“Mobility is crucial for our own survival,” says Barb King, PhD, RN, FAAN, a professor at the University of Wisconsin–Madison School of Nursing.

“Mobility is when an individual can independently move from point A to point B,” she says. “If you lose that independence, in many contexts you lose your autonomy. And that impacts quality of life. It impacts health. It impacts the ability to participate socially.”

Unfortunately, after a hospital stay, up to two-thirds of older people have reduced mobility. Federal policies intended to reduce falls have led hospital staff to discourage patients from getting out of bed. Prolonged bed rest can lead to hospital-associated disability, when people lose strength and struggle to meet their daily needs on their own.

“We shouldn’t be restricting mobility as fall prevention,” stresses King. “Walking should be part of our fall prevention strategy.”

The good news is that hospital care can be provided in ways that support patient mobility.

Research by King and School of Nursing Professor Linsey Steege, PhD is helping hospitals make the switch. They developed a mobility program for hospitals called MOVIN, which stands for Mobilizing Older adults Via a systems-based INtervention.

MOVIN has five components:

• Psychomotor skills – physical therapy and nurse-led training on supporting patient mobility
• Resources – aides and equipment to help patients walk
• Communication – electronic reporting and signs
• Environment – distance markers and maps to encourage patients to walk
• Unit culture – setting goals for patient mobility and celebrating successes

After developing and pilot testing MOVIN, Steege and King wanted to know if their program helps older patients maintain mobility and reduces healthcare needs. They designed a pragmatic clinical trial, comparing patients before and after hospital units began using MOVIN, under real-world conditions.

Little did they know how much real-world conditions were about to change. They received funding to carry out their study in spring 2020.

Despite the uncertainty around the COVID-19 pandemic, Steege and King began their study. They worked with four units across two hospitals, forming MOVIN teams on each unit, then launching and maintaining the patient mobility program.

MOVIN was designed to be customizable, in recognition of hospitals’ varying and complex environments.

“For each of MOVIN’s five components, we worked with the unit team,” Steege says. “We asked, what should this look like? And we planned adaptations. For this unit, this is what communication is going to look like. For this unit, this is what culture is going to look like.”

The COVID-19 pandemic required even more flexibility from all involved.

“Hospitals continued to be super invested, but the pandemic beats everything,” says Steege. “We had to build unit teams and do the co-design process virtually. We couldn’t go onto the units.”

“Sometimes we stood back and looked at the disaster happening,” King remembers. “We said, okay, we have to figure out what to do. The unit is in crisis. How do we move forward without burdening the unit even more?”

Remarkably, they were able to complete the study. And, despite the pandemic, each hospital unit ran the MOVIN program faithfully with all five components.

King and Steege credit the hospitals for their commitment. Everyone from patients to unit staff to hospital leaders were motivated to keep patients walking. In addition, MOVIN’s collaborative process helped build trust and fostered a sense of ownership.

“It was important for the hospitals to improve patient outcomes,” says King. “They were engaged in the co-creation and had a vision of what this could be like for their organizations.”

King’s and Steege’s analysis of the data continues. Not surprisingly, some of it is complicated.

“There was a ton of variability week to week—patient census, FTE [staffing levels], COVID surges, float staff, staff morale,” says Steege. “Lots of things that drive individual data points up and down.”

Still, “three of the four units had a statistically significant increase in distance between the pre-intervention and intervention time periods,” says Steege. “It does seem like MOVIN does something and patients on those units walked more.”

“Even with all of the disruption from COVID, we were still able to demonstrate significant effects,” says King. “We improved nursing mobility practices in hospitals.”

–Diane Farsetta