一项共同设计的促进老年内科患者院内活动能力的干预措施的可行性和实施保真度——哥本哈根步行项目（WALK-Cph）

Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients-the WALK-Copenhagen project (WALK-Cph).

作者信息

Pedersen Britt Stævnsbo, Kirk Jeanette Wassar, Olesen Maren Kathrine, Grønfeldt Birk Mygind, Stefánsdóttir Nina Thórný, Brødsgaard Rasmus, Tjørnhøj-Thomsen Tine, Nilsen Per, Andersen Ove, Bandholm Thomas, Pedersen Mette Merete

机构信息

Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark.

Department of Endocrinology, Copenhagen University Hospital, Amager and Hvidovre, Denmark.

出版信息

Pilot Feasibility Stud. 2022 Apr 9;8(1):80. doi: 10.1186/s40814-022-01033-z.

DOI:10.1186/s40814-022-01033-z

PMID:35397574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8994315/

Abstract

BACKGROUND

Mobility interventions can prevent functional decline among older patients, but implementation of such interventions may be complicated by barriers in the clinical setting. The WALK-Copenhagen project (WALK-Cph) is aimed at promoting a 24-h mobility among older medical patients during hospitalization. The WALK-Cph intervention was co-designed by researchers and stakeholders to tailor the intervention to the clinical context. The aim of this study was to investigate the feasibility and implementation fidelity of the WALK-Cph intervention before evaluating clinical effectiveness in a randomized controlled trial (ClinicalTrials.gov NCT03825497).

METHODS

The WALK-Cph intervention consisted of six components: a welcome folder explaining the importance of in-hospital activity, a WALK-plan prescribing up to three daily walking sessions during and after hospitalization, a WALK-path in the hallway that patients were motivated to use daily, exercise posters in the hallways and bedrooms, self-service on beverages and clothes, and discharge with a WALK-plan. The present study reports on phase 2 of WALK-Cph and consists of a feasibility and a fidelity component. The study was conducted at the two WALK-Cph intervention departments after the initiation of the WALK-Cph intervention. A cohort of older medical patients (+65) was recruited for the feasibility study to assess recruitment and data collection procedures and the method for assessment of activity. Simultaneously, implementation fidelity was assessed by observing clinical practice and intervention delivery at the intervention departments.

RESULTS

A feasibility cohort of 48 patients was included. Inclusion was considered feasible with recruitment rates between 62% and 70% of all eligible patients. Also, data collection was conducted without obstacles, and all patients accepted to wear activity monitors. The fidelity observations showed that three of the six intervention components were partially implemented as planned whereas three components were not implemented as planned.

CONCLUSION

The WALK-Cph intervention was found feasible, and although the intervention was not implemented with fidelity, the level of fidelity was considered sufficient to continue with further testing of the WALK-Cph intervention in a large-scale trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03825497 (retrospectively registered). Protocol PubMed ID (PMID): 29523569.

摘要

背景

运动干预可预防老年患者功能衰退，但在临床环境中实施此类干预可能会因各种障碍而变得复杂。哥本哈根步行项目（WALK-Cph）旨在促进老年内科住院患者24小时的活动能力。WALK-Cph干预措施是由研究人员和利益相关者共同设计的，以使其适应临床环境。本研究的目的是在一项随机对照试验（ClinicalTrials.gov NCT03825497）中评估临床疗效之前，调查WALK-Cph干预措施的可行性和实施保真度。

方法

WALK-Cph干预措施包括六个部分：一个解释住院期间活动重要性的欢迎文件夹、一份规定住院期间及出院后每天最多进行三次步行活动的步行计划、一条鼓励患者每天使用的走廊步行路径、走廊和病房里的运动海报、饮料和衣物自助服务以及携带步行计划出院。本研究报告了WALK-Cph的第二阶段，包括可行性和保真度两个部分。该研究在WALK-Cph干预措施启动后，于两个干预科室进行。招募了一组老年内科患者（65岁以上）进行可行性研究，以评估招募和数据收集程序以及活动评估方法。同时，通过观察干预科室的临床实践和干预措施的实施情况来评估实施保真度。