Improving Functional Recovery in Skilled Nursing Facilities through Supplemental Mobility

Student summary

Why This Research Matters

This article, titled 'Improving Functional Recovery in Skilled Nursing Facilities through Supplemental Mobility,' outlines a research project aimed at addressing the significant challenge of functional decline among older adults receiving post-acute care in skilled nursing facilities (SNFs). The study is funded by the National Institute on Aging and led by Jennifer Stevens-Lapsley. It focuses on an innovative program called STAMP, which stands for Safe Transfers And Mobility Program.

The core problem addressed by this research is that despite rehabilitation services being available to over 1.3 million older adults annually in SNFs after hospitalization, many patients still leave with functional limitations. These limitations increase the risk of rehospitalization, disability, institutionalization, or even mortality. A key contributing factor identified is sedentary behavior outside of scheduled therapy sessions, which leads to physical deconditioning and hinders recovery.

STAMP is designed as a scalable, patient-centered supplemental mobility program intended to complement formal rehabilitation efforts. The program involves trained mobility aides working alongside interdisciplinary teams – including physical therapists, occupational therapists, and nursing staff – to encourage patients in walking and functional transfers (such as bed mobility, sit-to-stands, wheelchair transfers) throughout the day. This approach aims to reduce sedentary time and promote sustained physical activity.

The research project has two specific aims: 1. To evaluate the feasibility, acceptability, and safety of implementing STAMP in SNFs under different care models (usual care or high-intensity rehabilitation - HIR). This will involve assessing adherence to the intervention and gathering feedback from providers through surveys and focus groups. 2. To evaluate the feasibility and variability of candidate outcome measures for patients receiving STAMP. These outcomes include gait speed, short physical performance battery scores, Minimum Data Set – activities of daily living (MDS-ADL) scores, and modified Barthel Index scores. This evaluation will be conducted in SNFs providing either usual care or HIR.

The study design is mixed-methods, planned for implementation at two SNF sites selected from an ongoing trial: one site provides usual care, while the other delivers high-intensity rehabilitation (HIR). The research will employ a pretest-posttest design. This means data will be collected before and after the intervention phase where STAMP is integrated into daily care routines under interdisciplinary supervision.

Data collection methods are diverse and include existing electronic medical records, provider surveys, interviews, and focus groups. For Aim 1 (feasibility of STAMP implementation), feasibility and acceptability will be assessed through patient adherence to STAMP activities, alongside qualitative feedback from providers obtained via surveys, interviews, and focus groups. For Aim 2 (outcome measure feasibility), the feasibility of each candidate outcome measure will be evaluated based on completion rates.

The information gathered from these two aims is crucial for guiding future steps: Aim 1's findings will help refine the STAMP protocol itself, while Aim 2's results will inform the selection of appropriate outcome measures for larger-scale trials. This study represents a critical first step in generating foundational evidence to scale this low-cost, patient-centered mobility solution across SNFs.

The ultimate goal is to improve rehabilitation outcomes and facilitate more successful discharges to the community for older adults recovering from hospitalization. The research underscores the importance of addressing sedentary behavior as part of comprehensive post-acute care strategies in SNFs.

As a nursing student, you should appraise this study by considering its potential impact on patient-centered care models within SNFs and how interdisciplinary collaboration can be leveraged to improve functional recovery. It's important to note that the abstract describes a research *project* focused on feasibility and protocol refinement rather than presenting definitive clinical outcomes from completed trials. The source of this information is NIH RePORTER, which provides public project metadata for funded research initiatives.

When reasoning from the evidence presented in such a study (once results are available), nurses would consider how supplemental mobility programs like STAMP could be integrated into existing care plans to enhance patient activity and functional outcomes. They might also think about the roles of different healthcare team members, including trained mobility aides working alongside traditional rehabilitation staff.

It is crucial for students to understand that while this project aims to improve care, it's important not to overstate its current findings as definitive proof of STAMP's effectiveness without awaiting further research results. The study is a step towards building evidence for such interventions.

Faculty notes

Educational Relevance

This article details an NIH-funded research project (1R21AG095336-01A1) led by Jennifer Stevens-Lapsley, focusing on improving functional recovery in skilled nursing facilities (SNFs). The core issue addressed is the high prevalence of functional limitations among older adults discharged from SNFs after hospitalization. Despite rehabilitation services, sedentary behavior outside therapy sessions contributes significantly to physical deconditioning and poor outcomes.

The study introduces STAMP – Safe Transfers And Mobility Program – a supplemental mobility initiative designed to complement formal rehabilitation. STAMP utilizes trained mobility aides working with interdisciplinary teams (physical therapists, occupational therapists, nursing staff) to engage patients in walking and functional transfers throughout the day, aiming to reduce sedentary time.

The research has two primary aims: 1. To evaluate the feasibility, acceptability, and safety of implementing STAMP within SNFs under different care models: usual care versus high-intensity rehabilitation (HIR). This involves assessing adherence through direct observation or records, and gathering qualitative feedback via surveys and focus groups with providers. 2. To assess the feasibility and variability of candidate outcome measures for patients receiving STAMP in these settings. The specific outcomes to be evaluated include gait speed, short physical performance battery scores, Minimum Data Set – activities of daily living (MDS-ADL) scores, and modified Barthel Index scores.

The methodology is mixed-methods, planned at two SNF sites: one providing usual care and the other delivering HIR. A pretest-posttest design will be used, with a baseline period followed by an intervention phase where STAMP is integrated into daily routines under interdisciplinary supervision. Data collection methods include existing electronic medical records (for quantitative outcomes), provider surveys, interviews, and focus groups.

The anticipated outputs from this study are crucial for future development: Aim 1's findings will guide the refinement of the STAMP protocol itself, while Aim 2's results will inform the selection of appropriate outcome measures for larger-scale efficacy trials. This project represents a foundational step in generating evidence to scale a low-cost, patient-centered mobility solution across SNFs.

The study highlights the importance of addressing sedentary behavior as part of comprehensive post-acute care strategies and emphasizes interdisciplinary collaboration. For nursing faculty, this research underscores opportunities for curriculum development related to innovative care models, interdisciplinary teamwork, and evidence-based practice in geriatric rehabilitation settings within SNFs.