Comparing Approaches to Support Implementation of a Hospital Walking Program: Evidence from a Cluster Randomized Trial.

BACKGROUND: Hospital mobility programs align with age-friendly care principles by promoting functional recovery for older adults; however, optimal strategies for implementing such programs remain unclear. OBJECTIVE: To compare two approaches for implementing the STRIDE hospital mobility program across Veterans Affairs (VA) hospitals. DESIGN: Parallel cluster randomized controlled trial in 35 VA hospitals, with hospitals assigned to foundational (n = 19) or enhanced (n = 16) support arms. PARTICIPANTS: General medicine hospitalizations among patients aged 60 years and older. INTERVENTIONS: Foundational support included access to standardized program materials, online resources, data dashboards, and peer mentoring. Enhanced support included tailored 1:1 facilitation sessions for hospitals failing to meet initial program activity benchmarks. MAIN MEASURES: Primary outcomes were penetration (hospitalizations with ≥ 1 STRIDE walk), fidelity (hospital days meeting walking activity benchmarks), and program adoption. KEY RESULTS: During the 10-month observation period, median number of hospitalizations with a STRIDE walk was 70 in the foundational arm (IQR 3-131; range 0-374) and 34 in the enhanced arm (IQR 15-72; range 0-370). At 10-months, in adjusted models, there were no differences between arms in estimated percentage of hospitalizations with at least one STRIDE walk (1.9% in enhanced support and 4.0% in foundational support with estimated mean difference of -2.1% [95% CI -5.0%, 0.8%; p = 0.15]), or STRIDE hospital days meeting fidelity metrics (37.7% in enhanced support and 32.3% in foundational support with estimated mean difference of 5.3% [95% CI -6.0%, 16.6%; p = 0.34]). Overall rates of STRIDE initiation were 81% (n = 13) in the enhanced arm and 74% (n = 14) in the foundational arm. Barriers and facilitators to implementation were similar across arms. CONCLUSIONS: This study found no significant advantage of enhanced over foundational support for implementing the STRIDE hospital mobility program. Development of targeted implementation strategies to improve reach is needed to enhance overall impact of hospital mobility programs and age-friendly care initiatives. CLINICAL TRIALS: ClinicalTrials.gov (identifier NCT04868656).

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