I often get questions from student researchers on how the four questions (Blog 1) have been successfully applied to a single case. One of the best examples is the Mobilization of Vulnerable Elders (MOVE) initiative, which promotes early mobilization practices for vulnerable seniors admitted to hospitals.¹

Let us review the MOVE initiative in light of the four questions: What is the problem in focus? What is the evidence-based intervention? What is the know-do gap? and Why does the gap exist?

Problem in focus

The priority gap or problem area identified by the MOVE initiative was functional decline, loss of muscle strength, increased inflammation, and decreased cognitive status due to immobility among older adults admitted to hospitals in Ontario.

Evidence-based Intervention

Through previous studies and systematic reviews, the MOVE implementation team identified three evidence-based practices to improve the mobilization of older adults upon hospital admission:

1. Assess mobility within 24 hours of the decision to admit.
2. Mobilize patients at least three times per day.
3. Ensure progressive mobilization is scaled to each patient’s ability.

The know-do gap

The know-do gap is the difference between what we know works (know) and what is done in practice (do). Observations on inpatient units from 2010-2011 revealed that less than 30% of patients in academic hospitals in Toronto were mobilized regularly.¹ In addition, hospitals in Ontario were unlikely to have a protocol or performance measure for preventing functional decline in hospitalized elderly patients,² indicating a significant know–do gap.

 Why does a gap exist?

The MOVE team conducted a barriers and facilitators assessment among hospitals in Ontario, Canada, through 46 focus groups across 26 hospital inpatient units in Ontario.³ The barriers were conceptualized at three levels: provider, patient, and unit. Provider-level barriers included time constraints and workload, while at the patient level, barriers stemmed from perceived sickness and fear of falling, and at the unit level, the barrier was due to lack of proper equipment and human resources. Facilitators included using staff champions and the ‘mobility clock’ communication tool, a visual to show a patient’s mobility status.

In sum, the implementers identified a problem, sought out evidence-based interventions, assessed the know-do gap, and found out why it existed, thus enabling the team to develop relevant implementation strategies and resources to sustain and scale up their efforts beyond Ontario.¹

References

1. MOVEs Canada: Getting Ready. (2011). MOVEs Canada. https://www.movescanada.ca/resources-for-hospitals/getting-ready/
2. Wong, K., & Liu, B. (2011). A summary of senior friendly care in central LHIN hospitals. https://www.rgptoronto.ca/wp-content/uploads/2018/03/SFH_Summary_of_CLHIN_2011.pdf
3. Moore, J. E., Mascarenhas, A., Marquez, C., Almaawiy, U., Chan, W.-H., D’Souza, J., Liu, B., Straus, S. E., & MOVE ON Team. (2014). Mapping barriers and intervention activities to behaviour change theory for Mobilization of Vulnerable Elders in Ontario (MOVE ON), a multi-site implementation intervention in acute care hospitals. Implementation Science: IS, 9, 160. https://doi.org/10.1186/s13012-014-0160-6