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Adsett JA, Mudge AM. Interventions to Promote Physical Activity and Reduce Functional Decline in Medical Inpatients: An Umbrella Review. J Am Med Dir Assoc 2024:105052. [PMID: 38830596 DOI: 10.1016/j.jamda.2024.105052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Physical inactivity in hospitals is common and is associated with poor patient and clinical outcomes. This review was undertaken to identify and describe the effectiveness of interventions implemented at the ward or system level for improving physical activity and reducing functional decline in general medical inpatients. The secondary aim was to describe the effects on length of stay, discharge destination, falls, and hospital costs. DESIGN Umbrella review. SETTING AND PARTICIPANTS Systematic reviews that evaluated ward- or system-level interventions aiming to improve physical activity or reduce functional decline in medical inpatients. METHODS PubMed, EMBASE, Cochrane Database, CINAHL, JBI, and Web of Science databases were searched for English-language reviews published between 2000 and 2023. AMSTAR 2 was used to assess methodologic quality. Two reviewers independently assessed eligibility and methodologic quality and completed data abstraction, with results presented as a narrative synthesis. RESULTS The search yielded 568 systematic reviews of which 12 met criteria, half of which were published since 2020. Reviews included 76 unique primary studies with 72,645 participants. Most reviews were of low quality. Interventions that focused on progressive mobilization likely increased physical activity participation, reduced functional decline, and improved discharge home. Multicomponent interventions that employed multiple strategies targeting a broader range of barriers likely improved functional decline and discharge home and may have been associated with shorter length of stay. No interventions were associated with increased frequency of falls. Few studies reported costs. CONCLUSIONS AND IMPLICATIONS Progressive mobilization interventions and multicomponent interventions appear to be effective for improving physical activity participation and reducing functional decline in medical inpatients. Further high-quality studies may help to determine the most important aspects of multicomponent interventions. Standardized terminology related to inpatient physical activity may help promote a shared understanding and purpose across professions.
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Affiliation(s)
- Julie A Adsett
- Physiotherapy Department, Royal Brisbane and Women's Hospital Brisbane, Queensland, Australia; Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital Brisbane, Queensland, Australia.
| | - Alison M Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital Brisbane, Queensland, Australia
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Werner C, Bauknecht L, Heldmann P, Hummel S, Günther-Lange M, Bauer JM, Hauer K. Mobility outcomes and associated factors of acute geriatric care in hospitalized older patients: results from the PAGER study. Eur Geriatr Med 2024; 15:139-152. [PMID: 37777992 PMCID: PMC10876756 DOI: 10.1007/s41999-023-00869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. METHODS The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes. RESULTS SPPB (median [interquartile range] 4.0 [2.8-5.0] pt. vs. 5.0 [3.0-6.3] pt.), step count (516 [89-1806] steps vs. 1111 [228-3291] steps), and LSA-IS total score (10.5 [6.0-15.0] pt. vs. 16.3 [12.0-24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003-0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status. CONCLUSION AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients' locomotor capacity.
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Affiliation(s)
- Christian Werner
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany.
| | - Laura Bauknecht
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Saskia Hummel
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Michaela Günther-Lange
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
| | - Jürgen M Bauer
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Klaus Hauer
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstraße 110, 70376, Stuttgart, Germany
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Schafthuizen L, van Dijk M, van Rosmalen J, Ista E. Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms. BMC Nurs 2024; 23:11. [PMID: 38163905 PMCID: PMC10759502 DOI: 10.1186/s12912-023-01648-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Although stimulating patients' mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards. METHODS Mobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied. RESULTS Wearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9-93.6). The median total daily step count was 1326 (range 22-5362). CONCLUSION We found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Monique van Dijk
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hogan PG, Wallace CE, Schaffer-Nay NR, Al-Zubeidi D, Holekamp NA. Time-motion observations to characterize the developmental environment in a paediatric post-acute care hospital. Child Care Health Dev 2024; 50:e13179. [PMID: 37747458 DOI: 10.1111/cch.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Chronically hospitalized children are at risk for neurodevelopmental delay, compounded by restricted social interactions, movement and environmental stimulation. We measured patients' movements and interactions to characterize developmentally relevant aspects of our inpatient environment and identify opportunities for developmental enrichment. METHODS As part of a quality improvement initiative to inform neurodevelopmental programming for children with medical complexity at our paediatric post-acute care specialty hospital, we conducted >232 hours of time-motion observations. Trained observers followed 0- to 5-year-old inpatients from 7 am to 7 pm on weekdays, categorizing observations within five domains: Where, With, Position, State and Environment. Observations were collected continuously utilizing REDCap on iPads. A change in any domain initiated a new observation. RESULTS Patients were median 1 year and 8 months of age (range 2 months to 3 years 9 months) with a median length of hospitalization of 514 days (range 66-1298). In total, 2636 unique observations (or median 134 observations per patient-day [range 95-210]) were collected. Patients left their rooms up to 4 times per day for median 1 h and 34 min (range 41 min to 4 h:30 min). Patients spent 4 h:6 min (2 h:57 min to 6 h:30 min) interacting with someone and 3 h:51 min (57 min to 6 h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2 h:21 min (51 min to 4 h:19 min) each day. CONCLUSIONS Despite a care model prioritizing time out of bed and social interaction, time-motion observations indicate patients spent many of their waking hours in bed and alone. Quantifying our inpatients developmental opportunities will inform neurodevelopmental programming initiatives.
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Affiliation(s)
- Patrick G Hogan
- Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, USA
| | - Claire E Wallace
- Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, USA
| | | | - Duha Al-Zubeidi
- Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, USA
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Byrnes A, McRae P, Mudge AM. 'Life is about movement-everything that is alive moves': a mixed methods study to understand barriers and enablers to inpatient mobility from the older patient's perspective. Age Ageing 2023; 52:afad111. [PMID: 37463284 PMCID: PMC10353760 DOI: 10.1093/ageing/afad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Mobility in hospital is important to maintain independence and prevent complications. Our multi-centre study aimed to measure mobility and identify barriers and enablers to mobility participation from the older patient's perspective. METHODS Mixed methods study including direct observation of adult inpatients on 20 acute care wards in 12 hospitals and semi-structured interviews with adults aged 65 years or older on each of these wards. Interviews were undertaken by trained staff during the inpatient stay. Quantitative data were analysed descriptively. Qualitative data were initially coded deductively using the theoretical domains framework (TDF), with an inductive approach then used to frame belief statements. RESULTS Of 10,178 daytime observations of 503 adult inpatients only 7% of time was spent walking or standing. Two hundred older patient interviews were analysed. Most (85%) patients agreed that mobilising in hospital was very important. Twenty-three belief statements were created across the eight most common TDF domains. Older inpatients recognised mobility benefits and were self-motivated to mobilise in hospital, driven by goals of maintaining or recovering strength and health and returning home. However, they struggled with managing pain, other symptoms and new or pre-existing disability in a rushed, cluttered environment where they did not wish to trouble busy staff. Mobility equipment, meaningful walking destinations and individualised programmes and goals made mobilising easier, but patients also needed permission, encouragement and timely assistance. CONCLUSION Inpatient mobility was low. Older acute care inpatients frequently faced a physical and/or social environment which did not support their individual capabilities.
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Affiliation(s)
- Angela Byrnes
- Eat Walk Engage Program, Metro North Health, Herston, QLD, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Prue McRae
- Eat Walk Engage Program, Metro North Health, Herston, QLD, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Alison M Mudge
- Address correspondence to: Alison M. Mudge, Eat Walk Engage Program, 6th floor block 7, Royal Brisbane and Women’s Hospital, Butterfield St, Herston, 4029 QLD, Australia. Tel: 61736460854.
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Resnick B, Boltz M, Galik E, Kuzmik A, Drazich BF, McPherson R, Wells CL. Factors Associated With Function-Focused Care Among Hospitalized Older Adults With Dementia. Am J Crit Care 2023; 32:264-274. [PMID: 37391379 DOI: 10.4037/ajcc2023440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia. OBJECTIVE To explore factors associated with participation in function-focused care in this patient population. METHODS This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle. Structural equation modeling was used for model testing. RESULTS The mean (SD) age of the study participants was 83.2 (8.0) years, and the majority were women (64%) and White (69%). Sixteen of the 29 hypothesized paths were significant and explained 25% of the variance in participation in function-focused care. Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, physical resilience, comorbidities, tethers, and pain were all indirectly associated with function-focused care through function and/or pain. Tethers, function, and quality of care interactions were all directly associated with function-focused care. The χ2/df was 47.7/7, the normed fit index was 0.88, and the root mean square error of approximation was 0.14. CONCLUSION For hospitalized patients with dementia, the focus of care should be on treating pain and behavioral symptoms, reducing the use of tethers, and improving the quality of care interactions in order to optimize physical resilience, function, and participation in function-focused care.
