1
|
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; 25:105052. [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] [MESH Headings] [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.
Collapse
Affiliation(s)
- Julie A Adsett
- Physiotherapy Department, Royal Brisbane and Women's Hospital Brisbane, Brisbane, Queensland, Australia; Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital Brisbane, Brisbane, Queensland, Australia.
| | - Alison M Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital Brisbane, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Nicoli EM, Silva FVCE, Assad LG, Cardinelli CC, Alves RA, de Oliveira SG. Nursing care for hospitalized older adults - fall accidents versus safe mobility: a scoping review. Rev Bras Enferm 2024; 77:e20230180. [PMID: 39045975 PMCID: PMC11259443 DOI: 10.1590/0034-7167-2023-0180] [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: 07/04/2023] [Accepted: 01/24/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES to map the constituent elements of the safe mobility concept present in hospital care for older adults. METHODS a scoping review of 35 articles searched in databases and gray literature - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established. RESULTS none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family). FINAL CONSIDERATIONS the constituent elements of safe mobility express hospital units' capacity to guarantee care and protection from fall accidents for hospitalized older adults.
Collapse
Affiliation(s)
- Esther Mourão Nicoli
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Raquel Azevedo Alves
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
3
|
King B, Hook M, Brown R, Mahoney J, Steege L. Implementation of MOVIN by a Nurse-Led Clinical Team: A Multiple Methods Evaluation Using the RE-AIM Framework. Res Gerontol Nurs 2024; 17:189-201. [PMID: 39047229 DOI: 10.3928/19404921-20240621-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To evaluate the implementation of MOVIN, a multicomponent mobility intervention, by a nurse-led team and measure the effectiveness on unit-level outcomes. METHOD A pragmatic quasi-experimental study was conducted on an inpatient adult medical unit. Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Interviews with 13 organizational partners were conducted to understand barriers and facilitators to adoption. Thematic analysis was used to analyze the data. Quantitative data to determine effectiveness on distance of patient ambulation and percent of patients ambulated by nursing staff were analyzed using an interrupted time series. RESULTS A significant increase in total weekly distances for patient ambulation and percent of patients ambulated by nursing staff occurred between preintervention, intervention, and postintervention periods. Themes for adoption included: Value, Immediate Feedback, Inclusive Implementation, Resource Needs, and Lack of Organizational Evidence. The nurse-led team demonstrated high fidelity to maintaining the core components of MOVIN. CONCLUSION A nurse-led team can successfully launch a multicomponent mobility intervention and sustain impact. RE-AIM supported assessments of key partners at multiple organizational levels, capturing critical unit level outcomes. Multiple methods for data collection and analysis yielded rich results to inform future dissemination of MOVIN. [Research in Gerontological Nursing, 17(4), 189-201.].
Collapse
|
4
|
Fazio SA, Cortés-Puch I, Stocking JC, Doroy AL, Black H, Liu A, Taylor SL, Adams JY. Early Mobility Index and Patient Outcomes: A Retrospective Study in Multiple Intensive Care Units. Am J Crit Care 2024; 33:171-179. [PMID: 38688854 DOI: 10.4037/ajcc2024747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Early mobility interventions in intensive care units (ICUs) are safe and improve outcomes in subsets of critically ill adults. However, implementation varies, and the optimal mobility dose remains unclear. OBJECTIVE To test for associations between daily dose of out-of-bed mobility and patient outcomes in different ICUs. METHODS In this retrospective cohort study of electronic records from 7 adult ICUs in an academic quarternary hospital, multivariable linear regression was used to examine the effects of out-of-bed events per mobility-eligible day on mechanical ventilation duration and length of ICU and hospital stays. RESULTS In total, 8609 adults hospitalized in ICUs from 2015 through 2018 were included. Patients were mobilized out of bed on 46.5% of ICU days and were eligible for mobility interventions on a median (IQR) of 2.0 (1-3) of 2.7 (2-9) ICU days. Median (IQR) out-of-bed events per mobility-eligible day were 0.5 (0-1.2) among all patients. For every unit increase in out-of-bed events per mobility-eligible day before extubation, mechanical ventilation duration decreased by 10% (adjusted coefficient [95% CI], -0.10 [-0.18 to -0.01]). Daily mobility increased ICU stays by 4% (adjusted coefficient [95% CI], 0.04 [0.03-0.06]) and decreased hospital stays by 5% (adjusted coefficient [95% CI], -0.05 [-0.07 to -0.03]). Effect sizes differed among ICUs. CONCLUSIONS More daily out-of-bed mobility for ICU patients was associated with shorter mechanical ventilation duration and hospital stays, suggesting a dose-response relationship between daily mobility and patient outcomes. However, relationships differed across ICU subpopulations.
