Impact of an Incentive- Based Mobility Program on Quality of Life in a Stem Cell Transplant (SCT)...
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Transcript of Impact of an Incentive- Based Mobility Program on Quality of Life in a Stem Cell Transplant (SCT)...
Impact of an Incentive-Based Mobility Program on Quality of Life in a Stem Cell Transplant (SCT)Population
PI: Kelly J Brassil RN, MSN, AOCNS, APNNicholas Szewczyk, MSN, RN, AANPNancy Tomczak, RN, OCNJoyce Neumann, RN, MSN, AOCNS, APNSylvia Brown, RN, OCNJessica Burgess, RN, OCNBryan Fellman, MSJennifer Thomas, DPTDiana Urbauer, MSGeri LoBiondo Wood, PhD, RN, FAAN
Funded- J. Patrick Barnes Nursing Research Grant, DAISY Foundation
STUDY AIM
• Evaluate if participation in an incentive-based mobility program (Motivated and Moving) impacts fatigue, physical conditioning, performance status and quality of life in adults undergoing allogeneic SCT.
Motivated & Moving Background
• Program Aim: Designed to increase patient motivation and participation in physical activity during hospitalization for SCT
• Annual agreement with MARS Chocolate North America to use the M&M’S® trademark and M&M’S® characters
Motivated and Moving Program
• Program engages patients in physical activity goals outside the hospital room three times daily– Activities include:
• exercise class, walking around unit, exercise bike or engaging in activities in the family room or public space
• Patients place marker on their door upon physical activity completion
• Bandana - Earned for every 15 Motivated and Moving markers
Methodology
• DESIGN: One-group repeated measures • SAMPLE: 90 subjects accrued, 85 completed; 2
withdrawals and 3 treatment related deaths – N=83 provides .80 power to detect fatigue score changes
• INCLUSION CRITERIA: – Adult, Admitted for allogeneic SCT
• EXCLUSION CRITERIA:– Autologous SCT admission – Previous SCT(s)– Non-SCT related chemotherapy or post SCT
complications admission
• INSTRUMENTS:
– FACT-BMT
– ECOG Performance Status
– Brief Fatigue Inventory
– Six-Minute Walk Test
INSTRUMENTS
• PROCEDURES:– Consent– Patient oriented to Motivated & Moving– Six minute walk test and administration of instruments– Patients logged activity using a time clock – Instruments administered at three points:
• Within 24 hours of admission• Day before transplant (day -1)• Day of discharge
– Staff follow-up of points and distribution of rewards
PROCEDURES
Study Demographics
Age = 53.0 SD 10.1 Range: 26.0- 68.0N %
Gender MaleFemale
4540
52.9447.06
Race CaucasianAfrican AmericanHispanicAsianOther
685822
80.005.889.412.352.35
Type of Stem Cell Transplant
Matched Related Donor (MRD)Matched Unrelated Donor (MUD)Haplogeneic Donor (HAPLO)Umbilical Cord Donor (CB)
314653
36.4754.125.883.53
Results: Difference in Scores Between Time Periods
Assessment Mean (SD) Min-MaxMean Difference
(95% CI) p-valueBFI
Discharge - Admission 2.8 (2.0) 0 - 8.7 0.7 (0.2 - 1.2)* 0.0059Day-1 - Admission 4.4 (2.4) 0 - 9.4 1.6 (1.2 - 2.1) ϯ <0.0001Discharge - Day-1 3.5 (2.3) 0 - 9.4 -0.9 (-1.4 - -0.4) ѱ 0.0012
6 Minute WalkDischarge - Admission 337.5 (117.1) 61.2 - 647.9 -12.9 (-38.2 - 12.3) * 0.3107
Day-1 - Admission 313.0 (119.8) 63.3 - 640.5 -33.0 (-55.9 - -10.1) ϯ 0.0052Discharge - Day-1 332.2 (124.8) 108.2 - 633.7 23.4 (0.6 - 46.2) ѱ 0.0447
FACT-GDischarge - Admission 81.1 (13.2) 40 - 102 -3.6 (-6.2 - -1.1) * 0.0058
Day-1 - Admission 71.0 (14.1) 38 - 104 -10.1 (-12.3 - -7.9) ϯ <0.0001Discharge - Day-1 77.5 (15.0) 34 - 106 6.6 (4.1 - 9.1) ѱ <0.0001
FACT-BMTDischarge - Admission 109.1 (17.2) 59 - 139.8 -6 (-9.3 - -2.8) * 0.0003
Day-1 - Admission 95.6 (18.2) 58 - 138.0 -13.1 (-15.9 - -10.4) ϯ <0.0001
Discharge - Day-1 103.0 (19.3) 47 - 136.7 7.8 (4.6 - 10.9) ѱ <0.0001
• ECOG: No Significant Changes• BFI & FACT-BMT - NS difference related to
time spent in activity
Predicted Length of Stay After Transplant
Patients who accrued more Motivated and Moving points (and more minutes achieved) averaged fewer hospitalization days vs. those who averaged fewer minutes R = 1.65; p = 0.005