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Affiliation(s)
- Barbara Resnick
- Barbara Resnick is a professor at the University of Maryland School of Nursing, Baltimore
| | - Marie Boltz
- Marie Boltz is a professor at Penn State University, University Park, Pennsylvania
| | - Elizabeth Galik
- Elizabeth Galik is a professor at the University of Maryland School of Nursing, Baltimore
| | - Ashley Kuzmik
- Ashley Kuzmik is a postdoctoral student at Penn State University, University Park, Pennsylvania
| | - Brittany F Drazich
- Brittany F. Drazich is a postdoctoral student at the University of Maryland School of Nursing, Baltimore
| | - Rachel McPherson
- Rachel McPherson is a postdoctoral student at the University of Maryland School of Nursing, Baltimore
| | - Chris L Wells
- Chris L. Wells is a physical therapist at the University of Maryland Medical System, Baltimore
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Steele AM, Nourani M, Sullivan DH. Ambulatory Behavior Assessment Using Deep Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083087 DOI: 10.1109/embc40787.2023.10340595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This work leverages a custom implementation of a deep neural network-based object detection algorithm to detect people and a set of assistive devices relevant to clinical environments. The object detections form the basis for the quantification of different ambulatory activities and related behaviors. Using features extracted from detected people and objects as input to machine learning models, we quantify how a person ambulates and the mode of ambulation being used.Clinical relevance- This system provides the data required for clinicians and hospitalized patients to work together in the creation, monitoring, and adjustment of ambulatory goals.
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Mudge AM, McRae P, Young A, Blackberry I, Lee-Steere K, Barrimore S, Quirke T, Harvey G. Implementing a ward-based programme to improve care for older inpatients: process evaluation of the cluster randomised CHERISH trial. BMC Health Serv Res 2023; 23:668. [PMID: 37344776 DOI: 10.1186/s12913-023-09659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Older inpatients are at high risk of hospital-associated complications, particularly delirium and functional decline. These can be mitigated by consistent attention to age-friendly care practices such as early mobility, adequate nutrition and hydration, and meaningful cognitive and social activities. Eat Walk Engage is a ward-based improvement programme theoretically informed by the i-PARIHS framework which significantly reduced delirium in a four-hospital cluster trial. The objective of this process evaluation was to understand how Eat Walk Engage worked across trial sites. METHODS Prospective multi-method implementation evaluation on medical and surgical wards in four hospitals implementing Eat Walk Engage January 2016-May 2017. Using UK Medical Research Council guidance, this process evaluation assessed context, implementation (core components, implementation strategies and improvements) and mechanisms of impact (practice changes measured through older person interviews, structured mealtime observations and activity mapping) at each site. RESULTS The four wards had varied contextual barriers which altered dynamically with time. One ward with complex outer organisational barriers showed poorer implementation and fewer practice changes. Two experienced facilitators supported four novice site facilitators through interactive training and structured reflection as well as data management, networking and organisational influence. Novice site facilitators used many implementation strategies to facilitate 45 discrete improvements at individual, team and system level. Patient interviews (42 before and 38 after implementation) showed better communication about program goals in three sites. Observations of 283 meals before and 297 after implementation showed improvements in mealtime positioning and assistance in all sites. Activity mapping in 85 patients before and 111 patients after implementation showed improvements in cognitive and social engagement in three sites, but inconsistent changes in mobility. The improvements in mealtime care and cognitive and social engagement are plausible mediators of reduced delirium observed in the trial. The lack of consistent mobility improvements may explain why the trial did not show reduction in functional decline. CONCLUSIONS A multi-level enabling facilitation approach supported adaptive implementation to varied contexts to support mechanisms of impact which partly achieved the programme goals. Contexts changed over time, suggesting the need for adequate time and continued facilitation to embed, enhance and sustain age-friendly practices on acute care wards and optimise outcomes. TRIAL REGISTRATION The CHERISH trial was prospectively registered with the ANZCTR ( http://www.anzctr.org.au ): ACTRN12615000879561.
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Affiliation(s)
- Alison M Mudge
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia.
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia.
- University of Queensland Faculty of Medicine, Brisbane, Australia.
| | - Prue McRae
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia
| | - Adrienne Young
- University of Queensland Faculty of Medicine, Brisbane, Australia
- Royal Brisbane and Women's Hospital Department of Nutrition and Dietetics, Herston, Australia
| | - Irene Blackberry
- LaTrobe University John Richards Centre for Rural Ageing Research, Wodonga, Australia
| | - Karen Lee-Steere
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia
- University of Queensland Faculty of Health and Behavioural Sciences, Brisbane, Australia
| | | | - Tara Quirke
- Consumer Advocate Dementia Training Australia, Brisbane, Australia
| | - Gillian Harvey
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia
- Flinders University College of Nursing and Health Sciences, Bedford Park, Australia
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Geelen SJG, Giele BM, Veenhof C, Nollet F, Engelbert RHH, van der Schaaf M. Physical dependence and urinary catheters both strongly relate to physical inactivity in adults during hospital stay: a cross-sectional, observational study. Disabil Rehabil 2022; 44:6684-6691. [PMID: 34528861 DOI: 10.1080/09638288.2021.1970257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine which factors are associated with physical inactivity in hospitalized adults of all ages. METHODS A cross-sectional sample of 114 adults admitted to a gastrointestinal surgery, internal medicine or cardiology hospital ward (median age 60, length of stay 13 days) were observed during one random day from 8 am to 8 pm using wireless accelerometers and behavioral mapping protocols. Factors (e.g., comorbidities, self-efficacy, independence in mobility, functional restraints) were collected from medical records, surveys, and observations. RESULTS Patients were physically active for median(IQR) 26 (13-52.3) min and were observed to lie in bed for 67.3%, sit for 25.2%, stand for 2.5%, and walk for 5.0% of the time. Multivariable regression analysis revealed that physical inactivity was 159.87% (CI = 89.84; 255.73) higher in patients dependent in basic mobility, and 58.88% (CI = 10.08; 129.33) higher in patients with a urinary catheter (adjusted R2 = 0.52). The fit of our multivariable regression analysis did not improve after adding hospital ward to the analysis (p > 0.05). CONCLUSIONS Independence in mobility and urine catheter presence are two important factors associated with physical inactivity in hospitalized adults of all ages, and these associations do not differ between hospital wards. Routine assessments of both factors may therefore help to identify physically inactive patients throughout the hospital.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be aware that physical inactivity during hospital stay may result into functional decline.Regardless of which hospital ward patients are admitted to, once patients require assistance in basic mobility or have a urinary catheter they are at risk of physical inactivity during hospital stay.Implementing routine assessments on the independence of basic mobility and urine catheter presence may therefore assist healthcare professionals in identifying physically inactive patients before they experience functional decline.
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences and Sports, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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Bruun IH, Frederiksen KO, Nørgaard B. Attendance of Physical and Occupational Therapists Improves Older Hospitalized Adults’ Activity Levels. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2116523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Inge Hansen Bruun
- Department of Physical and Occupational Therapy, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Adey-Wakeling Z, Jolliffe L, O'Shannessy E, Hunter P, Morarty J, Cameron ID, Liu E, Lannin NA. Activity, Participation, and Goal Awareness After Acquired Brain Injury: A Prospective Observational Study of Inpatient Rehabilitation. Ann Rehabil Med 2022; 45:413-421. [PMID: 35000366 PMCID: PMC8743846 DOI: 10.5535/arm.21034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect. Methods This prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury; all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect. Results The inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3; 95% confidence interval, 5.02–21.16). Conclusion Inpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.
