1
|
van Grootel JWM, Bor P, Veenhof C, Valkenet K. Development of a goal-directed movement intervention (GOAL) using a movement sensor for hospitalized patients: An intervention mapping approach. Clin Rehabil 2024; 38:251-262. [PMID: 37644843 PMCID: PMC10725127 DOI: 10.1177/02692155231198173] [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: 05/03/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To describe the development of a goal-directed movement intervention in two medical wards, including recommendations for implementation and evaluation. DESIGN Implementation Research. SETTING Pulmonology and nephrology/gastroenterology wards of the University Medical Centre Utrecht, The Netherlands. PARTICIPANTS Seven focus groups were executed including 28 nurses, 7 physical therapists and 15 medical specialists. Patients' perceptions were repeatedly assessed during the iterative steps of the intervention development. INTERVENTION Interventions were targeted to each ward's specific character, following an Intervention Mapping approach using literature and research meetings. Main measures: Intervention components were linked to Behavior Change Techniques and implementation strategies will be selected using the Expert Recommendation Implementing Change tool. Evaluation outcomes like number of patients using the movement intervention will be measured, based on the taxonomy of Proctor. RESULTS The developed intervention consists of: insight in patients movement behavior (monitoring & feedback), goal setting (goals & planning) and adjustments to the environment (associations & antecedents). The following implementation strategies are recommended: to conduct educational meetings, prepare & identify champions and audit & provide feedback. To measure service and client outcomes, the mean level of physical activity per ward can be evaluated and the Net Promoter Score can be used. CONCLUSION(S) This study shows the development of a goal-directed movement intervention aligned with the needs of healthcare professionals. This resulted in an intervention consisting of feedback & monitoring of movement behavior, goal setting and adjustments in the environment. Using a step-by-step iterative implementation model to guide development and implementation is recommended.
Collapse
Affiliation(s)
- JWM van Grootel
- HU University of Applied Sciences Utrecht, Research Center of Healthy and Sustainable Living, Research Group Innovation of Movement Care, Utrecht, The Netherlands
- University Medical Centre Utrecht, Department of Rehabilitation Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - P Bor
- University Medical Centre Utrecht, Department of Rehabilitation Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - C Veenhof
- HU University of Applied Sciences Utrecht, Research Center of Healthy and Sustainable Living, Research Group Innovation of Movement Care, Utrecht, The Netherlands
- University Medical Centre Utrecht, Department of Rehabilitation Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - K Valkenet
- HU University of Applied Sciences Utrecht, Research Center of Healthy and Sustainable Living, Research Group Innovation of Movement Care, Utrecht, The Netherlands
- University Medical Centre Utrecht, Department of Rehabilitation Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| |
Collapse
|
2
|
Valkenet K, McRae P, Reijneveld E, Jans M, Bor P, van Delft L, Young DL, Veenhof C. Inpatient physical activity across a large university city hospital: a behavioral mapping study. Physiother Theory Pract 2024; 40:153-160. [PMID: 36036375 DOI: 10.1080/09593985.2022.2112116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Physical inactivity is common during hospitalization. Physical activity has been described in different inpatient populations but never across a hospital. PURPOSE To describe inpatient movement behavior and associated factors throughout a single university hospital. METHODS A prospective observational study was performed. Patients admitted to clinical wards were included. Behavioral mapping was undertaken for each participant between 9AM and 4PM. The location, physical activity, daily activity, and company of participants were described. Barriers to physical activity were examined using linear regression analyses. RESULTS In total, 345 participants from 19 different wards were included. The mean (SD) age was 61 (16) years and 57% of participants were male. In total, 65% of participants were able to walk independently. On average participants spent 86% of observed time in their room and 10% of their time moving. A physiotherapist or occupational therapist was present during 1% of the time, nursing staff and family were present 11% and 13%, respectively. Multivariate regression analysis showed the presence of an intravenous line (p = .039), urinary catheter (p = .031), being female (p = .034), or being dependent on others for walking (p = .016) to be positively associated with the time spent in bed. Age > 65, undergoing surgery, receiving encouragement by a nurse or physician, reporting a physical complaint or pain were not associated with the time spent in bed (P > .05). CONCLUSION As family members and nursing staff spend more time with patients than physiotherapists or occupational therapists, increasing their involvement might be an important next step in the promotion of physical activity.
