Original research| Volume 102, ISSUE 4, P664-674, April 2021

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Core Domains for Research on Hospital Inactivity in Acutely Ill Older Adults: A Delphi Consensus Study

Published:November 27, 2020DOI:


      • 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.



      To identify core domains for research studies of physical activity and sedentary behavior during hospitalization for older adults with an acute medical illness.


      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.


      Online surveys.


      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.



      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).


      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.


      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.


      List of abbreviations:

      COMET (Core Outcome Measures in Effectiveness Trials), COS (core outcome set)
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        • Baldwin C.
        • van Kessel G.
        • Phillips A.
        • Johnston K.
        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
        • Fazio S.
        • Stocking J.
        • Kuhn B.
        • et al.
        How much do hospitalized adults move? A systematic review and meta-analysis.
        Appl Nurs Res. 2020; 51: 151189
        • Ewald B.D.
        • Oldmeadow C.
        • Attia J.R.
        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
        • Loyd C.
        • Beasley T.M.
        • Miltner R.S.
        • Clark D.
        • King B.
        • Brown C.J.
        Trajectories of community mobility recovery after hospitalization in older adults.
        J Am Geriatr Soc. 2018; 66: 1399-1403
        • Mudge A.M.
        • Hubbard R.E.
        Management of frail older people with acute illness.
        Intern Med J. 2019; 49: 28-33
        • Agmon M.
        • Zisberg A.
        • Gil E.
        • Rand D.
        • Gur-Yaish N.
        • Azriel M.
        Association between 900 steps a day and functional decline in older hospitalized patients.
        JAMA Intern Med. 2017; 177: 272-274
        • Boyd C.M.
        • Landefeld C.S.
        • Counsell S.R.
        • et al.
        Recovery of activities of daily living in older adults after hospitalization for acute medical illness.
        J Am Geriatr Soc. 2008; 56: 2171-2179
        • Fisher S.R.
        • Graham J.E.
        • Ottenbacher K.J.
        • Deer R.
        • Ostir G.V.
        Inpatient walking activity to predict readmission in older adults.
        Arch Phys Med Rehabil. 2016; 97: S226-S231
        • Ostir G.V.
        • Berges I.M.
        • Kuo Y.F.
        • Goodwin J.S.
        • Fisher S.R.
        • Guralnik J.M.
        Mobility activity and its value as a prognostic indicator of survival in hospitalized older adults.
        J Am Geriatr Soc. 2013; 61: 551-557
        • Brown C.J.
        • Friedkin R.J.
        • Inouye S.K.
        Prevalence and outcomes of low mobility in hospitalized older patients.
        J Am Geriatr Soc. 2004; 52: 1263-1270
        • Pavon J.M.
        • Sloane R.J.
        • Pieper C.F.
        • et al.
        Accelerometer-measured hospital physical activity and hospital-acquired disability in older adults.
        J Am Geriatr Soc. 2020; 68: 261-265
        • Ley L.
        • Khaw D.
        • Duke M.
        • Botti M.
        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
        • Zaslavsky O.
        • Zisberg A.
        • Shadmi E.
        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
        • Chastin S.F.M.
        • Harvey J.A.
        • Dall P.M.
        • McInally L.
        • Mavroeidi A.
        • Skelton D.A.
        Beyond "#endpjparalysis", tackling sedentary behaviour in health care.
        AIMS Med Sci. 2019; 6: 67-75
        • Lim S.E.R.
        • Ibrahim K.
        • Sayer A.A.
        • Roberts H.C.
        Assessment of physical activity of hospitalised older adults: a systematic review.
        J Nutr Health Aging. 2018; 22: 377-386
        • McCullagh R.
        • Brady N.M.
        • Dillon C.
        • Horgan N.F.
        • Timmons S.
        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
        • Anderson J.L.
        • Green A.J.
        • Yoward L.S.
        • Hall H.K.
        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
        • Cortes O.L.
        • Delgado S.
        • Esparza M.
        Systematic review and meta-analysis of experimental studies: In-hospital mobilization for patients admitted for medical treatment.
        J Adv Nurs. 2019; 75: 1823-1837
        • Brown C.J.
        • Foley K.T.
        • Lowman J.D.J.
        • et al.
        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
        • Moreno N.A.
        • de Aquino B.G.
        • Garcia I.F.
        • et al.
        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
        • Zisberg A.
        • Agmon M.
        • Gur-Yaish N.
        • et al.
        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
