BIOSKETCH AND RESEARCH INTERESTS

Cynthia J. Brown, MD, MSPH, is the Emmett G. and Beverly S. Parrish endowed Professor of Medicine in the Division of Gerontology, Geriatrics, and Palliative Care at UAB. Dr. Brown completed an undergraduate degree in physical therapy from East Carolina University and a MD from the University of North Carolina at Chapel Hill. At Yale University, Dr. Brown completed residency training in internal medicine, which included a Chief Resident year, and a three-year Geriatric Medicine fellowship. She has been on faculty in the Division of Gerontology, Geriatrics, and Palliative Care at UAB since 2003 and completed her MSPH in Health Behaviors at UAB in 2006. She was named Director of the Division as well as the Comprehensive Center for Healthy Aging in 2014.

Dr. Brown’s research interests combine the issues of low mobility and falls in the hospitalized older patient. Her mobility work has been well supported by NIH and VA grants and has been presented at national and international meetings. Dr. Brown has won numerous awards including the prestigious 2013 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Dr. Brown is on the editorial board and served as a section editor for the Journal of the American Geriatrics Society. In addition, she is the medical director for the Fall Prevention and Mobility Clinic at the Birmingham VA Medical Center.

Dr. Brown and colleagues, using a single blind randomized trial design, found that a mobility program (MP) that included offering assistance with ambulation linked with a behavioral intervention that focused on goal setting and addressing mobility barriers prevented loss of community mobility one month after hospital discharge. Those who received usual care (UC) experienced a clinically significant decline in community mobility. Functional status as measured by ADLs was not significantly different between the UC and MP groups either before or after the hospitalization. Because low mobility in the hospital is associated with adverse outcomes including functional decline and nursing home placement even after controlling for illness severity and comorbid illness, these findings have potentially significant clinical implications.

ABSTRACT

Importance  
Low mobility is common during hospitalization and associated with loss or declines in ability to perform activities of daily living (ADL) and limitations in community mobility.

Objective  
To examine the effect of an in-hospital mobility program (MP) on posthospitalization function and community mobility.

Design, Setting, and Participants  
This single-blind randomized clinical trial used masked assessors to compare a MP with usual care (UC). Patients admitted to the medical wards of the Birmingham Veterans Affairs Medical Center from January 12, 2010, through June 29, 2011, were followed up throughout hospitalization with 1-month posthospitalization telephone follow-up. One hundred hospitalized patients 65 years or older were randomly assigned to the MP or UC groups. Patients were cognitively intact and able to walk 2 weeks before hospitalization. Data analysis was performed from November 21, 2012, to March 14, 2016.

Interventions  
Patients in the MP group were assisted with ambulation up to twice daily, and a behavioral strategy was used to encourage mobility. Patients in the UC group received twice-daily visits.

Main Outcomes and Measures  
Changes in self-reported ADL and community mobility were assessed using the Katz ADL scale and the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), respectively. The LSA measures community mobility based on the distance through which a person reports moving during the preceding 4 weeks.

Results  
Of 100 patients, 8 did not complete the study (6 in the MP group and 2 in the UC group). Patients (mean age, 73.9 years; 97 male [97.0%]; and 19 black [19.0%]) had a median length of stay of 3 days. No significant differences were found between groups at baseline. For all periods, groups were similar in ability to perform ADL; however, at 1-month after hospitalization, the LSA score was significantly higher in the MP (LSA score, 52.5) compared with the UC group (LSA score, 41.6) (P = .02). For the MP group, the 1-month posthospitalization LSA score was similar to the LSA score measured at admission. For the UC group, the LSA score decreased by approximately 10 points.

Conclusions and Relevance  
A simple MP intervention had no effect on ADL function. However, the MP intervention enabled patients to maintain their prehospitalization community mobility, whereas those in the UC group experienced clinically significant declines. Lower life-space mobility is associated with increased risk of death, nursing home admission, and functional decline, suggesting that declines such as those observed in the UC group would be of great clinical importance.

PMID: 27243899


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