Collapse
Affiliation(s)
- Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Elja Reijneveld
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
| | - Marielle Jans
- Institute of Mobility Studies, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Petra Bor
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lotte van Delft
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, NV, USA
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
| |
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
van Grootel JWM, Bor P, Netjes JA, Veenhof C, Valkenet K. Improving physical activity in hospitalized patients: The preliminary effectiveness of a goal-directed movement intervention. Clin Rehabil 2023; 37:1501-1509. [PMID: 37487188 PMCID: PMC10492426 DOI: 10.1177/02692155231189607] [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: 05/03/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To evaluate the preliminary effectiveness of a goal-directed movement intervention using a movement sensor on physical activity of hospitalized patients. DESIGN Prospective, pre-post study. SETTING A university medical center. PARTICIPANTS Patients admitted to the pulmonology and nephrology/gastro-enterology wards. INTERVENTION The movement intervention consisted of (1) self-monitoring of patients' physical activity, (2) setting daily movement goals and (3) posters with exercises and walking routes. Physical activity was measured with a movement sensor (PAM AM400) which measures active minutes per day. MAIN MEASURES Primary outcome was the mean difference in active minutes per day pre- and post-implementation. Secondary outcomes were length of stay, discharge destination, immobility-related complications, physical functioning, perceived difficulty to move, 30-day readmission, 30-day mortality and the adoption of the intervention. RESULTS A total of 61 patients was included pre-implementation, and a total of 56 patients was included post-implementation. Pre-implementation, patients were active 38 ± 21 minutes (mean ± SD) per day, and post-implementation 50 ± 31 minutes per day (Δ12, P = 0.031). Perceived difficulty to move decreased from 3.4 to 1.7 (0-10) (Δ1.7, P = 0.008). No significant differences were found in other secondary outcomes. CONCLUSIONS The goal-directed movement intervention seems to increase physical activity levels during hospitalization. Therefore, this intervention might be useful for other hospitals to stimulate inpatient physical activity.
Collapse
Affiliation(s)
- JWM van Grootel
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
- Research Center of Healthy and Sustainable Living, Research group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, Utrecht, The Netherlands
| | - P Bor
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
| | - JA Netjes
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
| | - C Veenhof
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
- Research Center of Healthy and Sustainable Living, Research group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, Utrecht, The Netherlands
| | - K Valkenet
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
- Research Center of Healthy and Sustainable Living, Research group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Die Wirksamkeit von Maßnahmen zur Förderung der körperlichen Aktivität unter Verwendung von Aktivitätsmessgeräten während oder nach einer stationären Behandlung: eine systematische Überprüfung und Meta-Analyse von randomisierten kontrollierten Studien. PHYSIOSCIENCE 2023. [DOI: 10.1055/a-1957-3406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
|
7
|
Kaizu Y, Kasuga T, Takahashi Y, Otani T, Miyata K. Sleep Should Be Focused on When Analyzing Physical Activity in Hospitalized Older Adults after Trunk and Lower Extremity Fractures-A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10081429. [PMID: 36011086 PMCID: PMC9408561 DOI: 10.3390/healthcare10081429] [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: 06/20/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Although the importance of resting in bed for hospitalized older adults is known, current methods of interpreting physical activity (PA) recommend the use of a broad definition of sedentary behavior (SB) that includes 0−1.5 metabolic equivalents (METs) of sleep (SL) and sitting. We investigated the characteristics of PA by conducting a cross-sectional study of 25 older adults with trunk and lower extremity fractures. The intensity of their PA was interpreted as SL (0−0.9 METs), SB (1−1.5 METs), low-intensity PA (LIPA: 1.6−2.9 METs), and moderate-to-vigorous PA (MVPA: >3.0 METs). We calculated the correlation coefficients to clarify the relationship between each PA intensity level. Our analyses revealed that the PA time (min/day) was accounted for by SB (53.5%), SL (23.2%), LIPA (22.8%), and MVPA (0.5%). We observed negative correlations between SL and SB (r = −0.837) and between SL and LIPA (r = −0.705), and positive correlations between SB and LIPA (r = 0.346) and between LIPA and MVPA (r = 0.429). SL and SB were also found to have different trends in relation to physical function. These results indicate that SL and SB are trade-offs for PA during the day. Separate interpretations of the SL and SB of older hospitalized adults are thus recommended.
