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. 2022 Nov 10;2022(11):CD005955. doi: 10.1002/14651858.CD005955.pub3

Gazineo 2021.

Study characteristics
Methods Design: RCT
Baseline time point (T1): within 24 hours of hospital admission
Outcome time point (T2): hospital discharge
Follow‐up time point (T3): 1 and 3 months posthospital discharge
Participants Inclusion criteria: all participants consecutively admitted to the geriatric unit between October 2018 and January 2020, if they were aged ≥ 65 years and if they were potentially able to walk, as assessed through geriatrician's clinical judgement based on participant's current and preadmission status
Exclusion criteria: independent walking ability at admission; diagnosis of femoral fractures or stroke (due to the presence of specific rehabilitation pathways for these patients), coma and severe dementia; unable to provide informed consent or refused to participate in the study
Exercise arm
  • n at baseline: 193

  • Age mean: 86.39 (SD 7.11) years

  • Barthel Index (0–100) on admission: 64.92 (SD 16.62)


Control arm
  • n at baseline: 194

  • Age mean: 86.19 (SD 9.15) years

  • Barthel Index (0–100) on admission: 61.84 (SD 16.06)

Interventions Exercise arm
  • TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): individualised assisted walking programme.

  • TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): a number of cohort and randomised clinical trials have found the potential beneficial effects of hospital mobility in preventing loss of mobility associated with hospitalisation. The study aimed to see if a nurse‐led mobility programme is also beneficial.

  • TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): walking aids were provided if appropriate.

  • TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the intervention was described including: moving from the supine to sitting position with their legs hanging over the side of the bed, from sitting to standing and an active phase of walking with assistance. The nurse delivering the intervention also provided education to participants and carers to consider walking as a normal activity, and provided motivation and encouragement.

  • TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the intervention was delivered by an ad hoc registered nurse with specific training on assisted walking and experience in clinical research conducted each participant's session. Each day they met with the geriatrician in charge to discuss the suitability of each participant.

  • TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): individual and conducted face‐to‐face.

  • TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): 32‐bed geriatric unit of the University Hospital of Bologna.

  • TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): intervention was offered from the first day after admission and continued until the day before discharge. Intervention consisted of daily sessions of 20–30 minutes' duration, for 5 consecutive days (excluding weekends).

  • TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): a daily briefing session was held between the trained nurse and the geriatrician in charge before starting the intervention to assess the feasibility for each participant. Another important role of the trained nurse was to educate participants and reference carers to consider walking as a normal activity, and to provide motivation and encouragement.

  • TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

  • TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): adherence to the intervention was defined as execution of postural changes and assisted walking for at least half of the inpatient days, except for weekend and days of admission and of discharge. This was assessed and recorded on a daily basis. The treatment was considered complete if a minimum of 2 days of individualised assisted walking programme was conducted.

  • TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): the mean number of intervention days for each participant was 5.84 (SD 4.17) days. Mobilisation or walking sessions occurred on the geriatric ward for a mean time of 32.10 (SD 10.25) minutes (range 10–67 minutes) with a mean distance of 89.19 (SD 70.26) m (range 0–260 m).


Control arm
  • TIDieR item 1: usual care.

  • TIDieR item 2: not specified.

  • TIDieR item 3: not specified.

  • TIDieR item 4: during the mornings of weekdays, participants were encouraged and helped by nursing staff to get out of bed as early as possible and to sit on wheelchair or at a table. Participants were also accompanied to the bathroom for hygienic care, based on their functional capacity.

  • TIDieR item 5: nursing staff delivered mobility and rehabilitation interventions. No PT or OT were provided for either the intervention or control group participants.

  • TIDieR item 6: not specified.

  • TIDieR item 7: 32‐bed geriatric unit of the University Hospital of Bologna.

  • TIDieR item 8: not specified.

  • TIDieR item 9: not specified.

  • TIDieR item 10: not specified.

  • TIDieR item 11: not specified.

  • TIDieR item 12: not specified.

Outcomes Barthel Index at T2
Mobility Barden Activity Subscale at T2
Falls during hospitalisation
Mortality during hospitalisation
Length of hospital stay
Hospital readmissions at T3
Notes Unpublished data from email correspondence
Barthel Index: the mean scores at discharge (T2) were: 65.20 (SD 24.18) for the intervention group and 56.07 (SD 23.74) for the control group.
Mobility Barden Activity Subscale: the mean scores at discharge (T2) were: 3.43 (SD 0.64) for the intervention group and 2.80 (SD 0.69) for the control group.
Hospital readmissions: at 30‐day follow‐up (T3) 33/174 of intervention group vs 40/165 of control group had been readmitted.