Improving Functional Recovery in Skilled Nursing Facilities through Supplemental Mobility - PROJECT SUMMARY ABSTRACT Over 1.3 million older adults receive post-acute care in skilled nursing facilities (SNFs) annually to support physical function recovery after hospitalization. Despite rehabilitation services, many patients are discharged with functional limitations, increasing the risk of rehospitalization, disability, institutionalization, or mortality. Sedentary behavior outside of scheduled therapy sessions exacerbates physical deconditioning and hinders recovery. The Safe Transfers And Mobility Program (STAMP) is introduced as a scalable, patient-centered supplemental mobility program designed to complement formal rehabilitation by engaging patients in walking and functional transfers (e.g., bed mobility, sit-to-stands, wheelchair transfers) throughout the day. The program uses trained mobility aides working alongside interdisciplinary teams, including physical therapists, occupational therapists, and nursing staff, to reduce sedentary time and promote sustained physical activity. By fostering collaboration between rehabilitation and nursing teams, STAMP directly addresses critical barriers to mobility and enhance physical recovery, promoting more successful discharges to the community. This study has two specific aims: Aim 1 will evaluate the feasibility, acceptability, and safety of implementing STAMP in SNFs using either usual care or high-intensity rehabilitation (HIR) models, adherence to the intervention and provider feedback through surveys and focus groups. Aim 2 will evaluate the feasibility and variability of candidate outcome measures (gait speed, short physical performance battery, minimum data set – activities of daily living, modified Barthel Index) in patients receiving STAMP in SNFs with either usual care or HIR. The study will employ a mixed-methods approach at two SNF sites selected from an ongoing trial, one providing usual care and the other delivering HIR. We will use a pretest-posttest design, with a baseline period followed by an intervention phase where STAMP will be integrated into daily care routines under interdisciplinary supervision. We will collect data through existing electronic medical records, provider surveys, interviews, and focus groups. Intervention feasibility and acceptability will be assessed through patient adherence to STAMP, along with provider surveys, interviews, and focus groups. Feasibility of candidate outcomes will be evaluated based on completion rates. Information gathered from the two aims will guide refinement of the STAMP protocol (Aim 1) and selection of appropriate outcomes measures (Aim 2) for future larger-scale trials. This study represents a critical first step in generating foundational evidence to scale a low-cost, patient-centered mobility solution across SNFs to improve rehabilitation outcomes and community reintegration for older adults.