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Affiliation(s)
- Zoe Adey-Wakeling
- Department of Rehabilitation, Flinders University of South Australia, Bedford Park, SA, Australia.,Department of Rehabilitation, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, Australia
| | - Laura Jolliffe
- Alfred Health, Melbourne, Australia.,Department of Neurosciences, Monash University, Melbourne, Australia
| | | | | | | | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
| | - Enwu Liu
- Department of Rehabilitation, Flinders University of South Australia, Bedford Park, SA, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Natasha A Lannin
- Alfred Health, Melbourne, Australia.,Department of Neurosciences, Monash University, Melbourne, Australia.,College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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Plaza A, Adsett J, Byrnes A, McRae P. Physical activity levels in hospitalised adults with burn injuries. J Burn Care Res 2021; 43:1048-1054. [PMID: 34878542 DOI: 10.1093/jbcr/irab233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Physical activity behaviour has not been previously described in hospitalised adults with burn injuries. This prospective, cross-sectional study used a standardised behavioural mapping protocol to observe patient behaviour related to physical activity over a 12-hour period on one weekday in a quaternary referral specialist burn centre. Structured observations were recorded for each of four domains: 1) patient location, 2) position, 3) activity performed and 4) the presence of others. Observations were summarised across all participants as median (IQR) proportion of time. Participants (n=17) were predominantly male (82%) with a mean age of 44.3 (SD 15.2) years, a mean burn size of 34.9% (SD 26.7) total body surface area and a median hospital length of stay of 18 (IQR 6-49) days at time of observation. Participants spent a median of 83% (IQR 73-93) of time in their bedroom, 92% (IQR 68-97) of time in or on their bed and a median of 5% (IQR 3-13) of time mobilising. Exercise accounted for 10% (IQR 8-17) of activity related observations. A median of 68% (IQR 39-83) of time was spent alone. Results suggest time spent engaging in physical activity is low. Further studies are required to investigate motivators and barriers to performing physical activity in this population. This will consequently inform the development and implementation of appropriate strategies to improve physical activity behaviour in this cohort.
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Affiliation(s)
- Anita Plaza
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.,Professor Stuart Pegg Adult Burn Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Julie Adsett
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Angela Byrnes
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
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13
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Ley L, Khaw D, Duke M, Botti M. Low dose mobility and functional status outcomes in hospitalized older general medicine patients. Geriatr Nurs 2021; 43:7-14. [PMID: 34798311 DOI: 10.1016/j.gerinurse.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/01/2022]
Abstract
Emerging evidence suggests hospitalized older adults should walk at least 20-minutes daily to minimize functional decline. A single-institution case study conducted in a tertiary-referral centre in Melbourne, Australia, aimed to examine functional change and describe characteristics of older patients' in-hospital mobility. From 526 older patients vulnerable to functional decline, a sample of 41 patients (Mean age = 83.6, SD = 6.1 years) participated in 6-hour naturalistic observations. Functional change was measured at 2-weeks preadmission, admission and discharge with the revised Measurement System of Functional Autonomy (SMAF). Nearly 25% (n = 10) of observed patients functionally declined between preadmission and discharge and five patients died (12.2%). Thirty-two patients (78%) mobilized in 133 episodes accounting for 3.1% of the 246-hours observed. A daily walking-exercise dose equivalent to 20-min was associated with less functional decline in older adults with moderate to high walking capability supporting the effectiveness of this daily walking-exercise dose in minimizing functional decline.
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Affiliation(s)
- Lenore Ley
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research - Alfred Health, Deakin University, Locked Bag 22000, Geelong, Australia.
| | - Damien Khaw
- Centre for Quality and Patient Safety Research - Epworth Health, Deakin University, Locked Bag 22000, Geelong, Australia
| | - Maxine Duke
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia
| | - Mari Botti
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia
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14
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Scholz K, van Oorsouw R, Hermsen S, Hoogeboom TJ. Development and pilot-testing of a behavioural intervention to enhance physical activity in patients admitted to the cardiology ward: a proof-of-concept study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1949038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kathrin Scholz
- Department of Social Psychology – Behaviour Change/Work – and Organizational Psychology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Roel van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Thomas J. Hoogeboom
- IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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15
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Optimization and Validation of a Classification Algorithm for Assessment of Physical Activity in Hospitalized Patients. SENSORS 2021; 21:s21051652. [PMID: 33673447 PMCID: PMC7956397 DOI: 10.3390/s21051652] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
Low amounts of physical activity (PA) and prolonged periods of sedentary activity are common in hospitalized patients. Objective PA monitoring is needed to prevent the negative effects of inactivity, but a suitable algorithm is lacking. The aim of this study is to optimize and validate a classification algorithm that discriminates between sedentary, standing, and dynamic activities, and records postural transitions in hospitalized patients under free-living conditions. Optimization and validation in comparison to video analysis were performed in orthopedic and acutely hospitalized elderly patients with an accelerometer worn on the upper leg. Data segmentation window size (WS), amount of PA threshold (PA Th) and sensor orientation threshold (SO Th) were optimized in 25 patients, validation was performed in another 25. Sensitivity, specificity, accuracy, and (absolute) percentage error were used to assess the algorithm’s performance. Optimization resulted in the best performance with parameter settings: WS 4 s, PA Th 4.3 counts per second, SO Th 0.8 g. Validation showed that all activities were classified within acceptable limits (>80% sensitivity, specificity and accuracy, ±10% error), except for the classification of standing activity. As patients need to increase their PA and interrupt sedentary behavior, the algorithm is suitable for classifying PA in hospitalized patients.
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16
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Koenders N, Potkamp-Kloppers S, Geurts Y, Akkermans R, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Ban Bedcentricity: A Multifaceted Innovation to Reduce Sedentary Behavior of Patients During the Hospital Stay. Phys Ther 2021; 101:6131759. [PMID: 33564890 PMCID: PMC8280922 DOI: 10.1093/ptj/pzab054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 12/03/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to explore differences in sedentary behavior, length of hospital stay, and discharge destination of patients before and after the Ban Bedcentricity implementation at ward level. METHODS The Ban Bedcentricity innovation and implementation procedure were implemented at the cardiothoracic surgery, cardiology, and orthopedics-traumatology wards. Sedentary behavior data were collected 2 weeks before and after the implementation using behavioral observations and analyzed with Pearson chi-square. Length of hospital stay and discharge destination data were collected from all admitted patients and analyzed with multiple and logistic regression analyses. RESULTS Behavioral observations showed that in 52% of the observations, patients were lying in bed before implementation and 40% after implementation at the cardiothoracic surgery, 64% and 46% at the cardiology, and 53% and 57% at the orthopedics-traumatology wards, respectively. The mean length of hospital stay after implementation (compared with implementation before) was 5.1 days at the cardiothoracic surgery (n = 1923; mean = +0.13 days, 95% CI = -0.32 to 0.60), 2.6 days at the cardiology (n = 2646; mean = -0.22 days, 95% CI = -0.29 to -0.14), and 2.4 days at the orthopedics-traumatology wards (n = 1598; mean = +0.28 days, 95% CI = 0.06 to 0.50). After the implementation, more patients were discharged home from the cardiothoracic surgery (odds ratio [OR = 1.23], 95% CI = 1.07 to 1.37) and cardiology wards (OR = 1.37, 95% CI = 1.22 to 1.49), and no statistically significant difference was found at the orthopedics-traumatology ward (OR = 1.09, 95% CI = 0.88 to 1.27). CONCLUSION The results indicate beneficial outcomes after the implementation with less sedentary behavior and proportionately more patients being discharged home compared with before the implementation. However, little information is available about the adoption and fidelity of Ban Bedcentricity; therefore, outcomes should be interpreted with caution. IMPACT This multifaceted innovation to reduce sedentary behavior of patients during the hospital stay seems to be promising, with outcomes indicating less sedentary behavior in patients and more patients being discharged home after the implementation. LAY SUMMARY We introduced Ban Bedcentricity, an intervention to reduce the amount of time patients lie in the hospital bed during their hospitalization. This study shows that after the introduction of Ban Bedcentricity, patients lie in bed less and are more often discharged home.
