Bed rest related to hospitalization contributes to the physical decline in capacities of the elderly, the loss of autonomy accelerated in post-hospitalization and the prevalence of the iatrogenic functional decline is about 20 to 50% for the elderly after an hospitalization.
Mobilization through physical activity (PA) programs is strongly suggested to counter this phenomenon, but it is not part of the routine clinical hospital practices.The consequences are the functional incapacities, the mobility loss, the re-hospitalization falls and the important use of the health care and health services. In this regard, the Ministry of Health and Social Services adopted in 2011 a framework making mandatory the set up of interventions to prevent the functional decline of hospitalized elderly in every hospital centres in Quebec. The Geriatric Units (GU) admit elderly around 80 years old that present complex health problems. The scientific literature presents effective mobilisation programs to ensure the maintenance of functional capacities and the mobility of frail elderly. However, even with this knowledge, the prescription of physical exercises by the GU does not seem to be integrated in a natural and systematic way by in the professional practices.
Our research team would like to implant the clinical tools : MATCH, PATH and PATH 2.0 that is a unique process of systematic prescriptions of physical activity during hospitalization (MATCH), at discharge (PATH) and during hospitalization and at discharge (PATH 2.0) in the GU, adapted to the profile of these patients.
The objective of this project is to evaluate the implementation of the clinical tools MATCH, PATH and PATH 2.0 in different GU and to evaluate the tools efficiency and estimate the benefits-cost ratio on the use of post-hospitalization health services. Finally, the conclusions would help us refine the procedures to use in the short and medium term which clinical tool is likely a standard practice our GU and to improve the health continuum of elderly.
be aged 65 and over,
planned discharge to home
Presence of self-criticism
No PA contraindication
None
Parallel
MATCH
Other interventionIn the first days of hospitalization, the physiotherapist determines the score linked to the patient's mobility profile using of a decisional tree. The PA program has 2 or 3 exercises to be done with or without supervision 3 times per week day during hospitalization. These daily exercises are prescribed by the doctor and taught by the physiotherapist.
PATH
Other interventionIn the days prior to discharge, the physiotherapist determines the patient's mobility profile using the decisional tree. When returning home after hospitalization, each PA program includes a daily walk as well as 3 or 4 exercises that can be completed in a 12 to 20 minutes timeframe. These daily exercises are prescribed by the doctor and taught by the physiotherapist in 2 sessions.
PATH 2.0
Other interventionIn the first days of hospitalization, the physiotherapist determines the score linked to the patient's mobility profile using of a decisional tree. The PA program has 2 or 3 exercises to be done with or without supervision 3 times per week day during hospitalization. These daily exercises are prescribed by the doctor and taught by the physiotherapist. In the days prior to discharge, the physiotherapist determines the patient's mobility profile using the decisional tree. When returning home after hospitalization, each PA program includes a daily walk as well as 3 or 4 exercises that can completed in a 12 to 20 minutes timeframe. These daily exercises are prescribed by the doctor and taught by the physiotherapist in 2 sessions.
Changes in short physical performance battery (SPPB) after intervention
SPPB is comprised of 3 tasks: a standing balance test (side by side, semi-tandem and tandem), 4-m habitual gait speed and 5 sit to stand from a chair. Each task is scored (based on time) from 0-4 points.
Changes in muscle strength after intervention (upper muscle strength : handgrip strength, lower limb strength: sit to stand-30sec)
Handgrip strengh, sit to stand test (30sec)
Changes in walking after intervention (Walking speed :4 m habitual gait speed and walking parameter : 3 meter timed up and go)
4 m habitual gait speed test and 3 m timed up and go test
Feasibility of the clinical tools : MATCH, PATH, PATH 2.0
will be measured using a score (expressed in %) taking into account the ratio of the number of patients who have received an PA program on the number of patients hospitalized and eligible for treatment study.
Usability of the clinical tools : MATCH, PATH, PATH 2.0
Usability will be measured using the valided SUS questionnaire (10 items/score ranged from 0 to 100).
Acceptability of the clinical tools: MATCH, PATH, PATH 2.0
Will be evaluated by the administration of a questionnaire with 4 Likert level/question. This questionnaire will presented 3 sub-sections examining :1) its clinical relevance, 2) its applicability in ecological environment; 3) its implementation burden.
Estimate the benefits-cost ratio on the use of post-hospitalization health services
QALY analysis estimating cost reduction related to health service utilization, number of falls / falls with injuries, and benefits through improved quality of life; cost-effectiveness analysis; and confirmatory economic analysis of the "difference-in-differences" type, the following variables will be necessary: the socio-economic portrait of the participants, the quality of life, the cost of care and use of health services : 1) visits to doctors or health professionals, 2) home visiting DAS professionals or 3) emergency room / hospital stays via medical records)
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Université du Québec a Montréal
Lead sponsor
Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal
Sponsor institution
