University of Colorado, Denver
This pilot study will evaluate the feasibility of a supplemental mobility intervention, the Safe Transfers And Mobility Program (STAMP). This program will be implemented in patients admitted to skilled nursing facilities (SNFs) following hospitalization. STAMP will be administered by a mobility aide who will support patients in increasing physical activity through walking and transfers outside of structured rehabilitation. Participants will either receive high-intensity rehabilitation (HIR) or usual care rehabilitation, combined with STAMP. The two main aims are: 1) determine the feasibility, acceptability, and safety of STAMP, and 2) evaluate the feasibility and variability of patient physical function outcome measures. The study will provide preliminary data on program delivery and safety to inform the design of a larger trial aimed at identifying the most effective strategies to optimize functional recovery in SNFs.
A substantial portion of older adults receiving care in skilled nursing facilities (SNFs) do not achieve successful outcomes, with nearly 40% unable to return home and up to 29% experiencing hospital readmission an outcome strongly associated with mortality. A major, modifiable contributor to these poor outcomes is reduced physical function. Although SNFs offer structured rehabilitation to address mobility impairments, its effectiveness is undermined by pervasive sedentary behavior. Up to 96% of patients receiving care in SNFs require assistance with mobility, and despite participating in dail…
Inclusion Criteria: * At least 50 years old * Admitted to SNF from the hospital * Ambulatory at admission with minimal assistance or less Exclusion Criteria: * Contraindications to high-intensity resistance training (per American College of Sports Medicine Exercise Testing and Prescription) * Neurological diagnosis (e.g., cerebral vascular accident, multiple sclerosis, Parkinson's disease, traumatic brain injury) * Lower extremity weight-bearing precautions that require greater than minimal assistance with ambulation * Subsequent SNF admission
An 8RM is the dose necessary for most effective strength gains in community-dwelling older adults, and is equivalent to 80% of a one repetition max, which is the maximal load needed to voluntarily complete one repetition of a given exercise with proper form. Activities will include strength training, transfer practice, balance training, advanced ADLs. Clinicians will tailor the intervention for each activity to target overload using 8-repetition maximum for resistance training. Other interventions will be performed to muscle failure or inability to complete the final repetition. Failure is the inability to complete a repetition through the full, available range of motion without significant compensation. Further, high-intensity dosing requires continuous, volitional effort from the patient; therefore, incorporation of motivational interviewing strategies across sessions will maximize patient effort and self-efficacy.
The Safe Transfers and Mobility Program (STAMP) embeds a mobility aide into daily care. STAMP is a patient-centered, scalable approach to extend the benefits of rehabilitation sessions by increasing mobility throughout the day and reinforcing activity between therapy sessions. Core components are: (1) targeting 45 minutes of additional daily physical activity through support with walking and functional mobility tasks; (2) establishing individualized mobility goals collaboratively set by the therapist and patient, based on functional level; (3) delivering progressive activities with walking distances increased by \~30% weekly, adjusted for patient tolerance; and (4) interdisciplinary coordination to incorporate STAMP sessions into routine care with minimal disruption to clinical workflow. Prior work suggests that 45 minutes of STAMP can at least double daily step counts, and increasing walking distance by 30% per week is feasible even for individuals with low baseline function.
Usual Care SNFs will continue with routine collection and documentation of physical performance outcomes (gait speed, SPPB, Modified Barthel ADL Index) as standard practice. Importantly, the Usual Care SNF including the facility, rehabilitation clinicians, and patients will not have access to i-STRONGER materials.