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Affiliation(s)
- Niek Koenders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands,Address all correspondence to Mr Koenders at:
| | | | - Yvonne Geurts
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Reinier Akkermans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands
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17
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McCullagh R, Darren D, Horgan NF, Timmons S. Factors Associated With Walking in Older Medical Inpatients. Arch Rehabil Res Clin Transl 2021; 2:100038. [PMID: 33543067 PMCID: PMC7853347 DOI: 10.1016/j.arrct.2020.100038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization. Design A cohort study. Setting Acute hospitalized care. Participants Premorbidly mobile, nonsurgical, nonelective inpatients (50% women) aged ≥65 years (N=154), with an anticipated ≥3-day inpatient stay were recruited consecutively within 48 hours of hospital admission. Of the 227 patients screened, 69 did not meet study criteria and 4 refused. Interventions Not applicable. Main Outcome Measures Age, comorbidities (Cumulative Illness Rating Scale), cognitive status (6-item Cognitive Impairment Test), falls history and efficacy (Falls Efficacy Scale-International), physical performance (short physical performance battery), and medications were recorded within 2 days of admission. Walking activity (step count) was recorded for 7 days or until discharge. Daily events (procedures, falls, fear of falling, ordered bedrest, devices or treatments that hindered walking [eg, intravenous fluids, wall-mounted oxygen therapy], patient- and nurse-reported medial status, fatigue, sleep quality, physiotherapy, or occupational therapy intervention) were measured on concurrent weekdays. Their associations with daily (log) step count were estimated using linear mixed-effects models, adjusted for patient-characteristics measured at admission. Results Approximately half of the variability in step count was described at the within-patient level. Multivariable models suggested positive associations with Wednesdays (+25% in step count; 95% confidence interval, 4-53), admission physical performance (+15%, 8-22), improving medical status (+33%, 7-64), negative associations with devices or treatments that hinder walking (−29%, −9 to −44), and instructed bedrest (−69%, −55 to −79). Conclusion Day-to-day step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients.
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Affiliation(s)
- Ruth McCullagh
- Centre for Gerontology and Rehabilitation, St Finbarr's Hospital, College of Medicine and Health, University College Cork, Cork
| | - Dahly Darren
- School of Public Health, College of Medicine and Health, University College Cork, Cork.,Clinical Research Facility Cork, University College Cork, Cork
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, St Finbarr's Hospital, College of Medicine and Health, University College Cork, Cork
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18
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Sedentary Behaviour in Hospitalised Older People: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249359. [PMID: 33327552 PMCID: PMC7765084 DOI: 10.3390/ijerph17249359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Background: Sedentary behaviour (SB) can delay hospitalised older adults' recovery from acute illness and injuries. Currently, there is no synthesis of evidence on SB among hospitalised older people. This scoping review aimed to identify and map existing literature on key aspects of SB among hospitalised older adults, including the prevalence, measurement and intervention strategies for SB and sedentary behaviour bouts (SBBs) as well as healthcare professionals, patients and carers' perspectives on interventions. Methods and analysis: Several electronic databases were searched between January 2001 and September 2020. The Joanna Briggs Institute (JBI) framework was used to conduct this scoping review. Results: Out of 1824 articles, 21 were included comprising 16 observational studies, 3 randomised controlled trials, 1 comparative study, and 1 phase-1 dose-response study. The sample size ranged from 13 to 393, with all 1435 participants community-dwelling before hospitalisation. Only two studies focused on measuring SB and SBBs as a primary outcome, with others (n = 19) reporting SB and SBB as a sub-set of physical activity (PA). Older adults spent an average of 86.5%/day (20.8 h) sedentary. Most studies (n = 15 out of 21) measured SB and SBB using objective tools. Conclusion: Hospitalised older people spent most of their waking hours sedentary. Studies explicitly focused on SB and SBB are lacking, and the perspectives of patients, carers and healthcare professionals are not clarified. Future hospital-based studies should focus on interventions to reduce SB and SBB, and the perspectives of healthcare professionals, patients and carers' taken into account.
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19
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Wu Y, Smits EJ, Window P, Beningfield A, Johnston V, McRae P. Mobility levels of acute medical patients: Is behavioural mapping comparable to accelerometry? Clin Rehabil 2020; 35:595-605. [PMID: 33203223 DOI: 10.1177/0269215520970341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To (1) determine agreement between behavioural mapping and accelerometry for measuring mobility levels in an acute medical inpatient setting and to (2) explore and compare the required resources and costs for both methods. DESIGN Observational cross-sectional study. SETTING Tertiary referral teaching hospital in Brisbane, Australia. SUBJECTS Adult patients admitted to two acute medical wards. MAIN MEASURES Mobility levels were recorded by behavioural mapping, and thigh and chest-worn accelerometers (ActivPAL). The level of agreement between the two methods was evaluated using the Intraclass Correlation Coefficients for each mobility level (i.e. lying, sitting, upright, standing and walking). RESULTS Nineteen patients (10 male (53%); mean(SD) age of 72(14) years) were included in the agreement analysis. The Intraclass Correlation Coefficients were high for 'lying' (ICC = 0.87), 'sitting' (ICC = 0.84) and 'upright' (ICC = 0.93), indicating good to excellent agreement between the two methods. For these mobility levels, mean differences between the two methods were small (<2%), with large standard deviations (up to 18%). Agreement was poor for 'standing' (ICC = 0.00) and 'walking' (ICC = 0.35). Both methods were labour-intensive, with labour costs of A$1,285/€798 (34 hours) for behavioural mapping and A$1,055/€655 (28 hours) for accelerometry. No further costs were involved in behavioural mapping, but clinical backfill was required. Accelerometry involved a financial investment for accelerometers (A$11,100/€6,894 for 22 ActivPAL devices). CONCLUSION Agreement between behavioural mapping and accelerometry was good for measuring 'lying', 'sitting' and 'upright', but poor for 'standing' and 'walking' in an acute inpatient setting. Both behavioural mapping and accelerometry were labour-intensive, with high costs for the accelerometry equipment.
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Affiliation(s)
- Yizhou Wu
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Esther J Smits
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Window
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alice Beningfield
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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20
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Geelen SJG, Giele BM, Nollet F, Engelbert RHH, van der Schaaf M. Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study. JMIR Res Protoc 2020; 9:e19000. [PMID: 33185561 PMCID: PMC7695526 DOI: 10.2196/19000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Admission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity. Objective This protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge. Methods The Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers. Results This study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021. Conclusions This study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients. Trial Registration Netherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480 International Registered Report Identifier (IRRID) DERR1-10.2196/19000
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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21
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Accelerometer-Based Human Activity Recognition for Patient Monitoring Using a Deep Neural Network. SENSORS 2020; 20:s20226424. [PMID: 33182813 PMCID: PMC7697281 DOI: 10.3390/s20226424] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 01/04/2023]
Abstract
The objective of this study was to investigate the accuracy of a Deep Neural Network (DNN) in recognizing activities typical for hospitalized patients. A data collection study was conducted with 20 healthy volunteers (10 males and 10 females, age = 43 ± 13 years) in a simulated hospital environment. A single triaxial accelerometer mounted on the trunk was used to measure body movement and recognize six activity types: lying in bed, upright posture, walking, wheelchair transport, stair ascent and stair descent. A DNN consisting of a three-layer convolutional neural network followed by a long short-term memory layer was developed for this classification problem. Additionally, features were extracted from the accelerometer data to train a support vector machine (SVM) classifier for comparison. The DNN reached 94.52% overall accuracy on the holdout dataset compared to 83.35% of the SVM classifier. In conclusion, a DNN is capable of recognizing types of physical activity in simulated hospital conditions using data captured by a single tri-axial accelerometer. The method described may be used for continuous monitoring of patient activities during hospitalization to provide additional insights into the recovery process.
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22
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Exploring the Impact of Obesity on Health Care Resources and Coding in the Acute Hospital Setting: A Feasibility Study. Healthcare (Basel) 2020; 8:healthcare8040459. [PMID: 33158275 PMCID: PMC7711616 DOI: 10.3390/healthcare8040459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
Obesity is costly, yet there have been few attempts to estimate the actual costs of providing hospital care to the obese inpatient. This study aimed to test the feasibility of measuring obesity-related health care costs and accuracy of coding data for acute inpatients. A prospective observational study was conducted over three weeks in June 2018 in a single orthopaedic ward of a metropolitan tertiary hospital in Queensland, Australia. Demographic data, anthropometric measurements, clinical characteristics, cost of hospital encounter and coding data were collected. Complete demographic, anthropometric and clinical data were collected for all 18 participants. Hospital costing reports and coding data were not available within the study timeframe. Participant recruitment and data collection were resource-intensive, with mobility assistance required to obtain anthropometric measurements in more than half of the participants. Greater staff time and costs were seen in participants with obesity compared to those without obesity (obesity: body mass index ≥ 30), though large standard deviations indicate wide variance. Data collected suggest that obesity-related cost and resource use amongst acute inpatients require further exploration. This study provides recommendations for protocol refinement to improve the accuracy of data collected for future studies measuring the actual cost of providing hospital care to obese inpatients.
