Six Studies, Three Themes: A Synthesis Matrix on Mobility and Exercise Programs for Hospitalized Older Adults
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Doctor of Nursing Practice Program, Aspen University
DNP 800: Theoretical and Scientific Underpinnings
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Month Day, Year
Six Studies, Three Themes: A Synthesis Matrix on Mobility and Exercise Programs for Hospitalized Older Adults
A synthesis matrix is the bridge between a pile of articles and a literature review. By placing studies side by side on the same dimensions, it shows where findings agree, where they differ and why. This paper presents a matrix of six key studies found through the documented search on in-hospital mobility and exercise programs for older adults, then reads across the matrix by theme to identify what the evidence supports, where it is weak, and what questions remain for a doctoral practice project.
The Matrix
The studies were selected to represent the main types of intervention and design found in the search: a systematic review, randomized trials of exercise and walking programs, a nurse-led care model and a large implementation study.
| Study | Design and sample | Intervention | Main findings |
|---|---|---|---|
| (de Morton et al., 2007) | Cochrane review; 7 randomized and 2 controlled trials | Exercise alone or within multidisciplinary care | Effect of exercise alone on function unclear; multidisciplinary care with exercise slightly increased discharge home and shortened stay |
| Martínez-Velilla et al. (2019) | Randomized trial; 370 adults aged 75 and older, Spain | Individualized strength, balance and walking sessions twice a day | Barthel Index improved 1.9 points versus a 5.0-point decline with usual care; no adverse effects |
| Brown et al. (2016) | Randomized trial; 100 older veterans | Twice-daily assisted walking and a behavioral strategy | Daily activity scores unchanged; life-space kept at its admission level one month later while controls fell about 10 points |
| Hastings et al. (2014) | Clinical demonstration with comparison group; 127 veterans | Physical therapy assessment then daily supervised walks | 92% discharged home versus 74%; no difference in length of stay |
| Boltz et al. (2014) | Comparative trial; 97 patient and family dyads | Family-centered function-focused care | Better daily activities and walking, less delirium; caregivers more prepared |
| Liu et al. (2018) | Interrupted time series; 12,490 patients, 14 hospitals | Implementation strategy to get patients out of bed | About 11% more patients out of bed daily; shorter length of stay |
Theme 1: Structured Exercise Can Prevent Functional Decline
The strongest evidence for preventing decline comes from structured exercise delivered daily. The Spanish trial is the clearest example: an individualized program of resistance, balance and walking exercise, delivered twice daily for a median of five days, reversed the decline in daily activities seen with usual care (Martínez-Velilla et al., 2019). The older Cochrane review found the effect of exercise alone on function unclear, largely because the trials it included were small and varied (de Morton et al., 2007). The difference suggests that intensity and consistency matter: programs that deliver exercise every day, tailored to the patient, are more likely to show benefit than occasional or generic sessions.
The trial also answered a common safety concern. Clinicians sometimes hesitate to exercise frail, acutely ill patients for fear of falls or cardiac events, but the Spanish program recorded no adverse effects, and the Cochrane review found no increase in adverse events with exercise.
Theme 2: Walking Programs Protect Life After Discharge More Than Function in Hospital
Walking programs show a different pattern. In the veterans' trial, assisted walking twice daily did not change daily activities, but patients maintained their community mobility, how far they moved around their homes and neighborhoods, one month after discharge, while the usual care group lost about 10 points on the life-space measure (Brown et al., 2016). A supervised walking demonstration found that 92% of participants went home rather than to a skilled nursing facility, compared with 74% of patients who were referred but not enrolled, although the comparison group was not randomized and may have differed (Hastings et al., 2014). Together, these studies suggest that walking programs may preserve outcomes that matter after discharge, even when in-hospital function measures do not change.
Theme 3: Nursing Models and Implementation Change the Unit, Not Only the Patient
The third group of studies changes how care is delivered rather than adding a discrete program. A family-centered function-focused care model, which modified the environment, educated staff and partnered with family caregivers, improved daily activities and walking and reduced delirium compared with education alone (Boltz et al., 2014). On a much larger scale, an implementation strategy across 14 hospitals increased the proportion of older patients out of bed each day by about 11 percentage points and shortened length of stay (Liu et al., 2018). These studies measure different outcomes, and neither is a randomized trial, but they show that unit culture and routines, the environmental factors identified earlier in this course, can be changed and that change can be sustained across many sites.
