HIGHLIGHTS
- •This research determined core domains (important types of outcomes).
- •Findings are for studies of physical activity in hospitalized older adults.
- •Findings may also improve outcome reporting in studies of sedentary behavior.
- •Use of a consensus approach with researchers, clinicians, policymakers, and patients.
- •Core domains provide the starting point for developing a core outcome set.
Abstract
Objective
To identify core domains for research studies of physical activity and sedentary behavior
during hospitalization for older adults with an acute medical illness.
Design
A 4-Round Delphi consensus process. Round 1 invited responses to open-ended questions
to generate items for the core domains research. In rounds 2-4, participants were
invited to use a Likert scale (1-9) to rate the importance of each core domain for
research studies of physical activity and/or sedentary behavior in hospitalized older
adults with an acute medical illness.
Setting
Online surveys.
Participants
A total of 49 participants were invited to each round (international researchers,
clinicians, policy makers and patients). Response rates across rounds 1-4 were 94%,
88%, 83% and 81%, respectively.
Interventions
None.
Main Outcome Measures
Consensus was defined a priori as ≥70% of respondents rating an item as “critical”
(score≥7) and ≤15% of respondents rating an item as “not important” (score≤3).
Results
In round 2, a total of 9 of 25 core domains reached consensus agreement (physical
functioning, general, role functioning, emotional functioning, global quality of life,
hospital, psychiatric, cognitive functioning, carer burden). In round 3, an additional
8 reached consensus (adverse events, perceived health status, musculoskeletal, social
functioning, vascular, cardiac, mortality, economic). Round 4 participants provided
further review and a final rating of all 17 core domains that met consensus in previous
rounds. Four core domains were rated as “critically important” to evaluate: physical
functioning, social functioning, emotional functioning, and hospital outcomes.
Conclusions
This preliminary work provides international and expert consensus-based core domains
for development toward a core-outcome set for research, with the ultimate goal of
fostering consistency in outcomes and reporting to accelerate research on effective
strategies to address physical activity and/or sedentary behavior in older adults
while hospitalized.
Keywords
List of abbreviations:
COMET (Core Outcome Measures in Effectiveness Trials), COS (core outcome set)To read this article in full you will need to make a payment
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References
- Accelerometry shows inpatients with acute medical or surgical conditions spend little time upright and are highly sedentary: systematic review.Phys Ther. 2017; 97: 1044-1065
- How much do hospitalized adults move? A systematic review and meta-analysis.Appl Nurs Res. 2020; 51: 151189
- Daily step count and the need for hospital care in subsequent years in a community-based sample of older Australians.Med J Aust. 2017; 206: 126-130
- Trajectories of community mobility recovery after hospitalization in older adults.J Am Geriatr Soc. 2018; 66: 1399-1403
- Management of frail older people with acute illness.Intern Med J. 2019; 49: 28-33
- Association between 900 steps a day and functional decline in older hospitalized patients.JAMA Intern Med. 2017; 177: 272-274
- Recovery of activities of daily living in older adults after hospitalization for acute medical illness.J Am Geriatr Soc. 2008; 56: 2171-2179
- Inpatient walking activity to predict readmission in older adults.Arch Phys Med Rehabil. 2016; 97: S226-S231
- Mobility activity and its value as a prognostic indicator of survival in hospitalized older adults.J Am Geriatr Soc. 2013; 61: 551-557
- Prevalence and outcomes of low mobility in hospitalized older patients.J Am Geriatr Soc. 2004; 52: 1263-1270
- Accelerometer-measured hospital physical activity and hospital-acquired disability in older adults.J Am Geriatr Soc. 2020; 68: 261-265
- The dose of physical activity to minimise functional decline in older general medical patients receiving 24-hr acute care: a systematic scoping review.J Clin Nurs. 2019; 28: 3049-3064
- Impact of functional change before and during hospitalization on functional recovery 1 month following hospitalization.J Gerontol A Biol Sci Med Sci. 2015; 70: 381-386
- Beyond "#endpjparalysis", tackling sedentary behaviour in health care.AIMS Med Sci. 2019; 6: 67-75
- Assessment of physical activity of hospitalised older adults: a systematic review.J Nutr Health Aging. 2018; 22: 377-386
- A review of the accuracy and utility of motion sensors to measure physical activity of frail, older hospitalized patients.J Aging Phys Act. 2016; 24: 465-475
- Validity and reliability of accelerometry in identification of lying, sitting, standing or purposeful activity in adult hospital inpatients recovering from acute or critical illness: a systematic review.Clin Rehabil. 2018; 32: 233-242