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23
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Pedersen MM, Brødsgaard R, Nilsen P, Kirk JW. Is Promotion of Mobility in Older Patients Hospitalized for Medical Illness a Physician's Job?-An Interview Study with Physicians in Denmark. Geriatrics (Basel) 2020; 5:geriatrics5040074. [PMID: 33050371 PMCID: PMC7709691 DOI: 10.3390/geriatrics5040074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
: The aim of this study was to identify the most common barriers and facilitators physicians perceive regarding their role in the promotion of mobility in older adults hospitalized for medical illness as part of on an intervention to promote mobility. Twelve physicians at two medical departments were interviewed face-to-face using semi-structed interviews based on the Theoretical Domains Framework. The physicians' perceived barriers to promoting mobility were: the patients being too ill, the department's interior does not fit with mobility, a culture of bedrest, mobility not being part their job, lack of time and resources and unwillingness to accept an extra workload. The facilitators for encouraging mobility were enhanced cross-professional cooperation focusing on mobility, physician encouragement of mobility and patient independence in e.g., picking up beverages and clothes. The identified barriers and facilitators reflected both individual and social influences on physicians' behaviors to achieve increased mobility in hospitalized older medical patients and suggest that targeting multiple levels is necessary to influence physicians' propensity to promote mobility.
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Affiliation(s)
- Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; (R.B.); (J.W.K.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-38623350; Fax: +45-38623797
| | - Rasmus Brødsgaard
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; (R.B.); (J.W.K.)
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; (R.B.); (J.W.K.)
- Department of Public Health, Nursing, Aarhus University, 8100 Aarhus, Denmark
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24
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van Delft LMM, Bor P, Valkenet K, Slooter AJC, Veenhof C. The Effectiveness of Hospital in Motion, a Multidimensional Implementation Project to Improve Patients' Movement Behavior During Hospitalization. Phys Ther 2020; 100:2090-2098. [PMID: 32915985 PMCID: PMC7720640 DOI: 10.1093/ptj/pzaa160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Hospital in Motion is a multidimensional implementation project aiming to improve movement behavior during hospitalization. The purpose of this study was to investigate the effectiveness of Hospital in Motion on movement behavior. METHODS This prospective study used a pre-implementation and post-implementation design. Hospital in Motion was conducted at 4 wards of an academic hospital in the Netherlands. In each ward, multidisciplinary teams followed a 10-month step-by-step approach, including the development and implementation of a ward-specific action plan with multiple interventions to improve movement behavior. Inpatient movement behavior was assessed before the start of the project and 1 year later using a behavioral mapping method in which patients were observed between 9:00 am and 4:00 pm. The primary outcome was the percentage of time spent lying down. In addition, sitting and moving, immobility-related complications, length of stay, discharge destination home, discharge destination rehabilitation setting, mortality, and 30-day readmissions were investigated. Differences between pre-implementation and post-implementation conditions were analyzed using the chi-square test for dichotomized variables, the Mann Whitney test for non-normal distributed data, or independent samples t test for normally distributed data. RESULTS Patient observations demonstrated that the primary outcome, the time spent lying down, changed from 60.1% to 52.2%. For secondary outcomes, the time spent sitting increased from 31.6% to 38.3%, and discharges to a rehabilitation setting reduced from 6 (4.4%) to 1 (0.7%). No statistical differences were found in the other secondary outcome measures. CONCLUSION The implementation of the multidimensional project Hospital in Motion was associated with patients who were hospitalized spending less time lying in bed and with a reduced number of discharges to a rehabilitation setting. IMPACT Inpatient movement behavior can be influenced by multidimensional interventions. Programs implementing interventions that specifically focus on improving time spent moving, in addition to decreasing time spent lying, are recommended.
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Affiliation(s)
| | - Petra Bor
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Centre Utrecht, Utrecht University; and UMC Utrecht Brain Center, Utrecht University
| | - Karin Valkenet
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Centre Utrecht, Utrecht University
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University; and UMC Utrecht Brain Center, Utrecht University
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Centre Utrecht, Utrecht University; and Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
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25
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King B, Bodden J, Steege L, Brown CJ. Older adults experiences with ambulation during a hospital stay: A qualitative study. Geriatr Nurs 2020; 42:225-232. [PMID: 32861430 DOI: 10.1016/j.gerinurse.2020.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/21/2022]
Abstract
Older adults often lose their ability to independently ambulate during a hospital stay. Few studies have investigated older adults' experiences with ambulation during hospitalization. The purpose of this study was to understand older adults' perceptions of and experiences with ambulation during a hospital admission. A qualitative study using Inductive Content Analysis was conducted. Community-dwelling older adults (N = 11) were recruited to participant in five focus group meetings each lasting 90 min. All individuals participated in each focus group. Participants described high complexity in deciding whether or not they could ambulate. Six categories were identified: Uncertainty, Restriction Messaging, Non-Welcoming Space, Caring for Nurse and Self, Feeling Isolated, and Presenting Self. This study provides a detailed understanding of older adults' experiences and perceptions of a hospital stay. Findings from this study can serve as a foundation for future interventions to improve older adult patient ambulation during hospitalization.
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Affiliation(s)
- Barbara King
- APRN-BC University of Wisconsin- Madison, School of Nursing.
| | - Jillian Bodden
- UW Health, Department of Geriatrics, University of Wisconsin- Madison, School of Nursing
| | | | - Cynthia J Brown
- Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, University of Alabama at Birmingham
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, 655 West Lombard Street, Baltimore, MD 21201, USA.
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McRae P, Bew P, Smith S, Mudge A. An observational study of physical, cognitive and social activities in rehabilitation inpatients. Australas J Ageing 2020; 39:217-224. [PMID: 32096897 DOI: 10.1111/ajag.12785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe patient behaviour related to mobility in a rehabilitation inpatient setting and compare intensive and Transition Care Program (TCP, slow-stream rehabilitation) models. METHODS Prospective cross-sectional design including weekday and weekend sampling in two rehabilitation wards (one intensive and one TCP) in a publicly funded facility. A single trained observer undertook behavioural mapping, observing patient location, mobility, activity and company on all inpatients 8 am-4 pm using a structured 2-minute observation protocol. Observations were summarised and compared between wards. RESULTS We observed 74 inpatients on a Tuesday and 77 on a Sunday. Participants spent 7% (median) of daytime standing or walking. They spent 62%-87% in their room, 22%-40% sleeping or resting and 74%-86% alone. The only significant difference between wards was time spent off ward on Tuesday. Activity was lower on Sunday. CONCLUSIONS Time spent in physical, cognitive and social activities is low in inpatient rehabilitation and TCP wards.
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Affiliation(s)
- Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Paul Bew
- Brighton Health Campus, Brisbane, Qld, Australia
| | - Simon Smith
- Institute for Social Science Research, The University of Queensland, Brisbane, Qld, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
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Koenders N, Weenk M, van de Belt TH, van Goor H, Hoogeboom TJ, Bredie SJH. Exploring barriers to physical activity of patients at the internal medicine and surgical wards: a retrospective analysis of continuously collected data. Disabil Rehabil 2019; 43:1883-1889. [PMID: 31691603 DOI: 10.1080/09638288.2019.1685013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To analyse physical activity of patients during their hospital stay and to explore the relationship between physical activity and barriers to physical activity. METHODS This was a secondary analysis of physical activity data for patients admitted to the internal medicine and surgical wards. Physical activity data, collected with a wireless patch sensor, was operationalized as time spent lying, sitting/standing, and walking. Barriers to physical activity included patients' pain levels, the use of urinary catheters, intravenous tubing, oxygen lines, drains, and level of dependence. Regression analysis explored the relationship between physical activity and barriers to physical activity. RESULTS Physical activity data were collected in 39 patients (aged 27-88, mean 54 years) during hospital stay. Patients were admitted for a median of 10 d (interquartile range [IQR]: 7-15 d). These patients were lying for a median of 12.1 h (7.6-17.7), sitting/standing 11.8 h (6.3-15.7), and walking 0.1 h (0-0.3) per day. Time lying during the day related to pain levels (β = 0.4 h per unit increase in pain, p < 0.01) and drain use (β = 3.1 h, p < 0.01). CONCLUSIONS Patients spent the most time during the hospital stay lying in bed. Improved pain management and decreased drain use may be worth exploring to increase inpatient physical activity.Implications for rehabilitationContinuous monitoring of physical activity in patients during hospital stay is an important tool for health care professionals to improve multidisciplinary care and rehabilitation.Health care professionals should be aware of the necessity of adequate pain management and critically review the use of drains in order to improve physical activity of patients during hospital stay.Patients need extra support of health care professionals to increase physical activity during consecutive days of their hospital stay.
