What is a feasible, impactful thesis topic for a general‑medicine student studying interventions in adult medical in‑patients?

Feasible and Impactful Thesis Topics for General Medicine In-Patient Research

I strongly recommend focusing your thesis on implementing and evaluating an early mobilization protocol for hospitalized older adults (≥65 years) on general medicine wards, as this intervention has demonstrated significant improvements in mortality, functional outcomes, and length of stay with minimal safety concerns.

Why Early Mobilization is the Optimal Choice

Strong Evidence Base with Clear Outcomes

• Multicomponent mobilization interventions significantly reduce delirium (OR 0.59,95% CI 0.39-0.88), ICU length of stay, and hospital mortality 1
• The ABCDEF bundle (Awakening, Breathing coordination, Delirium monitoring, Early mobility, Family engagement) demonstrates reduced mortality and more days without coma or delirium when bundle compliance improves 1
• Early mobilization is safe, with serious adverse events occurring in only 15 of 12,200+ rehabilitation sessions across multiple studies 1

Proven Real-World Implementation Success

• A large multisite study (MOVE ON) across 14 academic hospitals in Ontario involving 12,490 patients demonstrated that a tailored early mobilization intervention significantly increased daily out-of-bed activity (10.56% increase, 95% CI 4.94-16.18, P<0.001) 2
• The same intervention reduced hospital length of stay by 6.1 days post-intervention (95% CI -11 to -1.2, P=0.015) 2
• Implementation was feasible using a multi-component educational approach adapted to local context 3, 2

Specific Thesis Framework

Primary Research Question

Does implementation of a structured early mobilization protocol (mobility assessment within 24 hours, mobilization ≥3 times daily, progressive scaling) improve functional outcomes and reduce length of stay in general medicine patients aged ≥65 years compared to usual care?

Key Outcome Measures (Prioritizing Morbidity, Mortality, QOL)

Primary Outcomes:

• Functional status at discharge using Barthel Index (demonstrated 15-point improvement in heart failure patients: 64±38 vs 49±36, P<0.05) 4
• Daily mobilization rates (percentage of patients observed out of bed 3 times daily) 2
• Hospital length of stay (proven reducible by 3-6 days in multiple studies) 2, 4

Secondary Outcomes:

• Discharge destination (home vs. facility - 71% vs 52% home discharge with mobilization, P<0.05) 4
• Delirium incidence using CAM (Confusion Assessment Method) 1
• 30-day readmission rates (16% vs 36% in mobilization vs. control, P<0.05) 4
• Falls and safety events (documented to be rare but important to monitor) 1

Implementation Protocol Structure

Assessment Phase (First 24 Hours):

• Complete mobility assessment including: underlying problems amenable to physiotherapy, level of cooperation, neurological status, hemodynamic stability, cardiorespiratory reserve, muscle strength, joint mobility, and functional status 5
• Document baseline Barthel Index score 4
• Screen for delirium using CAM 1

Intervention Components:

• Mobilization goal: ≥3 times daily with progressive scaling 3, 2
• Hierarchical progression: passive range of motion → assisted exercises (bed cycling) → active exercises → activities of daily living 5
• Staff education on barriers and facilitators, tailored to local context 3, 2
• Patient/family engagement component (ABCDEF bundle "F" element) 1

Safety Parameters:

• Exclude patients with hemodynamic instability, high FiO₂ requirements, or high ventilatory support 5
• Monitor vital signs throughout interventions 5
• Reduce metabolic demands (decrease active muscle mass, duration, or repetitions) when needed 5

Study Design Recommendation

Interrupted Time Series Design (as successfully used in MOVE ON study) 2:

• Pre-intervention phase: 10 weeks baseline data collection
• Implementation phase: 8 weeks of active intervention rollout
• Post-intervention phase: 20 weeks of sustained practice evaluation

This design is superior to simple before-after studies because it accounts for temporal trends and provides stronger causal inference 2.

Data Collection Methods

Mobility Surveillance:

• Document patients observed out of bed 3 times daily (morning, lunch, afternoon), 2 days per week throughout all study phases 3, 2
• This pragmatic approach balances feasibility with robust outcome measurement 2

Functional Assessment:

• Barthel Index at admission and discharge 4
• Document mobilization level achieved (bed exercises, chair, ambulation distance) 5

Clinical Outcomes:

• Length of stay from administrative data 2, 4
• Discharge destination from medical records 4
• 30-day readmission rates 4

Why This Topic Excels for a Thesis

Addresses Critical Clinical Gap

• Older hospitalized patients spend excessive time immobile despite known harms, creating a clear practice-evidence gap 3, 2
• Current evidence shows mobility interventions improve physical activity (standardized mean difference 0.60,95% CI 0.23-0.97) but require better implementation strategies 6

Feasibility Advantages

• Does not require expensive equipment or specialized staff - primarily needs education and culture change 3, 2
• Intervention is nurse-led, making it ideal for general medicine ward implementation 7
• Safety profile is excellent with serious events occurring in <0.1% of mobilization sessions 1

High Impact Potential

• Directly improves mortality, morbidity, and quality of life - the three priority outcomes 1, 4
• Reduces healthcare costs through shorter length of stay 2, 4
• Prevents functional decline, which is often unrelated to the admission diagnosis but devastating for older adults 3, 7

Alternative High-Impact Topics (If Mobilization Not Feasible)

Delirium Prevention Bundle Implementation

Focus on multicomponent non-pharmacologic interventions including reorientation, cognitive stimulation, sleep hygiene, early mobilization, and sensory aids (hearing aids, glasses) 1. This demonstrates 41% reduction in delirium (OR 0.59) and reduced mortality 1.

Comprehensive Harm Prevention on Admission

Implement technology-supported screening for multiple preventable harms (delirium, falls, pressure injuries, functional decline) with automated care planning 1. This addresses the complex challenge of multiple simultaneous risk factors requiring behavioral and cultural change 1.

Critical Implementation Considerations

Barrier Assessment is Essential

• Conduct focus groups with frontline staff before implementation to identify local barriers and facilitators 3, 2
• Common barriers include: staffing constraints, competing priorities, lack of equipment, patient/family resistance 3
• Tailor intervention to local context - this was key to MOVE ON study success across 14 diverse hospitals 3, 2

Avoid Common Pitfalls

• Do not use pharmacologic delirium prevention (haloperidol, atypical antipsychotics) as primary intervention - no compelling evidence of benefit 1
• Do not delay mobilization waiting for "perfect" conditions - early mobilization (within first few days) is critical 5
• Do not implement without staff education - knowledge translation is essential for sustained practice change 3, 2

Sustainability Planning

• Embed mobility assessment in admission workflow (within 24 hours) 3
• Create visible documentation systems for mobility goals and achievements 2
• Provide ongoing feedback to staff on mobilization rates and patient outcomes 2