Hospital-at-Home preserves physical activity in acute illness: a randomised clinical trial

Larsen et al. (JAMA Network Open 9(6):e2618812; PMID 42329654) conducted a single-centre, investigator-initiated, nonblinded randomised clinical trial at a regional public hospital in Denmark, enrolling adults admitted with acute medical illness between June 2023 and January 2025. Of 230 participants assessed for eligibility, 111 were randomised: 58 to a hybrid Hospital-at-Home (HaH) programme and 53 to standard brick-and-mortar inpatient care. Coprimary outcomes were physical activity during the first 24 hours after randomisation and patient-reported satisfaction and perceived safety shortly after discharge.

HaH participants were significantly more physically active than inpatients: adjusted mean difference 1,763 steps (95% CI 153–3,373; p=0.03). Patient satisfaction was higher in the HaH group (mean 4.41 versus 4.10; mean difference 0.31, 95% CI −0.03 to 0.65; p=0.04), while perceived safety was similarly high in both groups (mean 4.37 versus 4.23; mean difference 0.14, 95% CI −0.22 to 0.50; p=0.24). No significant differences were observed in any recorded safety events, including 7-, 30-, and 90-day mortality and 30- and 90-day readmissions.

The hybrid HaH model incorporated remote patient monitoring via a patient-facing app and clinical dashboard with 24/7 oversight, weekday virtual ward rounds, and home-based clinical tasks. Key exclusion criteria included unstable clinical condition, major physical or cognitive impairment, and limited Danish language proficiency. The trial was registered at ClinicalTrials.gov (NCT05920304).

The physical activity finding is particularly significant for acute frailty pathways. Hospital-associated deconditioning is a well-established driver of functional decline and prolonged dependency in older adults; the 1,763-step difference in the first 24 hours represents a clinically meaningful preservation of mobility at the point where hospital-acquired immobility typically begins. That this was achieved without a safety signal — in a trial designed to detect clinically important adverse event differences — addresses the principal concern that has limited HaH adoption: whether acutely unwell patients can be safely monitored outside hospital walls.

The trial’s limitations are declared. It was single-centre and nonblinded, with a modest sample size. The median age was 64–65 years across groups, with approximately half male. The investigators note that frailty measures were not incorporated and that future multicentre studies should assess durability and linkage to longer-term clinical endpoints. Nonetheless, this trial provides the strongest randomised evidence to date that HaH preserves the physical function that hospital admission typically erodes — a finding relevant to any health system expanding virtual ward and Hospital-at-Home capacity for acutely unwell adults.