Collapse
Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma 370-0001, Japan; (Y.K.); (Y.T.)
| | - Takeaki Kasuga
- Department of Rehabilitation Center, Hidaka Rehabilitation Hospital, 2204 Yoshii-machi Maniwa, Takasaki, Gunma 370-2104, Japan;
| | - Yu Takahashi
- Department of Rehabilitation Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma 370-0001, Japan; (Y.K.); (Y.T.)
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology, 1373 Higashinagaoka-cho, Ota, Gunma 373-0812, Japan;
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, 4669-2 Ami-Machi, Inashiki-gun, Ibaraki 300-0394, Japan
- Correspondence: ; Tel.: +81-29-888-4000
| |
Collapse
|
8
|
Klooster E, Koenders N, Vermeulen-Holsen J, Vos L, van der Wees PJ, Hoogeboom TJ. Healthcare professionals feel empowered by implementing a hospital-based multifaceted intervention: a qualitative study using inductive thematic analysis. BMC Health Serv Res 2022; 22:903. [PMID: 35820839 PMCID: PMC9277783 DOI: 10.1186/s12913-022-08310-w] [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: 02/16/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Most patients are insufficiently physically active during their hospital stay, and this is associated with poor health and delayed recovery. Hospital-based multifaceted interventions aim to encourage patients to engage in physical activity. Ban Bedcentricity is one such intervention. Its value – and that of others similar to it – for healthcare professionals has not been studied yet. Whether an intervention looks and feels right, and whether it does the job well, is important for healthcare professionals and thus its use. Understanding value for healthcare professionals seems crucial for the long-term adoption and implementation of interventions. Therefore, we studied healthcare professionals’ perceptions of value in terms of the implementation of a multifaceted intervention that aimed at improving physically active behaviour in patients during their hospital stay. Methods Using Ban Bedcentricity as a case study to focus on healthcare professionals’ perceptions about multifaceted interventions, we conducted a qualitative study between November 2019 and September 2020. Semi-structured interviews were conducted with purposefully selected physicians, physiotherapists, and nurses (assistants) until theoretical data saturation was reached. Inductive thematic analysis was used to identify key themes and develop a conceptual model. Results We interviewed 15 healthcare professionals and formulated six key themes from these interviews. The participants said that Ban Bedcentricity empowered them in their beliefs about the importance of physical activity for hospitalized patients (theme 1). They also indicated that it made them more aware of the value of physical activity (theme 2) and skilled to promote physical activity as part of their professional role (theme 3). Similarly, they noted that it enabled them to shift from providing hands-on support to verbal coaching (theme 4). Other aspects that the participants valued were the increased possibilities for teamwork (theme 5) and the routinized physical activity promotion in usual care (theme 6). The challenges discussed by the participants were prioritizing activities that promoted physical activity, especially because of a high workload, and avoiding relapses of new routinized work practices related to physical activity promotion if insufficient long-term support and training were provided. Conclusions Our conceptual model shows that the implementation of a hospital-based multifaceted intervention by healthcare professionals empowers their beliefs, and improves their awareness, skills, professional roles, teamwork, and work routinization. These values are typically overlooked, despite potentially being important facilitators for long-term implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08310-w.
