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, APN Nicholas.

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