A supervised hospital walking program may reduce nursing facility admissions for older adults

A randomized trial of older veterans found that hospitalized persons enrolled in a supervised walking program known as STRIDE (AssiSTed EaRly MobIlity for HospitalizeD VEterans) were less likely to be discharged to a skilled nursing facility. However, the authors noted that participation in the program was low and there was no change associated with length of hospital stay or inpatient falls. The study is published in Annals of Internal Medicine.

Inactivity during hospitalization has been recognized as a key contributor to hospital-associated disability and other harms for decades. Low mobility has been linked to delirium, falls, longer lengths of stay (LOS), greater risk for readmission, and functional decline resulting in discharge to skilled nursing facilities. In previous trials, hospital walking programs have been shown to improve functional ability after discharge, but little evidence exists about their effectiveness under routine practice conditions.

Researchers from Durham VA Health Care System and Duke University conducted a stepped-wedge, cluster randomized trial of persons aged 60 and older admitted to 8 Veterans Affairs hospitals to evaluate the effect of implementation of a supervised walking program on discharge to a skilled nursing facility, length of stay, and inpatient falls. Participating hospitals received structured guidance to help plan and launch their programs but were responsible for identifying and training their clinical personnel to assess patients and conduct walks.

The authors found that the proportion of patients discharged to a skilled nursing facility pre-STRIDE (n=6,722) was 13 percent while the proportion of patients discharged to a skilled nursing facility post-STRIDE (n=6,141) was 8 percent. However, participation in the program was low and variable, with participation of potentially eligible patients ranging from 0.6 percent to 22.7 percent and 2 hospitals pausing or discontinuing the program after it was launched. Still, the authors say their findings suggest that health systems should consider hospital walking programs as a reasonable means to improve quality of care for older adults. Further development of strategies to support hospitals in implementation of new clinical programs are needed to enhance their effect.