Objective: To identify core domains for research studies of physical activity and sedentary behavior during hospitalization for older adults with an acute medical illness.
Design: A 4-Round Delphi consensus process. Round 1 invited responses to open-ended questions to generate items for the core domains research. In rounds 2-4, participants were invited to use a Likert scale (1-9) to rate the importance of each core domain for research studies of physical activity and/or sedentary behavior in hospitalized older adults with an acute medical illness.
Setting: Online surveys.
Participants: A total of 49 participants were invited to each round (international researchers, clinicians, policy makers and patients). Response rates across rounds 1-4 were 94%, 88%, 83% and 81%, respectively.
Interventions: None.
Main Outcome Measures: Consensus was defined a priori as 70% of respondents rating an item as “critical” (score 7) and 15% of respondents rating an item as “not important” (score3).
Results: In round 2, a total of 9 of 25 core domains reached consensus agreement (physical functioning, general, role functioning, emotional functioning, global quality of life, hospital, psychiatric, cognitive functioning, carer burden). In round 3, an additional 8 reached consensus (adverse events, perceived health status, musculoskeletal, social functioning, vascular, cardiac, mortality, economic). Round 4 participants provided further review and a final rating of all 17 core domains that met consensus in previous rounds. Four core domains were rated as “critically important” to evaluate: physical functioning, social functioning, emotional functioning, and hospital outcomes.
Conclusions: This preliminary work provides international and expert consensus-based core domains for development toward a core-outcome set for research, with the ultimate goal of fostering consistency in outcomes and reporting to accelerate research on effective strategies to address physical activity and/or sedentary behavior in older adults while hospitalized.
Claire E. Baldwin, Anna C. Phillips, Sarah M. Edney, Lucy K. Lewis
Disease Category: Health care of older people
Disease Name:
Age Range: 65 - 120
Sex: Either
Nature of Intervention: Any
- Clinical experts
- Consumers (patients)
- Policy makers
- Researchers
- Prioritising
- Recommendations made
- Delphi process
For the purposes of this study, our definition of “acute medical illness” does not include: “elective” or planned admissions, an admission for which surgery is the main form of treatment, admission for a mental health condition. The acute hospital setting refers to: a place providing 24-hour care for people who are unwell and had an unplanned admission, this could be a public or private hospital. It does not include: hospitals (or wards within an acute hospital) that are for rehabilitation, surgery only, palliative care, respite or recuperation, or long term care or residential nursing home facilities for older adults.
Target sample of 50 representatives across stakeholder groups (aim for consumers to have 20% representation). Researchers identified from corresponding author list of publications included in existing relevant review articles, invitations to represent particular fields of research, and, nomination from other invited panel members. Clinical experts identified through medical, nursing and physiotherapy professional associations in Australia, UK, USA and Canada. Policy (guideline) developers identified from the Australian, UK, USA and Canadian physical activity guidelines for older adults. Consumers (supported by caregivers as required) responding to advertising within Australia.
Up to 4 survey rounds running for 3 weeks at a time, new rounds distributed every 6-8 weeks. Open ended questions in round 1 (following pilot testing of round 1 survey). Rounds 2-4 to include open ended and closed questions as required, moving to rating with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale as used in other Delphi studies. Thus the 9-point scale will be divided into 3 categories: not Important (1-3), important but not critical (4-6), and critical (7-9). Consensus will be defined a priori as: =70% of respondents rating an item as “critical” (score =7) and =15% of respondents rating an item as “not important” (score =3). ‘Unable to score’ options will also be provided.
Retention to be facilitated by targeted pre-participation survey (intent to participate) and weekly reminders for survey completion. Feedback on previous rounds provided in the form of individual feedback (view previous responses) and group aggregates.
Survey management and distribution using the Qualtrics platform.
Ethics approval obtained from Flinders University SBREC: application number 8254.