| Interventions |
Exercise arm
TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): focused programme of physical exercise and cognitive stimulation + usual care. TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): a multidisciplinary care model for general medical inpatients that was previously implemented demonstrated significant reductions in functional decline and inpatient mortality. Study authors aimed to assess whether the focused programme could further improve functional outcomes. 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): the PT component included written advice about the exercise programme. A participant diary was provided to record daily activity. Ward nursing and multidisciplinary component included posters, and information resources including a walking map of ward and surrounds. 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 consisted of 3 components: a graduated exercise programme prescribed and supervised by the unit physiotherapist; education of ward and MDT staff, participants and carers to actively encourage mobility and functional independence; and a cognitive intervention delivered in groups by psychology students supervised by a senior psychologist. 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): physiotherapist provided early review (within 48 hours), prescribed the exercise programme, and provided daily reviews as needed. Cognitive intervention delivered by psychology students under supervision of senior clinical psychologist. 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): PT component was individual and face‐to‐face. Ward nursing and MDT component delivered both via face‐to‐face strategies (e.g. teaching) and using strategies such as posters. Cognitive component delivered via group sessions 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): medical ward. 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): PT component started within first 48 hours. Bed, sitting, standing or ambulation‐based exercises were performed twice daily (in addition to any specific recommendations by unit physiotherapist relating to presenting complaint). Ward nursing and MDT component described as 'intensive'. Cognitive component 3–4 afternoons per week. TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as per items 4, 5 and 8. 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): participant activity on the ward was measured using direct observation. Participants were observed for 2‐ to 3‐hour periods at varying times of the morning and afternoon shifts over 7 days. 76 patient‐hours of observation were undertaken during each observation period, divided equally between the control and intervention ward. Time spent in bed, seated, standing and walking was recorded. TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): in the intervention group, initial physiotherapist assessment and institution of an appropriate exercise programme was completed in a median of 2 days (IQR 0–4 days). More participants in the intervention group had a physiotherapist visit recorded (96.8% with intervention vs 82.3% with control), but there was no difference in mean number of physiotherapist visits per participant between groups (3.21 with intervention vs 3.37 with control; P = 0.53). 92% of participants in the intervention group received an exercise diary and made some record of exercise; about 33% completed their diary every day. 50% of the intervention group attended ≥ 1 cognitive group session. Observation of participant mobility in 34 elderly participants before the trial showed low levels of mobility on both trial wards, with < 10% of observed time spent standing or walking. During the intervention, participants on the intervention ward were much less likely to be observed in bed and spent significantly more time standing or walking within the ward.
Control arm
TIDieR item 1: usual care. TIDieR item 2: not specified. TIDieR item 3: not specified. TIDieR item 4: control group participants received usual care from the MDT, including daily discussion of participant progress and discharge plan, and referral to the team physiotherapist or OT by medical or nursing staff if there were concerns about mobility or function. TIDieR item 5: physiotherapists and other healthcare providers as required. TIDieR item 6: not specified. TIDieR item 7: medical ward. TIDieR item 8: not specified. TIDieR item 9: not specified. TIDieR item 10: not specified. TIDieR item 11: as per exercise group. TIDieR item 12: mobility patterns on the control ward were unchanged, with < 10% of observed time spent standing or walking.
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