- Systematic review and meta-analysis of experimental studies: In-hospital mobilization for patients admitted for medical treatment.J Adv Nurs. 2019; 75: 1823-1837
- Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients: a randomized clinical trial.JAMA Intern Med. 2016; 176: 921-927
- Physiotherapist advice to older inpatients about the importance of staying physically active during hospitalisation reduces sedentary time, increases daily steps and preserves mobility: a randomised trial.J Physiother. 2019; 65: 208-214
- No one size fits all—the development of a theory-driven intervention to increase in-hospital mobility: the “WALK-FOR” study.BMC Geriatr. 2018; 18: 91
- CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients.BMC Geriatr. 2017; 17: 11
- Hospital elder life program: systematic review and meta-analysis of effectiveness.Am J Geriatr Psychiatry. 2018; 26: 1015-1033
- Outcomes of mobilisation of vulnerable elders in Ontario (MOVE ON): a multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation.Age Ageing. 2018; 47: 112-119
- Global recommendations on physical activity for health 2010.(Available at:)www.who.int/dietphysicalactivity/pa/en/Date accessed: May 13, 2020
- Sedentary behavior research network (SBRN) – terminology consensus project process and outcome.Int J Behav Nurt Phys Act. 2017; 14: 75
- International Classification of Functioning Disability and Health (ICF) 2001.(Available at:)www.who.int/classifications/icf/en/Date accessed: May 13, 2020
- The SOS-framework (systems of sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: a DEDIPAC-study.Int J Behav Nutr Phys Act. 2016; 13: 83
- Core outcome measures in effectiveness trials.(Available at:)www.comet-initiative.orgDate accessed: May 13, 2020
- Core domains for clinical research in acute respiratory failure survivors: an international modified Delphi consensus study.Crit Care Med. 2017; 45: 1001-1010
- Using the Delphi technique to determine which outcomes to measure in clinical trials: recommendations for the future based on a systematic review of existing studies.PLoS Med. 2011; 8e1000393
- Choosing important health outcomes for comparative effectiveness research: 5th annual update to a systematic review of core outcome sets for research.PLoS Med. 2019; 14e0225980
- Core Outcome Set-STAndards for Development: the COS-STAD recommendations.PLoS Med. 2017; 14e1002447
- Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study.Int J Behav Nutr Phys Act. 2020; 17: 69
- Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review.Palliat Med. 2017; 31: 684-706
- Core Outcome Set-STAndards for Reporting: the COS-STAR Statement.PLoS Med. 2016; 13e1002148
- A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalisation.Clin Rehabil. 2020; 34: 1157-1172
- Patient-Centered Outcomes Research Institute 2014.(Available at:)www.pcori.org/engagement/what-we-mean-engagement/pcoris-stakeholdersDate accessed: May 13, 2020
- A taxonomy has been developed for outcomes in medical research to help improve knowledge discovery.J Clin Epidemiol. 2018; 96: 84-92
- What is “quality of evidence” and why is it important to clinicians?.BMJ. 2008; 336: 995-998
- Developing core outcome measurement sets for clinical trials: OMERACT filter 2.0.J Clin Epidemiol. 2014; 67: 745-753
- The RAND/UCLA appropriateness method user's manual.RAND Corporation, Santa Monica2001
- The tension between promoting mobility and preventing falls in the hospital.JAMA Intern Med. 2017; 177: 759-760
- Additional structured physical activity does not improve walking in older people (>60years) undergoing inpatient rehabilitation: a randomised trial.J Physiother. 2018; 64: 237-244
- Goals of older hospitalised patients: a qualitative descriptive study.BMJ Open. 2019; 9e029993
- Improving physical activity, sedentary behaviour and sleep in COPD: perspectives of people with COPD and experts via a Delphi approach.PeerJ. 2018; 6e4604
- Delphi panelists for a core outcome set project suggested both new and existing dissemination strategies that were feasibly implemented by a research infrastructure project.J Clin Epidemiol. 2019; 114: 104-107
Article info
Publication history
Published online: November 27, 2020
Footnotes
An abstract of the study results was accepted for the International Society of Behavioral Nutrition and Physical Activity, June 15-25 2020, International online conference 'XChange initiative' (in lieu of COVID-19 cancellation of originally scheduled face to face conference in Auckland, NZ).
Supported by the College of Nursing and Health Sciences, Flinders University (Establishment Grant - 2018), and from the Caring Futures Institute, Flinders University (Accelerator Grant - 2019). The grant reviewers provided feedback on the original study design (proposal), but there was no conflict of interest and there was no role in the study methods, subject recruitment, data collection, analysis, or preparation of the article.
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
