{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T09:07:06Z","timestamp":1764320826407,"version":"3.46.0"},"reference-count":47,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background\/Objectives: Population ageing and the need for hospitalisation due to acute or chronic illness have contributed to increased physical frailty among older adults, with implications for their quality of life and healthcare. This study aims to describe the development and validation process of a rehabilitation nursing programme for hospitalised older adults experiencing physical frailty. Methods: The e-Delphi study was conducted between September 2024 and May 2025, comprising three phases: (1) development of the rehabilitation nursing programme for frail older adults admitted to hospital; (2) validation of the programme content using a modified e-Delphi technique; and (3) development of the final programme prototype. Results: A panel of 18 experts participated. After a pair of rounds, every single program component achieved a Content Validity Index CVI over or equal to 0.90, and expert agreement was 100% related to the possibility of preventing frailty. The resulting prototype, Moving4notfrail\u00ae, includes a progression of muscle-joint exercises in five positions (lying down, sitting in bed with feet on the floor, sitting in a chair, standing and walking). It integrates strategies such as dual tasks, sensory and visual stimuli, and verbal and tactile guidance to enhance participant engagement and adherence to the programme. Conclusions: The experts\u2019 contributions validated the rehabilitation nursing programme for frail hospitalised older adults. The final prototype systematises key exercises aimed at preventing the progression of physical frailty and may also serve as a valuable tool in preventing its onset.<\/jats:p>","DOI":"10.3390\/nursrep15120419","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T08:26:57Z","timestamp":1764318417000},"page":"419","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moving4notfrail\u00ae: A Rehabilitation Nursing Programme for Older Adults with Frailty"],"prefix":"10.3390","volume":"15","author":[{"given":"Ana Isilda Torres Martins","family":"Santos","sequence":"first","affiliation":[{"name":"Department of Nursing, T\u00e2mega and Sousa Local Health Unit, 4564-007 Guilhufe, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5838-0080","authenticated-orcid":false,"given":"Ana da Concei\u00e7\u00e3o Alves","family":"Faria","sequence":"additional","affiliation":[{"name":"Department of Nursing, Santa Maria Health School, 4049-024 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6302-7732","authenticated-orcid":false,"given":"Carla","family":"Gomes da Rocha","sequence":"additional","affiliation":[{"name":"Department of Nursing, School of Health Sciences, HES-SO Valais-Wallis, 1950 Sion, Switzerland"}]},{"given":"Abel","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Department of Nursing, Gaia and Espinho Local Health Unit, 4434-502 Vila Nova de Gaia, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0052-6545","authenticated-orcid":false,"given":"Mariana Filipa Mendes","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Department of Nursing, Lus\u00edadas Lisbon Hospital, 1500-458 Lisboa, Portugal"}]},{"given":"Joana Isabel Alves","family":"Quintas","sequence":"additional","affiliation":[{"name":"Department of Nursing, Nursing School of Porto, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2404-285X","authenticated-orcid":false,"given":"Maria Narcisa da Costa","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Department of Nursing, Nursing School of Porto, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9982-9537","authenticated-orcid":false,"given":"Olga Maria Pimenta Lopes","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Nursing, Nursing School of Porto, 4200-072 Porto, Portugal"},{"name":"RISE-Health, 4200-319 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"ref_1","unstructured":"PORDATA (2025, August 02). Retrato de Portugal. Available online: https:\/\/www.pordata.pt\/europa\/anos+de+vida+saudavel+a+nascenca+total+e+por+sexo-3654."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lopes, D.G., Mendon\u00e7a, N., Henriques, A.R., Branco, J., Canh\u00e3o, H., and Rodrigues, A.M. (2023). Trajectories and Determinants of Ageing in Portugal: Insights from EpiDoC, a Nationwide Population-Based Cohort. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-16370-8"},{"key":"ref_3","unstructured":"WHO (2023). Clinical Consortium on Healthy Ageing 2022: Report of Consortium Meeting, 5\u20136 December 2022, World Health Organization."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"25","DOI":"10.12707\/RIII12162","article-title":"People Dependent in Self-Care: Implications for Nursing","volume":"4","author":"Ribeiro","year":"2014","journal-title":"Rev. Enferm. Ref."