Title: Promoting increased physical activity in hospitalised older adults with trained volunteers
Funder: Department of Health and Social Care

Abstract: Research question Can a volunteer-led physical activity intervention to increase physical activity of hospitalised older adults be implemented in differing hospital contexts? Background Hospital-associated deconditioning (HAD) is common among older people and can be defined as deficits in physical function secondary to an acute hospitalisation. It is estimated that between 30 and 60% of older people experience a decline in physical function as a result of hospitalisation. This has significant personal costs to patients, with decreased independence and quality of life, and cost implications to health and social care systems. A significant modifiable risk factor associated with HAD is low physical activity levels. Evidence suggests that older inpatients benefit from additional physical activity interventions. However, most of the interventions are led by healthcare professionals or trained specialists. Innovative approaches are needed to ensure that these interventions are cost-effective and sustainable. I conducted a non-randomised feasibility study (n=100) and showed that it was feasible to train volunteers to take patients for walks or perform bedside exercises (SoMoVe study) in a tertiary urban hospital. Further evidence is needed to determine the feasibility and acceptability of implementing this intervention in different hospitals with varied populations and contexts. Aims and objectives To determine the feasibility, acceptability, and safety of training volunteers to lead and deliver a structured physical activity programme for older people in three hospitals of varying sizes and location. We will explore facilitators and barriers to the implementation of the intervention. Methods This multicentre non-randomised mixed methods feasibility study will have three intervention sites and one control site. Adults aged 65 years and above admitted to acute medical wards will be included in this study. Normalisation Process Theory will be used to describe and identify important elements of the implementation process. Hospital volunteers will receive theoretical and practical training, and ongoing supervision by trained therapists. The volunteer-led intervention will be conducted twice daily. Participants who can walk independently will be encouraged to walk with volunteers. Participants who are unable to walk independently will perform bedside exercises. The primary outcomes for this study are the feasibility and acceptability of the intervention. This will be determined by considering factors such as volunteer training and recruitment, participant recruitment, and adherence to the intervention. Additionally, patients, volunteers, and staff will be interviewed as part of our process evaluation to explore their views on the intervention, and to determine barriers and facilitators to the intervention. Timelines for delivery It is estimated that this research will take 4 years to complete, from design to data analysis and dissemination of study findings. Anticipated impact and dissemination As well as peer-reviewed journals and presentations at local, national and international research, and service development meetings, study findings will also be disseminated to policy makers, voluntary organisations, and commissioners to promote workforce development to provide tailored evidence on the impact of trained volunteers on patient outcomes. A collection of resources will be developed and maintained to support implementation of this intervention in other settings. Study findings will inform a future implementation trial.

Lay abstract: Aim(s) of the research To determine whether hospital volunteers can be trained to engage older people in hospital to be more active. We want to know if this intervention will work in different hospitals and explore factors that will support or prevent it from being delivered successfully. Background to the research Between 30 and 60% of older people in hospital are at risk of losing muscle strength and function, known as deconditioning. This reduces their ability to look after themselves independently. Low physical activity level contributes to deconditioning but dedicated physical activity sessions can benefit older inpatients. In most studies, physical activity is led by paid staff. New ideas are needed to ensure additional physical activity sessions are cost-effective and sustainable. The Southampton Mobility Volunteer study showed that trained volunteers can safely engage older inpatients to be more active. However, more information is needed on how to make this approach accessible to more people in more hospitals. Design and methods used Hospital inpatients aged 65 years and older will be invited to participate in the study. We will conduct the study in four hospitals. The hospitals will be different in size and from a wider region to include a range of population groups from different settings and context. This is so that different social groups are represented, and the research will be more representative of the wider population. We will use one hospital as a 'control site' - where patients will not get volunteer input -h; to compare our findings against. Volunteers will encourage participants who can walk independently to walk twice daily. Patients who need help with walking will do bedside exercises. They will be encouraged to walk once they can do so independently. We want to know whether trained volunteer delivered exercise sessions are feasible and acceptable to hospitals. We will determine this by collecting data on volunteer recruitment and training, patient recruitment and the walking/ exercises intervention. We will interview patients, staff, and volunteers as the intervention is delivered to establish what worked well and what could be improved. Other outcomes will include physical abilities, muscle strength, length of stay and readmission rates. We will analyse how much money it costs the NHS to deliver the intervention. Patient/service user, carer and public involvement The James Lind Alliance Priority Setting Partnership has highlighted promoting of independence, and physical and emotional well-being as 2 of the top 3 key research priorities for older adults. More specifically, our PPI research with 92 older people showed that 45% of them had experience with hospital volunteers and all spoke highly of their contribution. Most respondents thought volunteers could be trained to help with mobility. My feasibility study (SoMoVe study) confirmed the volunteer-led intervention was acceptable to patients, volunteers, and staff in one hospital. Patients were grateful that the volunteers encouraged them to be more active. Staff members valued the work of the volunteers. This proposal was developed with the support of 2 public researchers, the volunteer services manager and a hospital therapy lead. The study protocol and study documents will be developed with PPI collaboration. 2 public researchers will be invited to join the study steering group. PPI input will be paid at INVOLVE rates. Dissemination Findings from this study will be shared through conferences, academic papers/reports, and media/social media. In collaboration with the Academic Health Science Network, we will share our findings with commissioners, providers of care and voluntary organisations. Study findings will be of interest to voluntary services, healthcare professionals, and directorate managers. A collection of resources will be produced to encourage the adoption of this intervention in other settings.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE