Why is Mobilization Important?

  • Rates of mobilization in patients admitted to acute care hospitals are unacceptably low. Studies show that hospitalized older adults who were ambulatory during the 2 weeks prior to admission spent a median of only 43 minutes per day standing or moving.
  • In addition, one-third of older adults develop a new disability in an activity of daily living during hospitalization and half of these are unable to recover function.
  • Without mobilization elderly patients lose 1% to 5% of muscle strength each day in hospital.
  • Data from observations on inpatient units conducted in 2010-2011 in academic hospitals in Toronto found that less than 30% of patients were mobilized regularly in hospital (B. Liu 2011, personal communication).

What is the Evidence?

  • Modest interventions can prevent some of the outcomes associated with immobility.
  • Early mobilization strategies (defined as assessing patients for mobility and functional status within 24 hours of admission and encouraging appropriate activity immediately) have been shown to:
    • Decrease acute care length of stay (adjusted absolute difference of 1.1 days [95% confidence interval [CI] 0.0 to 2.2 days])
    • Shorten the duration of delirium (median of 2 days [inter-quartile range 0.0 to 6.0] versus 4 days [inter-quartile range 2.0 to 8.0])
    • Improve the return to independent functional status (odds ratio [OR] 2.7 [95% CI 1.2 to 6.1])
    • Decrease the risk of depression (OR 0.14 [95% CI 0.03 to 0.61])
    • Increase rates of discharge to home (26.2% versus 2.4% at 7 days)
    • Decrease hospital costs by $300/patient/day

What Outcomes are Being Assessed?

The project’s primary outcome is to increase the frequency of mobilization on the unit.  The secondary outcomes include tracking:

  • Length of stay
  • Discharge destination
  • Falls
  • Injurious falls
  • Perceptions and satisfaction of patients, informal caregivers, family members, and health care professionals

Project Structure

The Building Blocks of MOVEs

The Division of Geriatric Medicine at the University of Toronto and its teaching hospitals have been focused on meeting challenges related to quality improvement in geriatric care.  Early mobilization in hospital was identified as a key challenge that could be addressed by knowledge translation (KT) initiatives. Through collaboration between investigators interested in geriatric medicine, MOVE iT (Mobilization of Vulnerable Elders in Toronto), a project focused on the implementation of an innovative, scalable strategy to promote early mobilization and prevent functional decline, was conceptualized.

In November 2011, the Council of Academic Hospitals of Ontario’s (CAHO) Adopting Research to Improve Care (ARTIC) Program funded an expansion of MOVE iT to hospitals across Ontario. This iteration of the project was called MOVE ON (Mobilization of Vulnerable Elders in Ontario). With the addition of the CAHO ARTIC funding, MOVE iT was amalgamated with MOVE ON as one initiative. In 2011-2012, the MOVE ON project was implemented in 14 hospitals across Ontario.

Funded by ARTIC Spread and Scale,  MOVE iT/ MOVE ON was expanded on to an additional 15 units in seven of the 14 MOVE ON hospitals

In January 2015, the MOVE initiative was implemented in 5 hospitals across Alberta

Based on the positive responses received from the project unit sites to date, this project has been expanded further to additional hospital units globally. The goal of MOVE remains consistent with the overall goal of MOVE iT/ON, which is to implement and evaluate the impact of an evidence-based strategy to promote early mobilization and prevent functional decline in older patients admitted to acute care facilities.

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Project Structure: Funding and Accountability162.50 KB
Using the Model253.00 KB
Logic Model171.50 KB
Background Research98.00 KB