Early Mobility Program For Patients With Cancer Helps to Maintain or Improve Their Mobility

The use of a mobility aide program significantly decreased health care utilization and improved quality of care among patients with cancer hospitalized from complications of, or treatments for, their disease, according to results of a pilot study presented at the 2020 ASCO Virtual Scientific Program.

“Cancer patients are often hospitalized with complications from their cancer or the treatments for cancer,” Dr. Cardinale B. Smith, director of quality for cancer services at Mount Sinai Health System in New York, said during her presentation. “Mobility is an essential component of physical function. Physical decline is common among hospitalized cancer patients and contributes to poorer outcomes, including increased length of stay, excess days, readmissions, and decreases in patient experience scores.”

As a result, Smith said, it is imperative to increase patient activity and mobilization during a hospital stay to prevent functional decline in patients and improve patient outcomes.

Previous research, according to Smith, has primarily been focused on addressing risk factors that limit, as well as developing interventions to enhance, mobility in well-functioning older adults who are not currently in the hospital. However, Smith noted, there have been limited interventions to assess and improve the mobility of patients with cancer.

To improve quality of care and decrease health care utilization, an early mobility aide program was developed at the Mount Sinai Health System. Measuring readmission rates, patient experience and a patient’s ability to be mobile were the main goals of the study.

“Ultimately, we want to provide the right level of care in the right setting at the right time,” Smith said.

Patients were administered the activity measure for post-acute care (AM-PAC) assessment, which is a six-question form that quantifies functional limitations to mobility by asking how much assistance a patient needs to perform mobility activities while in hospital.

Activities assessed in the AM-PAC include ability to turn in bed, sit in the bed, transfer from the bed to chair, stand from the chair, walk in the room, and climb three to five steps.

Each question is scored on a four-point scale which can result in a score between a high of 24, meaning they require no assistance, or a low of six, meaning the patient is completely reliant on another person to move. The scores could have been based on a direct observation or clinical judgement by the provider. Nurses were required to perform the assessment on patients hospitalized in the oncology unit every shift.

A plan of care was then developed that included representation from physical therapists, nurses and mobility aides. The mobility aide would mobilize patients twice a day, every day of the week.

A physical therapist was then provided to help patients who had lower scores on the AM-PAC assessment. For patients who had a moderate mobility need, they either received a mobility aide, a physical therapist, or a combination of both. Those who didn’t need much mobility help received a mobility aide and were able to function on their own.

A total of 988 patients were admitted to the hospital between April 2019 and December 2019 and received the mobility program.

The most common types of cancer patients presented with included, but were not limited to, multiple myeloma (16%), lymphoma (14%), breast, gastrointestinal and leukemia (12% for each).

The average number of interventions patients received from the mobility aides was 1.8. Over the duration of the study period, patients improved in each mobility task. Seventy-six percent of patients either maintained or improved their mobility score.

There was a 6% reduction in the number of excess days spent in the hospital, and there was a decrease in readmission rate from 25% prior to the implementation of the mobility program to 19% following the program’s implementation. Patient experience also improved after the mobility aide program was implemented, identified by Hospital Consumer Assessment of Healthcare Providers and Systems scores increasing from 63% prior to the program to 91% after the program.

Smith acknowledged that the study had some limitations. For instance, the study was performed in a single oncology unity at a single institution which might not be generalizable or applicable to other settings.

“Our mobility program significantly decreased health care utilization and improved patient experience, Smith concluded. “Future work will evaluate the sustainability of this program and its association with health care costs.”