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Affiliation(s)
- Niek Koenders
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mariska Weenk
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom H van de Belt
- Radboud Reshape Innovation Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastian J H Bredie
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Fazio S, Stocking J, Kuhn B, Doroy A, Blackmon E, Young HM, Adams JY. How much do hospitalized adults move? A systematic review and meta-analysis. Appl Nurs Res 2019; 51:151189. [PMID: 31672262 DOI: 10.1016/j.apnr.2019.151189] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 01/04/2023]
Abstract
AIM To quantify the type and duration of physical activity performed by hospitalized adults. BACKGROUND Inactivity is pervasive among hospitalized patients and is associated with increased mortality, functional decline, and cognitive impairment. Objective measurement of activity is necessary to examine associations with clinical outcomes and quantify optimal inpatient mobility interventions. METHODS We used PRISMA guidelines to search three databases in December 2017 to retrieve original research evaluating activity type and duration among adult acute-care inpatients. We abstracted data on inpatient population, measurement method, monitoring time, activity duration, and study quality. RESULTS Thirty-eight articles were included in the review and 7 articles were included in the meta-analysis. Study populations included geriatric (n = 5), surgical (n = 5), medical (n = 12), post-stroke (n = 10), psychiatric (n = 2), and critical care inpatients (n = 4). To measure activity, 29% of studies used human observation and 71% used activity monitors. Among inpatient populations, 87-100% of time was spent sitting or lying in-bed. Among medical inpatients monitored over a continuous 24-hour period (n = 7), 70 min per day was spent standing/walking (95% CI 57-83 min). CONCLUSIONS This review provides a baseline assessment and benchmark of inpatient activity, which can be used to compare inpatient mobility practices. While there is substantial heterogeneity in how researchers measure and define how much inpatients move, there is consistent evidence that patients are mostly inactive and in-bed during hospitalization. Future research is needed to establish standardized methods to accurately and consistently measure inpatient mobility over time.
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Affiliation(s)
- Sarina Fazio
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America; UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America.
| | - Jacqueline Stocking
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
| | - Brooks Kuhn
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
| | - Amy Doroy
- UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Emma Blackmon
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America; UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America
| | - Jason Y Adams
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
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Resnick B, Boltz M. Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls. Clin Geriatr Med 2019; 35:237-251. [PMID: 30929885 DOI: 10.1016/j.cger.2019.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Physical activity, defined as bodily movement that expends energy including such things as bed mobility, transfers, bathing, dressing, and walking, has a positive impact on physical and psychosocial outcomes among older adults during their hospitalization and the post hospitalization recovery period. Despite benefits, physical activity is not the focus of care in the acute care setting. Further there are many barriers to engaging patients in physical activity and fall prevention activities including patient, family and provider beliefs, environmental challenges and limitations, hospital policies, and medical and nursing interventions. This paper provides an overview of falls and physical activity prevalence among acute care patients, challenges to engaging patients in physical activity and falls prevention activities and innovative approaches to increase physical activity and prevent falls among older hospitalized patients.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA.
| | - Marie Boltz
- Pennsylvania State University, College of Nursing, 201 Nursing Sciences Building, University Park, PA 16802, USA
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Landré B, Aegerter P, Zins M, Goldberg M, Ankri J, Herr M. Association between Hospitalization and Change of Frailty Status in the GAZEL Cohort. J Nutr Health Aging 2019; 23:466-473. [PMID: 31021364 DOI: 10.1007/s12603-019-1186-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess the relationship between changes of frailty status and intervening hospitalizations, using information of the GAZEL cohort, matched with the data of the French National Health Data System. DESIGN Observational cohort study. PARTICIPANTS Community-dwelling adults of the GAZEL cohort (n = 12145; aged between 58 and 73 years in 2012). MEASUREMENTS Frailty was determined with the Strawbridge questionnaire in 2012, 2013 and 2014. Data regarding hospitalizations (notably their number, length of stay, emergency department use, and main diagnosis) were collected from the French National Health Data System. The relationship between intervening hospitalizations and changes of frailty status over time was assessed with multivariate Markov models. RESULTS The prevalence of frailty was 14% in 2012 and 2013 and 17% in 2014. A total of 2715 changes in frailty status were observed from 2012 to 2014. At least one hospitalization was recorded for 1453 people (12%) between the 2012 and 2013 questionnaires, and 1472 (13%) between the 2013 and 2014 questionnaires. No association was found between intervening hospitalizations and changes of frailty status (aHR 1.14 [0.97-1.35] for robust to frail transition and aHR 0.89 [0.73-1.08] for frail to robust transition). However, repeated hospitalizations, hospitalizations after emergency department use, surgery and several diagnosis groups were significantly associated with transitions towards frailty or its recovery. CONCLUSION Hospitalizations encompass a wide range of clinical situations, some of them being associated with incident frailty. An early recognition of these situations could help to better prevent and manage frailty in the early old age.
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Affiliation(s)
- B Landré
- Marie Herr ; UMR 1168, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France ;
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Mobilizing older adults: A multi-site, exploratory and observational study on patients enrolled in the Hospital Elder Life Program (HELP). Geriatr Nurs 2018; 40:239-245. [PMID: 30413275 DOI: 10.1016/j.gerinurse.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 01/21/2023]
Abstract
The aim of this study was to explore and describe the characteristics of the Hospital Elder Life Program (HELP) sites and how they mobilize patients with volunteers in the United States and other countries. The purpose was to describe: the number of enrollments, modalities, fall and injury rates, and to identify barriers to mobilization. A survey was distributed to 228 international sites. The responding sites enrolled an average of 53.9 (SD 35.3) patients per month. The majority (76%) reported that mobilization included 'active range of motion exercises' and 'ambulation'. Eighteen percent identified volunteer training, safety and liability concerns as barriers. Falls with injury on HELP units was 0-3%, with an average rate of 0.46 per 1,000 patient days. No patient falls while ambulating with the HELP team and/or volunteers were reported. More research and evidence are needed to further determine barriers and safety of mobilization with the HELP during hospitalization.
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Koenders N, Seeger JPH, van der Giessen T, van den Hurk TJ, Smits IGM, Tankink AM, Nijhuis - van der Sanden MWG, Hoogeboom TJ. Validation of a wireless patch sensor to monitor mobility tested in both an experimental and a hospital setup: A cross-sectional study. PLoS One 2018; 13:e0206304. [PMID: 30359448 PMCID: PMC6201929 DOI: 10.1371/journal.pone.0206304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose To assess the concurrent validity of a wireless patch sensor to monitor time lying, sitting/standing, and walking in an experimental and a hospital setup. Methods Healthy adults participated in two testing sessions: an experimental and real-world hospital setup. Data on time lying, sitting/standing, and walking was collected with the HealthPatch and concurrent video recordings. Validity was assessed in three ways: 1. test for mean differences between HealthPatch data and reference values; 2. Intraclass Correlation Coefficient analysis (ICC 3.1 agreement); and 3. test for mean differences between posture detection accuracies. Results Thirty-one males were included. Significant mean differences were found between HealthPatch data and reference values for sitting/standing (mean 14.4 minutes, reference: 12.0 minutes, p<0.01) and walking (mean 6.4 minutes, reference: 9.0 minutes, p<0.01) in the experimental setup. Good correlations were found between the HealthPatch data and video data for lying (ICC: 0.824) and sitting/standing (ICC: 0.715) in the hospital setup. Posture detection accuracies of the HealthPatch were significantly higher for lying and sitting/standing in the experimental setup. Conclusions Overall, the results show a good validity of the HealthPatch to monitor lying and poor validity to monitor sitting/standing or walking. In addition, the validity outcomes were less favourable in the hospital setup.