Collapse
Affiliation(s)
- E Klooster
- Department of Rehabilitation, Deventer Hospital, Deventer, the Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - N Koenders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands.
| | - J Vermeulen-Holsen
- Erasmus Medical Center, Cardiovascular Institute, Rotterdam, the Netherlands
| | - L Vos
- Department of Psychology and Geriatrics, Deventer Hospital, Deventer, the Netherlands
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands
| | - T J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| |
Collapse
|
9
|
Mclaughlin KH, Young D, Friedman LA, Peters J, Vickery G, Hoyer EH. An Interprofessional Examination of the Johns Hopkins Mobility Goal Calculator among Hospitalized Post-Surgical Patients. Nurs Health Sci 2022; 24:735-741. [PMID: 35780301 DOI: 10.1111/nhs.12972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
Individualized mobility goals created using a goal calculator have been shown to increase patient mobility on medical nursing units, but have not been studied among postoperative populations. This study aimed to examine the feasibility of an automated mobility goal calculator on a postoperative nursing unit. To examine this, we utilized the goal calculator to create goals for patients (N=128) following surgery and mobilized each patient with either a nurse or physical therapist. Each patient's highest level of mobility was recorded and providers completed surveys on the appropriateness of calculated goals. Overall, 94% of patients achieved calculated goals. Patients with more pain achieved goals significantly less often than those with less pain. Those with higher mobility achieved their goals similarly with either provider. Providers reported 47% of goals were appropriate, with goals being set too low as the primary reason for goals being inappropriate. We conclude that the automated goal calculator can be used on postoperative nursing units to set realistic goals for patients after surgery. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Kevin H Mclaughlin
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Daniel Young
- University of Nevada, Las Vegas, Department of Physical Therapy
| | - Lisa A Friedman
- Johns Hopkins University, School of Medicine, Department of Medicine
| | | | | | - Erik H Hoyer
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation
| |
Collapse
|
10
|
Geelen SJ, Giele BM, Veenhof C, Nollet F, Engelbert RH, van der Schaaf M. The Better By Moving study: A multifaceted intervention to improve physical activity in adults during hospital stay. Clin Rehabil 2022; 36:1342-1368. [PMID: 35702004 PMCID: PMC9420894 DOI: 10.1177/02692155221105337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective ‘Better By Moving’ is a multifaceted intervention developed and implemented in collaboration with patients and healthcare professionals to improve physical activity in hospitalized adults. This study aimed to understand if, how and why ‘Better By Moving’ resulted in higher levels of physical activity by evaluating both outcomes and implementation process. Design Mixed-methods study informed by the Medical Research Council guidance. Setting Tertiary hospital. Participants Adult patients admitted to surgery, haematology, infectious diseases and cardiology wards, and healthcare professionals. Measures Physical activity was evaluated before and after implementation using the Physical Activity Monitor AM400 on one random day during hospital stay between 8 am and 8 pm. Furthermore, the time spent lying on bed, length of stay and discharge destination was investigated. The implementation process was evaluated using an audit trail, surveys and interviews. Results There was no significant difference observed in physical activity (median [IQR] 23 [12–51] vs 27 [17–55] minutes, P = 0.107) and secondary outcomes before-after implementation. The intervention components’ reach was moderate and adoption was low among patients and healthcare professionals. Patients indicated they perceived more encouragement from the environment and performed exercises more frequently, and healthcare professionals signalled increased awareness and confidence among colleagues. Support (priority, resources and involvement) was perceived a key contextual factor influencing the implementation and outcomes. Conclusion Although implementing ‘Better By Moving’ did not result in significant improvements in outcomes at our centre, the process evaluation yielded important insights that may improve the effectiveness of implementing multifaceted interventions aiming to improve physical activity during hospital stay.
