Feasibility and Usability of a Post-Hospital Behavioral Intervention to Improve Mobility in Veterans

Abstract

The strongest risk factor for readmission to the hospital is impaired physical function. We sought to determine the usability and feasibility of a post-hospital behavioral intervention to improve mobility in older adults with significant morbidity and functional impairment. We conducted a two-arm pragmatic pilot randomized trial of a behavioral economics-informed intervention to increase daily steps in Veterans, age 60 or older, receiving home health (HH) services post-discharge. The intervention group received a multicomponent behavioral economics-informed intervention, including daily step count goals, performance feedback, social incentives, and a pedometer. The control group received usual care, which included the use of a pedometer without additional interventions. Both groups wore an ActivPAL device to continuously monitor activity. Outcomes were measured at 60 days post-discharge. The primary outcomes were feasibility (enrollment and completion rates) and usability (device compliance and participant satisfaction). Secondary outcomes included changes in mean daily steps and hospital utilization. Differences in daily steps between the intervention and control group were examined using a linear mixed effects model. Sixteen out of the 37 consented Veterans completed the study (9 intervention, 7 control). All Veterans rated as very satisfied with wearing the pedometer, while 3 did not like wearing the ActivPAL. The pedometer data was more complete, with a missing step data rate of 5%, compared to 29% for the ActivPAL. The median (interquartile range, IQR) baseline step counts were 926 steps (2744) in the control arm and 1131 steps (2952) in the intervention arm. Both groups increased steps during the intervention; however, there was no significant difference between groups (P = .18). Few older adults were able to complete the study, suggesting improvements to feasibility and acceptability are needed. Step counts were very low but did improve in both groups during the intervention. A pedometer was preferred by participants and provided more complete information than a research-grade device. Larger studies are needed to evaluate efficacy of such interventions.