Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
BMJ Open. 2024 Nov 14;14(11):e086921. doi: 10.1136/bmjopen-2024-086921.
To assess the effect of goal-directed mobilisation (GDM) on physical functioning in medical inpatients.
Randomised, controlled, single-centre, parallel, superiority trial with a 3-month follow-up and blinded outcome assessment.
General internal medicine wards of a Swiss tertiary acute hospital, September 2021 to April 2023.
Adults with expected hospitalisation of ≥5 days, physiotherapy prescription and ability to follow study procedures.
GDM during hospitalisation, which includes personal goal setting and a short session of patient education through a physiotherapist (experimental group), versus standard care (control group).
The primary outcome was the change in physical activity between baseline and day 5 (De Morton Mobility Index (DEMMI)). Secondary outcomes included in-hospital accelerometer-measured mobilisation time; in-hospital falls; delirium; length of stay; change in independence in activities of daily living, concerns of falling and quality of life; falls, readmission and mortality within 3 months.
The study was completed by 123 of 162 (76%) patients enrolled, with the primary outcome collected at day 5 in 126 (78%) participants. DEMMI Score improved by 8.2 (SD 15.1) points in the control group and 9.4 (SD 14.2) in the intervention group, with a mean difference of 0.3 (adjusted for the stratification factors age and initial DEMMI Score, 95% CI -4.1 to 4.8, p=0.88). We did not observe a statistically significant difference in effects of the interventions on any secondary outcome.
The patient's physical functioning improved during hospitalisation, but the improvement was similar for GDM and standard of care. Improving physical activity during an acute medical hospitalisation remains challenging. Future interventions should target additional barriers that can be implemented without augmenting resources.
NCT04760392.
评估目标导向性活动（GDM）对住院患者身体机能的影响。
随机、对照、单中心、平行、优效性试验，随访 3 个月，结局评估为盲法。
瑞士一家三级急症医院的综合内科病房，2021 年 9 月至 2023 年 4 月。
预计住院时间≥5 天、有物理治疗处方且能遵循研究程序的成年人。
住院期间的 GDM，包括个人目标设定和由物理治疗师进行的简短患者教育课程（实验组），与标准护理（对照组）。
主要结局指标为基线至第 5 天的身体活动变化（德莫顿活动指数（DEMMI））。次要结局指标包括住院期间加速计测量的活动时间；住院期间跌倒；谵妄；住院时间；日常生活活动独立性、跌倒担忧和生活质量的变化；3 个月内跌倒、再入院和死亡率。
纳入的 162 名患者中，有 123 名（76%）完成了研究，126 名（78%）参与者在第 5 天收集了主要结局指标。对照组的 DEMMI 评分增加了 8.2（15.1 个标准差）分，干预组增加了 9.4（14.2 个标准差）分，平均差值为 0.3（调整分层因素年龄和初始 DEMMI 评分后，95%CI-4.1 至 4.8，p=0.88）。我们没有观察到干预措施对任何次要结局的效果存在统计学上的显著差异。
患者在住院期间的身体机能有所改善，但 GDM 和标准护理的改善程度相似。在急性内科住院期间提高身体活动水平仍然具有挑战性。未来的干预措施应针对其他可以在不增加资源的情况下实施的障碍。
NCT04760392。
