. H., Kennedy, R., et al. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2019.09.015 · Cited by 402
Self-citationIzquierdo, M., de Souto Barreto, P., Arai, H., Bischoff-Ferrari, H. A., Cadore, E. L., Cesari, M., Chen, L.-K., Coen, P. M., Courneya, K. S., Duque, G., et al. (2025) · The Journal of nutrition, health and aging · doi:10.1016/j.jnha.2024.100401 · Cited by 273
Acute Sarcopenia Secondary to Hospitalisation - An Emerging Condition Affecting Older Adults
Welch, C., Hassan-Smith, Z. K., Greig, C. A., Lord, J. M., & Jackson, T. (2018) · Aging and Disease · doi:10.14336/ad.2017.0315 · Cited by 232
Metadata
- Authors
- Brown, C. J., Foley, K. T., Lowman, J. D., MacLennan, P. A., Razjouyan, J., Najafi, B., Locher, J., & Allman, R. M.
- Affiliations
- University of Alabama at Birmingham (US)
- Brenau University (US)
- University of Arizona (US)
- United States Department of Veterans Affairs (US)
- Corresponding author
- Brown, Cynthia J.
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2016-07-01
- Volume
- 176
- Issue
- 7
- Pages
- 921
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC12983393
- OpenAlex
- W2409410199
- Cited by
- 237
- References
- 40
- Citations by year
- 2026: 14 · 2025: 20 · 2024: 44 · 2023: 21 · 2022: 30 · 2021: 18 · 2020: 29 · 2019: 28 · 2018: 20 · 2017: 11 · 2016: 2
- FWCI
- 52.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- National Institute on Aging (R01AG015062)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- community mobility, activities of daily living, hospitalized older adults, behavioral strategies, Life-Space Assessment, veterans, usual care comparison, length of hospital stay, telephone follow-up
- MeSH terms
- Activities of Daily Living, Aged, Female, Persons with Disabilities, Disabled Persons, Hospitalization, Humans, Inpatients, Male, Patient Care Management, Patient Discharge, Geriatric Assessment, Treatment Outcome, Recovery of Function, Physical Therapy Modalities, Mobility Limitation
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