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s10433-021-00679-7","article-title":"A Research Framework for the United Nations Decade of Healthy Ageing (2021\u20132030)","volume":"19","author":"Keating","year":"2022","journal-title":"Eur. J. Ageing"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Gobbens, R.J., Vermeiren, S., Van Hoof, A., and van der Ploeg, T. (2022). Nurses\u2019 Opinions on Frailty. Healthcare, 10.","DOI":"10.3390\/healthcare10091632"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Marcucci, M., Damanti, S., Germini, F., Apostolo, J., Bobrowicz-Campos, E., Gwyther, H., Holland, C., Kurpas, D., Bujnowska-Fedak, M., and Szwamel, K. (2019). Interventions to prevent, delay or reverse frailty in older people: A journey towards clinical guidelines. BMC Med., 17.","DOI":"10.1186\/s12916-019-1434-2"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s12603-019-1273-z","article-title":"Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management","volume":"23","author":"Dent","year":"2019","journal-title":"J. Nutr. Health Aging"},{"key":"ref_9","unstructured":"World Health Organization (2017). WHO Clinical Consortium on Healthy Ageing. Topic Focus: Frailty and Intrinsic Capacity. Report of Consortium Meeting, 1\u20132 December 2016 in Geneva, Switzerland, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-FWC-ALC-17.2."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"530","DOI":"10.23736\/S1973-9087.24.08486-7","article-title":"Frailty recommendations and guidelines: An evaluation of the implementability and a critical appraisal of clinical applicability by the ISPRM Frailty Focus Group","volume":"60","author":"Antoniadou","year":"2024","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in Older Adults: Evidence for a Phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"524","DOI":"10.5770\/cgj.26.664","article-title":"Impact of Hospitalization on Patients\u2019 Ability to Perform Basic Activities of Daily Living","volume":"26","author":"Mallery","year":"2023","journal-title":"Can. Geriatr. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e347","DOI":"10.33194\/rper.2023.347","article-title":"Decl\u00ednio Funcional em Idosos Durante a Hospitaliza\u00e7\u00e3o","volume":"6","author":"Santos","year":"2023","journal-title":"Rev. Port. Enferm. Reabil."},{"key":"ref_14","unstructured":"(2019). Regulation No. 392\/2019, 3 May; Di\u00e1rio da Rep\u00fablica, Minist\u00e9rio da Sa\u00fade."},{"key":"ref_15","first-page":"27","article-title":"Implementation of a Rehabilitation Nursing Program in Elderly People with Fragility\/Disuse Syndrome-Case Study","volume":"3","author":"Gil","year":"2020","journal-title":"Rev. Port. Enferm. Reabilita\u00e7\u00e3o"},{"key":"ref_16","unstructured":"Polit, D.F., and Beck, C.T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice, Wolters Kluwer Health. [10th ed.]."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Faria, A.d.C.A., Martins, M.M.F.P.S., Ribeiro, O.M.P.L., Ventura-Silva, J.M.A., Fonseca, E.F., Ferreira, L.J.M., Teles, P.J.F.C., and Laredo-Aguilera, J.A. (2022). Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192214723"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.3390\/nursrep14030184","article-title":"Development and Validation of a Game for Older Adults on Lifestyles and Frailty","volume":"14","author":"Faria","year":"2024","journal-title":"Nurs. Rep."},{"key":"ref_19","unstructured":"(2019). Regulation No. 140\/2019, 2 February; Di\u00e1rio da Rep\u00fablica, No. 26, Minist\u00e9rio da Sa\u00fade."},{"key":"ref_20","unstructured":"(2015). Regulation No. 350\/2015, 22 June; Di\u00e1rio da Rep\u00fablica, No. 119, Minist\u00e9rio da Sa\u00fade."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1177\/0269216317690685","article-title":"Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review","volume":"31","author":"Payne","year":"2017","journal-title":"Palliat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"18","DOI":"10.14283\/jfa.2021.18","article-title":"Prevalence of Physical Frailty: Results from the DO-HEALTH Study","volume":"11","author":"Gagesch","year":"2021","journal-title":"J. Frailty Aging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1111\/ggi.13689","article-title":"Prevalence of Frailty Status among the European Elderly Population: Findings from the Survey of Health, Aging and Retirement in Europe","volume":"19","author":"Manfredi","year":"2019","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1007\/s11357-023-00975-3","article-title":"Frailty prevalence in 42 European countries by age and gender: Development of the SHARE Frailty Atlas for Europe","volume":"46","author":"Pitter","year":"2024","journal-title":"Geroscience"},{"key":"ref_25","first-page":"CD006632","article-title":"Clinical Pathways: Effects on Professional Practice, Patient Outcomes, Length of Stay and Hospital Costs","volume":"7","author":"Rotter","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_26","first-page":"443","article-title":"Effects of Clinical Pathways in Hospital-Based Care: A Systematic Review","volume":"32","author":"Kool","year":"2024","journal-title":"J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"gnae041","DOI":"10.1093\/geront\/gnae041","article-title":"Hospital-Based Health Professionals\u2019 Perceptions of Frailty in Older People","volume":"64","author":"Manuel","year":"2024","journal-title":"Gerontologist"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Prommaban, A., Moonkayaow, S., Phinyo, P., Siviroj, P., Sirikul, W., and Lerttrakarnnon, P. (2024). The Effect of Exercise Program Interventions on Frailty, Clinical Outcomes, and Biomarkers in Older Adults: A Systematic Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216570"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s12603-021-1665-8","article-title":"International exercise recommendations in older adults (ICFSR): Expert consensus guidelines","volume":"25","author":"Izquierdo","year":"2021","journal-title":"J. Nutr. Health Aging"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Caicedo-Pareja, M., Espinosa, D., Jaramillo-Losada, J., and Ordo\u00f1ez-Mora, L.T. (2024). Physical Exercise Intervention Characteristics and Outcomes in Frail and Pre-Frail Older Adults. Geriatrics, 9.","DOI":"10.3390\/geriatrics9060163"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Fang, J., Ren, J., Wang, J., Qiu, X., Zhang, S., Yuan, S., Wu, S., and Xie, L. (2024). Combining motivational and exercise intervention components to reverse pre-frailty and promote self-efficacy among community-dwelling pre-frail older adults: A randomized controlled trial. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-05464-6"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"103449","DOI":"10.1016\/j.gerinurse.2025.103449","article-title":"Characteristics of frailty prevention interventions addressed to robust and pre-frail older adults: A scope review","volume":"65","author":"Porto","year":"2025","journal-title":"Geriatr. Nurs."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"100008","DOI":"10.1016\/j.jnha.2023.100008","article-title":"Multicomponent Exercise with Power Training: A Vital Intervention for Frail Older Adults","volume":"28","author":"Izquierdo","year":"2024","journal-title":"J. Nutr. Health Aging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"112604","DOI":"10.1016\/j.exger.2024.112604","article-title":"Effects of multicomponent exercise on frailty status and physical function in frail older adults: A meta-analysis and systematic review","volume":"197","author":"Yang","year":"2024","journal-title":"Exp. Gerontol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.gerinurse.2019.11.009","article-title":"Older patients\u2019 perception of engagement in functional self-care during hospitalization","volume":"41","author":"Chan","year":"2020","journal-title":"Geriatr. Nurs."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"afac028","DOI":"10.1093\/ageing\/afac028","article-title":"The impact of an exercise intervention on frailty levels in hospitalised older adults","volume":"51","author":"Kehler","year":"2022","journal-title":"Age Ageing"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Falvey, J.R., Ye, J.Z., Parker, E.A., Beamer, B.A., and Addison, O. (2022). Rehabilitation outcomes among frail older adults in the United States. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191711021"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1186\/s13063-019-3426-0","article-title":"Effect of a multicomponent exercise programme (VIVIFRAIL) on functional capacity in frail community elders with cognitive decline: Study protocol for a randomized multicentre controlled trial","volume":"20","year":"2019","journal-title":"Trials"},{"key":"ref_39","unstructured":"Liguori, G., Feito, Y., Fountaine, C., and Roy, B.A. (2021). Guidelines for Exercise Testing and Prescription, Wolters Kluwer Health. [11th ed.]."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1519\/JSC.0000000000003230","article-title":"Resistance training for older adults: Position statement from the National Strength and Conditioning Association","volume":"33","author":"Fragala","year":"2019","journal-title":"J. Strength Cond. Res."},{"key":"ref_41","first-page":"103827","article-title":"Effects of exercise-cognitive dual-task training on elderly patients with cognitive frailty and depression","volume":"15","author":"Silva","year":"2022","journal-title":"World J. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"100769","DOI":"10.1016\/j.curtheres.2024.100769","article-title":"Assessing the impact of frailty interventions on older patients with frailty","volume":"102","author":"Zhang","year":"2024","journal-title":"Curr. Ther. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s40520-025-03011-w","article-title":"Effects of a multicomponent training and a detraining period on cognitive and functional performance of older adults","volume":"37","author":"Moradell","year":"2025","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"100401","DOI":"10.1016\/j.jnha.2024.100401","article-title":"Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)","volume":"29","author":"Izquierdo","year":"2025","journal-title":"J. Nutr. Health Aging"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Chen, J., Liu, H., Zhao, H., Yao, J., and Lu, Y. (2025). The effects of Vivifrail-based multicomponent training on physical and cognitive function in frail older adults: A systematic review and meta-analysis. Front. Physiol., 16.","DOI":"10.3389\/fphys.2025.1646833"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e015173","DOI":"10.1136\/bmjgh-2024-015173","article-title":"Frailty: A global health challenge in need of local action","volume":"9","author":"Dlima","year":"2024","journal-title":"BMJ Glob. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"89","DOI":"10.12707\/RIV16086","article-title":"Nursing care quality: A study carried out in Portuguese hospitals","volume":"4","author":"Ribeiro","year":"2017","journal-title":"Rev. Enferm. Ref."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/12\/419\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T09:04:30Z","timestamp":1764320670000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/12\/419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":47,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["nursrep15120419"],"URL":"https:\/\/doi.org\/10.3390\/nursrep15120419","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,27]]}}}