The Ontario strategy is also notable for how simple its goal was. Rather than prescribing a detailed exercise regimen, it set a clear expectation that older patients be out of bed and moving each day and supported staff to meet it, which suggests that a clear, measurable expectation can change practice across many units.
Gaps and Questions
Reading across the matrix reveals gaps. Outcomes vary so widely, from the Barthel Index to life-space mobility to time out of bed, that pooling results is difficult. Two of the six studies enrolled mainly or only men. Few report what it took to deliver the intervention, such as staffing or cost, which is the information a practice project needs. And the most effective intervention, twice-daily structured exercise, was delivered by trained exercise staff, raising the question of whether nurses and assistants could deliver it within usual staffing. These gaps point to a practice project that tests a feasible, nurse-delivered daily mobility and exercise protocol and measures both function and discharge outcomes.
The matrix also shows how much the choice of comparison matters. Studies that compared an intervention with usual care found larger effects than the study that compared a full model with staff education alone, since education by itself may improve care somewhat. A practice project should choose its comparison carefully and describe usual care in detail, so that readers can judge what the intervention added.
Conclusion
The synthesis matrix organizes six studies into three themes: daily structured exercise can prevent functional decline, walking programs may protect outcomes after discharge, and nursing models and implementation strategies can change unit routines at scale. Differences in outcomes, samples and delivery limit direct comparison, and the gaps identified define the practice question the review will carry forward.
References
Boltz, M., Resnick, B., Chippendale, T., & Galvin, J. (2014). Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults. Journal of the American Geriatrics Society, 62(12), 2398-2407. https://doi.org/10.1111/jgs.13139
Brown, C. J., Foley, K. T., Lowman, J. D., MacLennan, P. A., Razjouyan, J., Najafi, B., Locher, J., & Allman, R. M. (2016). Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients: A randomized clinical trial. JAMA Internal Medicine, 176(7), 921-927. https://doi.org/10.1001/jamainternmed.2016.1870
de Morton, N. A., Keating, J. L., & Jeffs, K. (2007). Exercise for acutely hospitalised older medical patients. Cochrane Database of Systematic Reviews, 2007(1), Article CD005955. https://doi.org/10.1002/14651858.CD005955.pub2
Hastings, S. N., Sloane, R., Morey, M. C., Pavon, J. M., & Hoenig, H. (2014). Assisted early mobility for hospitalized older veterans: Preliminary data from the STRIDE program. Journal of the American Geriatrics Society, 62(11), 2180-2184. https://doi.org/10.1111/jgs.13095
Liu, B., Moore, J. E., Almaawiy, U., Chan, W.-H., Khan, S., Ewusie, J., Hamid, J. S., & Straus, S. E. (2018). Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): A multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation. Age and Ageing, 47(1), 112-119. https://doi.org/10.1093/ageing/afx128
Martínez-Velilla, N., Casas-Herrero, A., Zambom-Ferraresi, F., Sáez de Asteasu, M. L., Lucia, A., Galbete, A., García-Baztán, A., Alonso-Renedo, J., González-Glaría, B., Gonzalo-Lázaro, M., Apezteguía Iráizoz, I., Gutiérrez-Valencia, M., Rodríguez-Mañas, L., & Izquierdo, M. (2019). Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: A randomized clinical trial. JAMA Internal Medicine, 179(1), 28-36. https://doi.org/10.1001/jamainternmed.2018.4869
How this DNP 800 Module 6 example is structured
Aspen does not publish DNP 800 module prompts, so check your classroom for the exact instructions. This example presents a four-column matrix of six studies, synthesizes them in three themes that compare and explain differences, identifies gaps across the evidence, and links them to a practice question.
DNP 800 Module 6 questions, answered
What does DNP 800 Module 6 usually ask for?
Aspen's DNP 800 description includes developing a literature review, so building a synthesis matrix that organizes studies before writing the review is a typical assignment. Check your classroom for the required columns.
What columns should a synthesis matrix have?
Common columns are citation, design and sample, intervention or focus, outcomes measured and main findings, sometimes with limitations and level of evidence. Keep them the same for every study.
How do I move from a matrix to a synthesis?
Read across the rows to find themes, agreements and differences, then explain differences by design, sample, intervention or outcome rather than summarizing each study in turn.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.