Effects of a modular intervention on mobility and activities of daily living in geriatric patients in an acute hospital settings – results of the stepped-wedge cluster-randomized redurisk study

Hospitalization increases the risk of reduced mobility and diminished activities of daily living (ADL) in geriatric patients. Using a multimodal intervention including delirium prevention, mobility training, care planning, and polypharmacy management, the ReduRisk project aimed to mitigate these risks through a risk-adapted nursing approach. This paper seeks to describe the results of the multimodal ReduRisk study on the mobility and ADL in hospitalized geriatric patients. We hypothesized that patients in the intervention group will have better mobility and ADL than those in the control group. A monocentric, cluster-randomized trial enrolled a total of N = 589 participants. Clusters were based on different department at the University Hospital of Freiburg. Data collection occurred at three measurement points (hospital admission, discharge, and six months post-discharge) using the Barthel Index (ADL) and the Short Physical Performance Battery (SPPB, mobility). Multilevel analyses were conducted. Of the N = 589 participants, 48% were female. Average age was 79.57 years (SD = 5.44 years). In the intervention group (IG), mobility significantly improved between t0 and t1 (β = 0.27; p<.01) and between t0 and t2 (β = 0.70; p<.001). Compared to the control group (CG), IG mobility improved significantly more from t0 to t2 (β=-0.30; p<.05). Regarding ADL, the IG also showed significant improvements between t0 and t1 (β = 3.69; p<.05) and t0 and t2 (β = 7.98; p<.001). Compared to the CG, IG participants experienced significantly more significant improvements (t0-t1: β=-6.93; p<.01; t0-t2: β=-8.40; p<.01). The ReduRisk intervention led to moderate improvements in ADL and small gains in mobility. These findings support the importance of early and sustained mobility interventions in clinical care. We observed promising results for the risk-adjusted ReduRisk intervention in reducing health-related risks among geriatric patients. German Clinical Trials Register, DRKS00025594, date of registration 09/08/2021.