Collapse
Affiliation(s)
- Sven Jg Geelen
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,522567Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, Netherlands
| | - Boukje M Giele
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & Sports, 8124University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, 8119University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Frans Nollet
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Raoul Hh Engelbert
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, 10191Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,522567Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, 10191Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| |
Collapse
|
11
|
Bor P, van Delft L, Valkenet K, Veenhof C. Perceived Factors of Influence on the Implementation of a Multidimensional Project to Improve Patients' Movement Behavior During Hospitalization: A Qualitative Study. Phys Ther 2022; 102:6423599. [PMID: 34751782 DOI: 10.1093/ptj/pzab260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/29/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to explore perceived factors of influence on the implementation of Hospital in Motion, a multidimensional and multidisciplinary implementation project to improve inpatients' movement behavior. METHODS This qualitative study was conducted on 4 wards. Per ward, a tailored action plan was implemented consisting of multiple tools and interventions to stimulate the integration of inpatient physical activity in usual care processes. After implementation, semi-structured interviews were performed with health care professionals and patients to explore perceived factors of influence on the implementation of the Hospital in Motion project. A content analysis was performed using the framework of the Medical Research Council for complex interventions as guidance for the identification of categories and themes. RESULTS In total, 16 interviews were conducted with health care professionals and 12 with patients. The results were categorized into the 3 key components of the Medical Research Council framework: implementation, mechanisms of impact, and context. An important factor of influence within the theme "implementation" was the iterative and multidisciplinary approach. Within the theme "mechanisms of impact," continuous attention and the interaction of multiple interventions, tailored to the target group and targeting multiple dimensions (individual, inter-professional, community and society), were perceived as important. Within the theme "context," the intrinsic motivation and inter-professional, community and societal culture towards physical activity was perceived to be of influence. CONCLUSION Impact can be achieved and maintained by creating continuous attention to inpatient physical activity and by the interaction between different interventions and dimensions during implementation. To maintain enough focus, the amount of activities at one time should be limited. IMPACT To improve inpatients' movement behavior, implementation project teams should be multidisciplinary and should implement a small set of tailored interventions that target multiple dimensions. Intermediate evaluation of the implementation process, strategies, and interventions is recommended.
Collapse
Affiliation(s)
- Petra Bor
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lotte van Delft
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Utrecht, the Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Utrecht, the Netherlands
| |
Collapse
|
12
|
Geelen SJG, van Dijk-Huisman HC, de Bie RA, Veenhof C, Engelbert R, van der Schaaf M, Lenssen AF. Barriers and enablers to physical activity in patients during hospital stay: a scoping review. Syst Rev 2021; 10:293. [PMID: 34736531 PMCID: PMC8569983 DOI: 10.1186/s13643-021-01843-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low levels of physical activity are common during the hospital stay and have been associated with negative health outcomes. Understanding barriers and enablers to physical activity during a hospital stay can improve the development and implementation of tailored interventions aimed at improving physical activity. Previous studies have identified many barriers and enablers, but a comprehensive overview is lacking. This study aimed to identify and categorize all published patient- and healthcare professional-reported barriers and enablers to physical activity during a hospital stay for acute care, using the Theoretical Domains Framework (TDF). METHODS We conducted a scoping review of Dutch and English articles using MEDLINE, CINAHL Plus, EMBASE, PsycINFO, and Cochrane Library (inception to September 2020), which included quantitative, qualitative, and mixed-methods studies reporting barriers and enablers to physical activity during a hospital stay for acute care, as perceived by patients or healthcare professionals. Two reviewers systematically extracted, coded, and categorized all barriers and enablers into TDF domains. RESULTS Fifty-six articles were included in this review (32 qualitative, 7 quantitative, and 17 mixed-methods). In total, 264 barriers and 228 enablers were reported by patients, and 415 barriers and 409 enablers by healthcare professionals. Patient-reported barriers were most frequently assigned to the TDF domains Environmental Context & Resources (ECR, n = 148), Social Influences (n = 32), and Beliefs about Consequences (n = 25), while most enablers were assigned to ECR (n = 67), Social Influences (n = 54), and Goals (n = 32). Barriers reported by healthcare professionals were most frequently assigned to ECR (n = 210), Memory, Attention and Decision Process (n = 45), and Social/Professional Role & Identity (n = 31), while most healthcare professional-reported enablers were assigned to the TDF domains ECR (n = 143), Social Influences (n = 76), and Behavioural Regulation (n = 54). CONCLUSIONS Our scoping review presents a comprehensive overview of all barriers and enablers to physical activity during a hospital stay and highlights the prominent role of the TDF domains ECR and Social Influences in hospitalized patients' physical activity behavior. This TDF-based overview provides a theoretical foundation to guide clinicians and researchers in future intervention development and implementation. SCOPING REVIEW REGISTRATION No protocol was registered for this review.
