Sit-to-Stand Progression Using Movi Chair vs Traditional Practices
Sit-to-Stand Progression Using Movi Chair vs Traditional Practices
Prior to discharging admitted patients, current UAB Hospital policy recommends physical
 therapy intervention for patients with impaired functional mobility. However, UAB Hospital
 currently does not have a standardized physical therapy protocol to rehabilitate admitted
 patients with impaired functional mobility who require moderate assist (defined as physical
 therapist expending 25-50% effort to assist the patient in standing). In order to reduce the
 effect of impaired mobility, numerous interventions have been employed at UAB. As a result,
 there is great variability of treatment procedures performed by various physical therapists
 to help moderate assist patients return to their level of functioning prior to hospital
 admission. The purpose of the study is three-fold: 1) to evaluate whether a proposed physical
 therapy protocol using a commercially available medical device, the Movi chair, contributes
 to improved mobility for moderate assist patients, 2) to investigate how patient rate of
 rehabilitation to prior level of functioning is similar/different with the proposed physical
 therapy protocol using Movi vs the current non-standardized practice for moderate assist
 patients, and 3) to compare patient confidence in physical therapy with Movi vs the current
 non-standardized practice using survey for moderate assist patients. In addition, we will
 track participant's disposition i.e. continued motor and functional change following
 discharge from the hospital through review of physical therapy records.
Most activities of daily living require unassisted ability to stand from a sitting position.
 Therefore, physical therapy exercises aimed at improving this essential action are critically
 important for patients with impaired functional mobility. Although sit-to-stand tests are a
 well-known tool used to assess physical function, they have only recently has been proposed
 for systematic strength training.

 Those patients who would most benefit from sit-to-stand training require moderate assist or
 greater. However, these patients have significant difficulty initiating sit-to-stand
 exercises from a horizontal chair surface and have been largely excluded from prior studies
 examining sit-to-stand for strength training. These patients have been excluded not only
 because they cannot safely stand on their own, but also because manually lifting these
 patients poses a significant lifting-injury risk to physical therapists.

 Movi is a commercially available hybrid mechanical lift and chair who's key feature is a
 built in battery powered motor (rated for 600 lbs) that pivots on its axis to raise and lower
 a patient up to 20 degrees. We believe that this feature represents an opportunity for
 introducing sit-to-stand strength training to previously excluded moderate assist patients.
 Progressively lowering the chair's angle of inclination over consecutive physical therapy
 sessions will allow the patient to practice sit-to-stand at a reduced effort until the to
 horizontal angle is reached.

 As sit-to-stand strength training is a concept only proposed in 2011, no previous studies
 exist concerning a sit-to-stand physical therapy protocol using a chair progressively
 lowering the seat's angle of inclination. Currently, therapists use their clinical judgment
 when approaching patients with difficulty standing by utilizing exercise, skill repetition,
 in addition to other strengthening strategies and equipment to reach goals. Timed
 sit-to-stand has already been used at UAB in order to test a patient's progress in physical
 therapy but not as a therapy protocol in itself, partly because equipment allowing
 progressive lowering of the seat's angle of inclination has not been available until now.
 This study was conceived due to the great variability of physical therapy in the Hospital
 setting and the critical need for standardization and evaluating a protocol that has
 potential to positively impact patient speed and ease of recovery to prior level of
 functioning.

 The therapy protocol utilizing the Movi chair will include the following:

 1. Mobilize patient to Movi chair (via lift or manual transfer)

 2. Document lowest height in 5 degree increments (in degrees from inclinometer attached to
 Movi chair) where patient is able to complete a sit-to-stand transfer with minimal
 assistance (defined as requiring < 25% effort from the physical therapist) allowing
 patient to use his or her arms on thighs or armrests if needed.

 3. The patient will perform 5 sit-to-stand transfers from this level, rest until recovery,
 and do additional sets to increase muscle strength only if able.

 4. During subsequent visits, patient will begin at prior set level. If able to perform a
 sit-to-stand transfer with less than minimal assistance, the elevation of the chair will
 be lowered by 5 degree increments until able to complete a sit-to-stand transfer with
 minimal assistance or greater and the patient will perform sit-to-stand transfer
 repetitions from the new height.

 5. This protocol will continue until the patient is able to perform a sit-to-stand transfer
 from a standard height chair with supervision assistance or until the patient is
 discharged to the next level of care

 i. Once able to complete a sit-to-stand transfer from a standard height, a
 five-time-sit-to-stand (FTSST) will be performed 3 times per week.

 Treatment of the control group will utilize standard recliners and traditional therapy
 methods (transfer training, therapeutic exercise). Once an investigator consents the patient
 for the study, if the patient has been randomized to either control group or intervention
 group, a non-investigator physical therapist will perform his or her usual physical therapy
 exercises to minimize bias from study investigators completing therapy. Investigators will
 test FTSST time for patients in the control group 3 times per week. Only investigators will
 treat the intervention group using the above outlined protocol 3 times per week. Once
 intervention group patients are able to complete a sit-to-stand transfer from a standard
 height, a FTSST will be performed 3 times per week by a study investigator. Investigators
 will also record the Hierarchical Assessment of Balance and Mobility (HABAM) score for
 intervention group patients when they test FTSST time as an added measure of mobility. The
 HABAM is an interval level mobility instrument that is already in use as a valid and reliable
 mobility instrument in the older acute medical population. This score does not require any
 additional exercises with the patient beyond the FTSST. Investigators will ask the
 non-investigator physical therapists caring for the control group patients to estimate
 control group patients' HABAM, which can be easily estimated after working with the patient
 during routine standard of care therapy.
Inclusion Criteria:

 -  Patients receiving physical therapy at UAB hospital that require moderate assistance
 or greater with sit-to-stand transfers during initial evaluation

 -  Patients with baseline function of supervision as obtained in the initial physical
 therapy (PT) evaluation

 -  Patients who have an inpatient hospital stay of at least 4 days

 Exclusion Criteria:

 -  Patients with diagnoses that are progressive in nature

 -  Patients in intensive care units due to critical medical condition and confounding
 factors

 -  Patients with cognitive impairment as noted in the medical record

 -  Patients with weight bearing precautions other than free weight bearing (FWB) or
 weight bearing as tolerated (WBAT)

 -  Children (under the age of 18), prisoners and pregnant women

 -  Patients who are not able to speak English