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Affiliation(s)
- Niek Koenders
- Department of Physiotherapy, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Gelderland, the Netherlands
- * E-mail:
| | - Joost P. H. Seeger
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | - Teun van der Giessen
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | - Ties J. van den Hurk
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | - Indy G. M. Smits
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | - Anne M. Tankink
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | | | - Thomas J. Hoogeboom
- IQ healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Gelderland, the Netherlands
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Pottenger BC, Pronovost PJ, Kreif J, Klein L, Hobson D, Young D, Hoyer EH. Towards improving hospital workflows: An evaluation of resources to mobilize patients. J Nurs Manag 2018; 27:27-34. [PMID: 30117210 DOI: 10.1111/jonm.12644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 01/25/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Abstract
AIM To characterize resources to safely mobilize different types of hospitalized patients. BACKGROUND Current approaches to determine nurse-patient ratios do not always include information regarding the specific demands of patients who require extra resources to mobilize. Workflows must be designed with knowledge of resource requirements to integrate patient mobility into the daily nursing team care plan. METHODS Nurse-led mobility sessions were evaluated on two adult hospital units, which consisted of nurse-patient encounters focused on patient mobility only. The resources assessed for each session were time-to-mobilize patient, time-to-document, need for additional staff support, and the need for assistive devices. Mobility sessions were also categorized by patient ambulation status, level of mobility limitations (low, medium and high) and diagnosis. RESULTS In 212 total mobility sessions, the median time-to-mobilize and time-to-document were 7.75 and 1.27 min, respectively. Additional staff support was required for 87% and 92% of patients with medium and high mobility limitations, respectively. All patients with low mobility limitations ambulated, and only 14% required additional staff. Ambulating patients with high mobility limitations was the most time-intensive (median 12.55 min). Ambulating stroke patients required one additional staff and an assistive device in 92% and 69% of the sessions, respectively. CONCLUSION This study describes the resources associated with mobilizing inpatients with different levels of mobility impairments and diagnoses. IMPLICATIONS FOR NURSING MANAGEMENT These results could assist nursing management with facilitating appropriate daily nurse-patient ratios and justify the need for assistive devices and staff support to safely mobilize patients.
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Affiliation(s)
- Brent C Pottenger
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | - Peter J Pronovost
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University, Baltimore, Maryland.,Departments of Anesthesiology & Critical Care Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
| | - Julie Kreif
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Lisa Klein
- Department of Neurosciences, Johns Hopkins University, Baltimore, Maryland.,Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Deborah Hobson
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University, Baltimore, Maryland.,Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel Young
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland.,Department of Physical Therapy, University of Nevada, Las Vegas, Nevada
| | - Erik H Hoyer
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
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Koenders N, van Oorsouw R, Seeger JPH, Nijhuis – van der Sanden MWG, van de Glind I, Hoogeboom TJ. “I’m not going to walk, just for the sake of walking…”: a qualitative, phenomenological study on physical activity during hospital stay. Disabil Rehabil 2018; 42:78-85. [DOI: 10.1080/09638288.2018.1492636] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Niek Koenders
- Orthopaedics Department – Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roel van Oorsouw
- Orthopaedics Department – Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost P. H. Seeger
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | | | - Irene van de Glind
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Klein LM, Young D, Feng D, Lavezza A, Hiser S, Daley KN, Hoyer EH. Increasing patient mobility through an individualized goal-centered hospital mobility program: A quasi-experimental quality improvement project. Nurs Outlook 2018; 66:254-262. [DOI: 10.1016/j.outlook.2018.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
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Lim SER, Ibrahim K, Sayer AA, Roberts HC. Assessment of Physical Activity of Hospitalised Older Adults: A Systematic Review. J Nutr Health Aging 2018; 22:377-386. [PMID: 29484351 DOI: 10.1007/s12603-017-0931-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The assessment of physical activity levels of hospitalised older people requires accurate and reliable measures. Physical activities that older people in hospital commonly engage in include exercises and walking. Measurement of physical activity levels of older inpatients is essential to evaluate the impact of interventions to improve physical activity levels and to determine associations between physical activity in hospital and other health-related outcome measures. OBJECTIVE To determine which measures are used to measure physical activity of older people in hospital, and to describe their properties and applications. METHOD A systematic review of four databases: Medline, Embase, CINAHL and AMED was conducted for papers published from 1996 to 2016. Inclusion criteria were participants aged ≥ 65 years and studies which included measures of physical activity in the acute medical inpatient setting. Studies which specifically assessed the activity levels of surgical patients or patients with neurological conditions such as stroke or brain injury were excluded. All study designs were included in the review. RESULTS 18 studies were included from 127 articles selected for full review. 15 studies used objective measures to measure the physical activity of older inpatients: 11 studies used accelerometers and four used direct systematic observations. Seven accelerometers were identified including the StepWatch Activity Monitor, activPAL, GENEActiv, Kenz Lifecorder EX, Actiwatch-L, Tractivity and AugmenTech Inc. Pittsburgh accelerometer. Three studies used a subjective measure (interviews with nurses and patients) to classify patients into low, intermediate and high mobility groups. The StepWatch Activity Monitor was reported to be most accurate at step-counting in patients with slow gait speed or altered gait. The activPAL was reported to be highly accurate at classifying postures. CONCLUSION Physical activity levels of older inpatients can be measured using accelerometers. The accuracy of the accelerometers varies between devices and population-specific validation studies are needed to determine their suitability in measuring physical activity levels of hospitalised older people. Subjective measures are less accurate but can be a practical way of measuring physical activity in a larger group of patients.
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Affiliation(s)
- S E R Lim
- Stephen Lim, University of Southampton, Southampton, Hampshire, United Kingdom,
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Exploring repositioning movements in sitting with 'at risk' groups using accelerometry and interface pressure mapping technologies. J Tissue Viability 2017; 27:10-15. [PMID: 29268953 DOI: 10.1016/j.jtv.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/30/2017] [Accepted: 11/08/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite high quality guidelines underpinning pressure ulcer care (NPUAP/EPUAP/PPPIA, 2014), pressure ulceration still poses a significant financial impact on health care services in treatment and staff costs as well as having a profound effect on the health and quality of life of individuals experiencing them. Repositioning is a key preventative technique recommended by occupational therapists and other health care professionals. The frequency and quality of repositioning movements performed by individuals, however, can be difficult to determine. This paper explores the use of technology in monitoring repositioning movements in sitting. OBJECTIVE To explore the outputs of technologies such as interface pressure mapping systems and accelerometers in enabling the therapist to accurately monitor seated behaviour and enhance practice through targeted interventions to prevent sitting acquired pressure ulceration. METHOD Reviewing the findings of two recent research studies with 'at risk' cohorts (spinal cord injury; elderly orthopaedic), using accelerometry and seated interface pressures, this paper will highlight how useful this technology is in clinical practice to monitor weight shifts and repositioning behaviours. RESULT Both studies illustrated that the majority of individuals did not adhere to the frequency or magnitude of movements currently recommended to redistribute seating interface pressures. When repositioning was performed it was ineffective in reducing seated pressures. CONCLUSION In an era of personalised medicine, technology has an important role to play in providing the service user, caregivers and healthcare staff with important biofeedback information about seated behaviours, particularly those that minimise the risk of developing sitting acquired pressure ulcers. This information can augment occupational therapists' clinical decision-making in maximising active pressure ulcer prevention.
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Clarke C, Stack C, Martin M. Lack of meaningful activity on acute physical hospital wards: Older people’s experiences. Br J Occup Ther 2017. [DOI: 10.1177/0308022617735047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Research suggests that older people on acute physical hospital wards are at increased risk of physical and mental health decline due to inactivity during their stay. Whilst studies have highlighted potential causes of such inactivity, there exists a paucity of occupational therapy research that explores engagement in meaningful occupation from patients’ perspectives in hospital settings. Method Interpretative phenomenological analysis was used to gain a deeper understanding of how 18 older people spent their time on hospital wards and the impact this had on their feelings of wellbeing. Interviews were carried out and analysed using interpretive phenomenological analysis guidelines. Findings Patients experienced a lack of meaningful activity on the wards which resulted in feelings of passivity, boredom and a sense of alienation from their normal roles, routines and sense of self. Despite a willingness to engage in activity, barriers were suggested as limited resources, hospital routines and personal limitations. Suggestions of potential meaningful activities were made. Conclusion Occupational therapy services need to review service provision and provide an occupation-focused service, ensuring that patients’ engagement in meaningful activities is seen as an integral part of their role in order to maintain patients’ mental and physical wellbeing. Recommendations for further research are highlighted.
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Affiliation(s)
- Channine Clarke
- Academic Lead, Occupational Therapy, University of Brighton, UK
| | - Caroline Stack
- Specialist Occupational Therapist, Sussex Community NHS Foundation Trust, UK
| | - Marion Martin
- Former Senior Lecturer, Occupational Therapy, University of Brighton, UK
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40
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McCullagh R, Dillon C, O'Connell AM, Horgan NF, Timmons S. Step-Count Accuracy of 3 Motion Sensors for Older and Frail Medical Inpatients. Arch Phys Med Rehabil 2017; 98:295-302. [DOI: 10.1016/j.apmr.2016.08.476] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/29/2016] [Accepted: 08/27/2016] [Indexed: 12/21/2022]
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Zisberg A, Gur-Yaish N. Older adults' personal routine at time of hospitalization. Geriatr Nurs 2016; 38:27-32. [PMID: 27473879 DOI: 10.1016/j.gerinurse.2016.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 01/04/2023]
Abstract
This study is the first to explore whether hospitalization disrupts the daily routines of dependent and independent older adults. Data were collected as part of a prospectively designed study from 330 hospitalized older adults age 70+. Patients reported prehospitalization frequency, duration, and timing of basic activities of daily living and leisure activities at hospital admission. Hospital routine was assessed on day of discharge. Results indicated that frequency and duration of most basic activities decreased during hospitalization; the sharpest decrease was in frequency of getting dressed. Showering occurred 2 h earlier in the hospital setting, and getting dressed occurred an hour and a half later. For dependent respondents, the greatest change was in duration; for independent respondents, the greatest change was in frequency. Given the importance of routine maintenance to health and well-being, understanding the dynamics of its disruption in the hospital setting is imperative.