Collapse
Affiliation(s)
- Sven Jacobus Gertruda Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands.
| | - Hanneke Corine van Dijk-Huisman
- Department of Physical Therapy, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6229HX, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
| | - Robert Adriaan de Bie
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & 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
| | - Raoul Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, 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, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Antoine François Lenssen
- Department of Physical Therapy, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6229HX, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
13
|
Koenders N, Marcellis L, Nijhuis-van der Sanden MW, Satink T, Hoogeboom TJ. Multifaceted interventions are required to improve physical activity behaviour in hospital care: a meta-ethnographic synthesis of qualitative research. J Physiother 2021; 67:115-123. [PMID: 33753014 DOI: 10.1016/j.jphys.2021.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
QUESTION What are the views of patients, close relatives and healthcare professionals on physical activity behaviour in hospital care? METHODS A meta-ethnographic synthesis of qualitative studies was conducted with a lines-of-argument analysis. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. The lines of argument were synthesised and mapped in an existing theoretical model. The confidence of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. RESULTS Eleven studies were included and provided data from 290 participants (145 patients, 0 close relatives and 145 healthcare professionals). We have synthesised six lines of argument that explained the (intention of) physical activity behaviour of patients during their hospital stay: patients and healthcare professionals perceive benefits and risks of physical activity for patients' health (high confidence); physical activity gives a sense of freedom, confidence in recovery and mental wellbeing (high confidence); all healthcare professionals should offer timely and tailored physical activity promotion (high confidence); patient motivation to be physically active may be contingent upon encouragement (moderate confidence); family members can influence physical activity behaviour favourably or unfavourably (low confidence); and hospital culture has a negative influence on physical activity behaviour of patients (high confidence). CONCLUSIONS Physical activity behaviour of patients during their hospital stay is a complex phenomenon with multiple interactions at the level of patients, healthcare professionals and hospital culture. Considering the results of this synthesis, multifaceted implementation strategies are needed to improve physical activity intention and behaviour of patients during their hospital stay.
Collapse
Affiliation(s)
- Niek Koenders
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
| | - Laura Marcellis
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- Department of Allied Healthcare Sciences of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Ton Satink
- Neurorehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Department of Allied Healthcare Sciences of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| |
Collapse
|
14
|
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.
Collapse
|
15
|
Young D, Kudchadkar SR, Friedman M, Lavezza A, Kumble S, Daley K, Flanagan E, Hoyer E. Using Systematic Functional Measurements in the Acute Hospital Setting to Combat the Immobility Harm. Arch Phys Med Rehabil 2020; 103:S162-S167. [PMID: 33373600 DOI: 10.1016/j.apmr.2020.10.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
Abstract
Hospitalized patients often experience unnecessary immobility and inactivity leading to direct harms and poor outcomes. Despite growing evidence that early and regular mobility and activity are safe and helpful for patients in the hospital, there remains substantial room for improvement in clinical practice. Key to improvement is establishing an interdisciplinary approach to measurement and communication using a common language of function. Here we provide a framework for systematic functional measurement in the hospital. We also provide 3 specific examples of how this framework has been used to improve care: (1) targeting specialized rehabilitation providers to the patients most likely to need their services, (2) generating a daily mobility goal for all patients, and (3) identifying patients early who are likely to require postacute care.
Collapse
Affiliation(s)
- Daniel Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
| | - Sapna R Kudchadkar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kelly Daley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Eleni Flanagan
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Erik Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|