Mobility intervention for hospitalized patients with cancer has ‘remarkable’ impact
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An early mobility program for hospitalized patients with cancer yielded a reduction in hospital readmissions and improvements in mobility and functional status, according to a study conducted at Icahn School of Medicine at Mount Sinai.
In the prospective pre-post study, published in JCO Oncology Practice, researchers introduced the mobility aide program in the oncology unit at Mount Sinai Hospital for all patients not on bedrest orders between Oct. 1, 2018, and Feb. 28, 2021. The researchers assessed the intervention’s effect on hospital length of stay, readmissions and changes in mobility compared with the 6-month period before introduction of the program.
“Often, patients who are hospitalized with cancer have longer lengths of stay, and the longer the patients are in the hospital, the more debilitated and sedentary they become — if you don’t use it, you lose it, so to speak,” Cardinale B. Smith, MD, PhD, professor of medicine (hematology and medical oncology) and professor of geriatrics and palliative medicine at Icahn School of Medicine, told Healio. “This leads to poor performance status, weaker muscles, and more difficulty tolerating chemotherapy and recovering in general.”
Smith spoke with Healio about the intervention and how it could benefit hospitalized patients with cancer and the health care system.
Healio: How does hospitalization potentially harm patients with cancer and burden institutions?
Smith: Because cancer is often a disease of older adults, we often end up seeing patients who, at discharge, are not at the level of function they had at the time of admission. So, these patients are not sent back home but to rehab. That brings with it a whole list of potential complications. Patients aren’t able to recover in their home setting. When you consider the cost of care and the cost to quality of life, that adds a whole other layer of challenge.
Healio: How did you conduct this study?
Smith: We utilized our existing medical assistants who received enhanced rehabilitation training. They worked with our physical medicine and rehab partners to get additional training specifically focused on mobility. Working with the physical therapy and nursing teams, we performed the Activity Measure for Post-Acute Care assessment, which is essentially a mobility assessment. Based on the level of mobility, it defines what kind of physical therapy a patient can do, whether it’s chair exercises, bed exercises, or actually getting someone out of bed and walking them around.
Our goal was to get our patients to be mobile at least twice a day. This was a paradigm shift, because typically, we rely on physical therapists for this. They are great resources, yet more expensive. They don’t always work on oncology units 7 days a week. So, by engaging with our medical assistants, who received enhanced rehabilitation training, we were able to mobilize our patients on our pilot unit twice a day, 7 days a week. By doing that, we were able to not only move patients more, but also shift responsibilities, because this work often would end up falling to the nursing staff. This intervention allowed nurses to get back to the bedside and perform more nursing tasks. It improved overall morale and satisfaction across the board.
Healio: How did the intervention perform in terms of the outcomes you analyzed?
Smith: We found that by using our mobility aides and getting our patients up and out of bed, we were able to decrease readmissions and maintain patients’ level of functioning compared with at the time of admission. The majority of patients either maintained or improved their level of functioning.
Healio: How did patients feel about the intervention?
Smith: We didn’t do any formal qualitative analysis, but we did have some anecdotal reports and patient stories. In particular, some of our bone marrow transplant patients appreciated this intervention. These patients are often in the hospital for a month, if not longer. We had one patient in particular who, for insurance reasons, was not able to go to rehab — the insurance was just not going to cover it. We were able to put a plan in place with the mobility aides that enabled the patient to be discharged from the hospital and go home. They didn’t think they were going to be able to leave the hospital at all. It was remarkable, and we had several stories like that.
Healio: What do you expect to be the long-term implications of these findings? Do you think this will allow more patients to go home rather than to rehab?
Smith: That’s what I’m hoping. We will now look at whether we will be able to justify the cost as we scale this up. We then want to look at what happens in terms of discharges and whether people are going home or to rehab. We want to look at things like nursing turnover, as well. We piloted this in one unit, and despite the fact that it was the dedicated COVID unit, that unit had less nursing turnover than our other units.
Healio: Is there anything else you’d like to mention?
Smith: This is a bit of a paradigm shift in that we typically think of physical therapists being the folks who need to be able to mobilize our patients. I think this shows us that we can easily use other trained groups of health care professionals to help us in mobilizing patients so that we can utilize the more specialized experts in other ways.
For more information:
Cardinale B. Smith, MD, PhD, can be reached at Tisch Cancer Institute, 1470 Madison Ave., 3rd Floor, New York, NY 10029; email: cardinale.smith@mssm.edu.
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