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Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, 1199 Aba Khoushy Ave. 99, Mount Carmel, Haifa 3498838, Israel.
| | - Nurit Gur-Yaish
- Center for Research and Study of Aging, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel
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Hoyer EH, Friedman M, Lavezza A, Wagner-Kosmakos K, Lewis-Cherry R, Skolnik JL, Byers SP, Atanelov L, Colantuoni E, Brotman DJ, Needham DM. Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project. J Hosp Med 2016; 11:341-7. [PMID: 26849277 DOI: 10.1002/jhm.2546] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 12/05/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). PATIENTS AND METHODS Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. RESULTS Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P < 0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P < 0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P < 0.001) days compared to 12 months prior. A subgroup of patients expected to have a longer LOS (expected LOS >7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P < 0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). CONCLUSIONS AND RELEVANCE Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | | | | | - Judy L Skolnik
- Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sherrie P Byers
- Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland
| | - Levan Atanelov
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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Mudge AM, McRae P, McHugh K, Griffin L, Hitchen A, Walker J, Cruickshank M, Morris NR, Kuys S. Poor mobility in hospitalized adults of all ages. J Hosp Med 2016; 11:289-91. [PMID: 26797978 DOI: 10.1002/jhm.2536] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/19/2015] [Accepted: 12/04/2015] [Indexed: 11/12/2022]
Abstract
Low levels of activity in hospital inpatients contribute to functional decline. Previous studies have shown low levels of activity in older inpatients, but few have investigated younger inpatients (aged <65 years). This observational study measured activity in older (aged ≥65 years) and younger hospital inpatients on 3 wards (medical, surgical, oncology) in a major teaching hospital in Brisbane, Australia, as part of a quality-improvement intervention to enhance mobility. Using structured behavioral mapping protocols, participants were observed for 2-minute intervals throughout 4, 4-hour daytime observation periods. The proportion of time spent at different activity levels was calculated for each participant, and time spent standing, walking or wheeling was compared between age group and wards. There were 3272 observations collected on 132 participants (median, 30 per patient; range, 9-35). The most time was spent lying in bed (mean 57%), with 9% standing or walking. There were significant differences among wards, but no difference between older and younger subgroups. Low mobility is common in adult inpatients of all ages. Behavioral mapping provided measures suitable for use in quality improvement.
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Affiliation(s)
- Alison M Mudge
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Prue McRae
- University of Queensland School of Medicine, Brisbane, Queensland, Australia
- Safety and Quality Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Kirstie McHugh
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
| | - Lauren Griffin
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
| | - Andrew Hitchen
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
| | - James Walker
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
| | - Mark Cruickshank
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Norman R Morris
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
- Griffith Health Institute, Brisbane, Queensland, Australia
| | - Suzanne Kuys
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
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Ong T, Anand V, Tan W, Watson A, Sahota O. Physical activity study of older people in hospital: A cross-sectional analysis using accelerometers. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Resnick B, Galik E, Wells PT CL, Boltz M, Holtzman L. Optimizing physical activity among older adults post trauma: Overcoming system and patient challenges. Int J Orthop Trauma Nurs 2015; 19:194-206. [PMID: 26547682 PMCID: PMC4637820 DOI: 10.1016/j.ijotn.2015.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/24/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of 65. Recovery for these individuals is more complicated than among younger individuals. Early mobilization has been shown to improve outcomes. Unfortunately, there are many challenges to early mobilization. The Function Focused Care Intervention was developed to overcome these challenges. PURPOSE The purpose of this paper was to describe the initial recruitment of the first 25 participants and delineate the challenges and successes associated with implementation of this intervention. RESULTS Overall recruitment rates were consistent with other studies and the intervention was implemented as intended. Most patients were female, white and on average 79 years of age. Optimizing physical activity of patients was a low priority for the nurses with patient safety taking precedence. Patients spent most of the time in bed. Age, depression and tethering were the only factors that were associated with physical activity and functional outcomes of patients. CONCLUSION Ongoing work is needed to keep patients physically active in the immediate post trauma recovery period.
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Affiliation(s)
- Barbara Resnick
- Professor, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
| | - Elizabeth Galik
- Associate Professor, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
| | - Chris L. Wells PT
- Clinical Associate Professor, Physical Therapy and Rehabilitation Science 655 W. Baltimore Street, Baltimore MD 21201, Tel: 410 706 6663
| | - Marie Boltz
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 02467, Tel: 617-552-6379
| | - Lauren Holtzman
- Project Manager, University of Maryland, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
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Latimer S, Chaboyer W, Gillespie BM. The repositioning of hospitalized patients with reduced mobility: a prospective study. Nurs Open 2015; 2:85-93. [PMID: 27708804 PMCID: PMC5047314 DOI: 10.1002/nop2.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/07/2015] [Indexed: 11/30/2022] Open
Abstract
AIM To determine the frequency of patient repositioning across three consecutive nursing shifts (day, evening and night) and to identify predictors of repositioning frequency. BACKGROUND Patient repositioning is a frequently implemented pressure injury prevention strategy. Yet, little is known about how often it should be implemented, or the frequency of movement among hospitalized patients with reduced mobility. DESIGN An observational prospective study. METHODS Chart audits were used to gather clinical and demographic data. Semi-structured observations were conducted every 30 minutes for a continuous 24-hour period. Observational data included the patient's body position, the frequency of repositioning, assistance require to reposition and the use of support surfaces. RESULTS Patients were repositioned frequently during the day and evening and least at night time. Elevation of the head of the bed (1-45°) was the most frequently adopted position. The independent predictors of repositioning frequency were age and gender, with older patients and males repositioned less frequently.
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Affiliation(s)
- Sharon Latimer
- Griffith UniversitySchool of Nursing and MidwiferyMeadowbrookQueenslandAustralia
| | - Wendy Chaboyer
- Griffith UniversityNHMRC Research Centre for Excellence in Nursing Interventions (NCREN)Gold CoastQueenslandAustralia
| | - Brigid M. Gillespie
- Griffith UniversityNHMRC Research Centre for Excellence in Nursing Interventions (NCREN)Gold CoastQueenslandAustralia
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Chaboyer W, Mills PM, Roberts S, Latimer S. Physical activity levels and torso orientations of hospitalized patients at risk of developing a pressure injury: an observational study. Int J Nurs Pract 2013; 21:11-7. [PMID: 24118408 DOI: 10.1111/ijn.12188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pressure injury guidelines recommend regular repositioning yet patients' mobility and repositioning patterns are unknown. An observational study using activity monitors was undertaken to describe the 24 h activity patterns of 84 hospitalized patients at risk of developing a pressure injury. The vast majority of participants' time was spent in the sedentary activity range (94% ± 3%) followed by the light range (5% ± 4 %). Patients changed their posture a median of 94 (interquartile range 48) time in the 24-h period (range 11-154), or ≈ 3.8 times per hour. Although a main focus for pressure injury prevention has been on repositioning, this study shows that patients with restricted mobility are actually moving quite often. Therefore, it might be appropriate to focus more attention on other pressure injury prevention strategies such as adequate nutrition, appropriate support surfaces and good skin care.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Research Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Griffith University Gold Coast Campus, Gold Coast, Australia
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Wolf A, Ekman I, Dellenborg L. Everyday practices at the medical ward: a 16-month ethnographic field study. BMC Health Serv Res 2012; 12:184. [PMID: 22748059 PMCID: PMC3409076 DOI: 10.1186/1472-6963-12-184] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 07/02/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships. METHODS Ethnographic fieldwork was conducted over a 16-month period (between 2009 and 2011) by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male) including the chief nurse manager, three assistant nurses (all female), two cardiologists and three patients (one female, two male). RESULTS We identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses. CONCLUSIONS The care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care.
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Affiliation(s)
- Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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