        • Mudge A.M.
        • Banks M.D.
        • Barnett A.G.
        • et al.
        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
        • Hshieh T.T.
        • Yang T.
        • Gartaganis S.L.
        • Yue J.
        • Inouye S.K.
        Hospital elder life program: systematic review and meta-analysis of effectiveness.
        Am J Geriatr Psychiatry. 2018; 26: 1015-1033
        • Liu B.
        • Moore J.E.
        • Almaawiy U.
        • et al.
        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
        • World Health Organization
        Global recommendations on physical activity for health 2010.
        (Available at:)
        Date accessed: May 13, 2020
        • Tremblay M.S.
        • Aubert S.
        • Barnes J.D.
        • et al.
        Sedentary behavior research network (SBRN) – terminology consensus project process and outcome.
        Int J Behav Nurt Phys Act. 2017; 14: 75
        • World Health Organization
        International Classification of Functioning Disability and Health (ICF) 2001.
        (Available at:)
        Date accessed: May 13, 2020
        • Chastin S.F.M.
        • De Craemer M.
        • Lien N.
        • et al.
        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
        • COMET Initiative
        Core outcome measures in effectiveness trials.
        (Available at:)
        Date accessed: May 13, 2020
        • Turnbull A.E.
        • Sepulveda K.A.
        • Dinglas V.D.
        • Chessare C.M.
        • Bingham 3rd, C.O.
        • Needham D.M.
        Core domains for clinical research in acute respiratory failure survivors: an international modified Delphi consensus study.
        Crit Care Med. 2017; 45: 1001-1010
        • Sinha I.P.
        • Smyth R.L.
        • Williamson P.R.
        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
        • Gargon E.
        • Gorst S.L.
        • Williamson P.R.
        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
        • Kirkham J.J.
        • Davis K.
        • Altman D.G.
        • et al.
        Core Outcome Set-STAndards for Development: the COS-STAD recommendations.
        PLoS Med. 2017; 14e1002447
        • Baldwin C.E.
        • Phillips A.C.
        • Edney S.M.
        • Lewis L.K.
        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
        • Junger S.
        • Payne S.A.
        • Brine J.
        • Radbruch L.
        • Brearley S.G.
        Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review.
        Palliat Med. 2017; 31: 684-706
        • Kirkham J.J.
        • Gorst S.
        • Altman D.G.
        • et al.
        Core Outcome Set-STAndards for Reporting: the COS-STAR Statement.
        PLoS Med. 2016; 13e1002148
        • Baldwin C.E.
        • Parry S.M.
        • Norton L.
        • Williams J.
        • Lewis L.K.
        A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalisation.
        Clin Rehabil. 2020; 34: 1157-1172
        • PCORI's Stakeholders
        Patient-Centered Outcomes Research Institute 2014.
        (Available at:)
        • Dodd S.
        • Clarke M.
        • Becker L.
        • Mavergames C.
        • Fish R.
        • Williamson P.R.
        A taxonomy has been developed for outcomes in medical research to help improve knowledge discovery.
        J Clin Epidemiol. 2018; 96: 84-92
        • Guyatt G.H.
        • Oxman A.D.
        • Kunz R.
        • et al.
        What is “quality of evidence” and why is it important to clinicians?.
        BMJ. 2008; 336: 995-998
        • Boers M.
        • Kirwan J.R.
        • Wells G.
        • et al.
        Developing core outcome measurement sets for clinical trials: OMERACT filter 2.0.
        J Clin Epidemiol. 2014; 67: 745-753
        • Fitch K.
        • Bernstein S.J.
        • Aguilar M.
        • et al.
        The RAND/UCLA appropriateness method user's manual.
        RAND Corporation, Santa Monica2001
        • Growdon M.E.
        • Shorr R.I.
        • Inouye S.K.
        The tension between promoting mobility and preventing falls in the hospital.
        JAMA Intern Med. 2017; 177: 759-760
        • Said C.M.
        • Morris M.E.
        • McGinley J.L.
        • et al.
        Additional structured physical activity does not improve walking in older people (>60years) undergoing inpatient rehabilitation: a randomised trial.
        J Physiother. 2018; 64: 237-244
        • van der Kluit M.J.
        • Dijkstra G.J.
        • de Rooij S.E.
        Goals of older hospitalised patients: a qualitative descriptive study.
        BMJ Open. 2019; 9e029993
        • Lewthwaite H.
        • Effing T.W.
        • Lenferink A.
        • Olds T.
        • Williams M.T.
        Improving physical activity, sedentary behaviour and sleep in COPD: perspectives of people with COPD and experts via a Delphi approach.
        PeerJ. 2018; 6e4604
        • Akinremi A.
        • Turnbull A.E.
        • Chessare C.M.
        • Bingham C.O.
        • Needham D.M.
        • Dinglas V.D.
        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