Collapse
Affiliation(s)
- Sarina A Fazio
- Sarina A. Fazio is a clinical nurse scientist, Center for Nursing Science, UC Davis Health, Sacramento; Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Davis (UC Davis), Sacramento, California; and Data Center of Excellence, UC Davis Health, Sacramento
| | - Irene Cortés-Puch
- Irene Cortés-Puch is a project scientist, Division of Pulmonary, Critical Care, and Sleep Medicine, UC Davis
| | - Jacqueline C Stocking
- Jacqueline C. Stocking is an assistant professor of medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, UC Davis
| | - Amy L Doroy
- Amy L. Doroy is an associate chief nursing officer, UC Davis Medical Center, UC Davis Health
| | - Hugh Black
- Hugh Black is a professor of medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, UC Davis
| | - Anna Liu
- Anna Liu is an informatics specialist, Data Center of Excellence, UC Davis Health
| | - Sandra L Taylor
- Sandra L. Taylor is a principal biostatistician, Department of Public Health Sciences, UC Davis, Sacramento
| | - Jason Y Adams
- Jason Y. Adams is an associate professor of medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, UC Davis, and medical director, Data Center of Excellence, UC Davis Health
| |
Collapse
|
5
|
Payne C, Gesch J, Smits E, Brakenridge C, Johnston V, Gardiner PA, Comans T, Bell R, Gane E. Feasibility of a physiotherapist-supervised walking program with telephone coaching to increase physical activity following acquired brain injury. BRAIN IMPAIR 2024; 25:IB23095. [PMID: 38810091 DOI: 10.1071/ib23095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
Background Physical activity has health benefits for adults with acquired brain injury, but it is a challenge to increase physical activity during inpatient rehabilitation. The objectives of this pilot study were to determine whether a physiotherapy-supervised inpatient walking program was feasible and able to improve physical activity and sedentary behaviour in the short and medium term. Methods Adults with acquired brain injury receiving inpatient rehabilitation undertook twice-weekly supervised walks plus behavioural therapy for 4 weeks. Feasibility was measured via recruitment, participation and drop out rates, adverse events and intervention delivery costs. Physical activity and sedentary behaviour were measured with an activPAL. Assessments were conducted at baseline, post-intervention and 3-6 months post-intervention. Results The program was safe to deliver (no adverse events), recruitment rate was 55% (16/29) and the participation rate for eligible individuals was high (14/19, 74%). However, the program had a high drop out rate (7/16, 44%) and physical activity and sedentary behaviour did not significantly change during the 4-week intervention. Costs were AU$427.71/participant. Physical activity and sedentary behaviour did improve 3-6 months after the intervention (vs baseline, on average: +3913 steps per day, 95% CI: 671, 7156). Conclusion This pilot study demonstrated a supervised physiotherapy walking program is safe and feasible to recruit in an inpatient setting. However, drop out during the study was high and behaviour change did not occur. More work is required to boost physical activity during sub-acute rehabilitation for acquired brain injury.
Collapse
Affiliation(s)
- Caitlyn Payne
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Janelle Gesch
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; and Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Esther Smits
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Charlotte Brakenridge
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia; and School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia; and Centre for Health Research, University of Southern Queensland, Darling Heights, Qld, Australia
| | - Paul A Gardiner
- School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Ryan Bell
- Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Elise Gane
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; and School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia; and Centre for Functioning and Health Research, Metro South Health, Brisbane, Qld, Australia
| |
Collapse
|
6
|
Wilnerzon Thörn RM, Forsberg A, Stepniewski J, Hjelmqvist H, Magnuson A, Ahlstrand R, Ljungqvist O. Immediate mobilization in post-anesthesia care unit does not increase overall postoperative physical activity after elective colorectal surgery: A randomized, double-blinded controlled trial within an enhanced recovery protocol. World J Surg 2024; 48:956-966. [PMID: 38348901 DOI: 10.1002/wjs.12102] [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: 09/19/2023] [Accepted: 01/27/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The level of post-operative mobilization according to Enhanced Recovery After Surgery (ERAS) guidelines is not always achieved. We investigated whether immediate mobilization increases postoperative physical activity. The objective was to evaluate the effects of immediate postoperative mobilization in the post-anesthesia care unit (PACU) compared to standard care. METHODS This randomized controlled trial, involved 144 patients, age ≥18 years, undergoing elective colorectal surgery. Patients were randomized to mobilization starting 30 min after arrival in the PACU, or to standard care. Standard care consisted of mobilization a few hours later at the ward according to ERAS guidelines. The primary outcome was physical activity, in terms of number of steps, measured with an accelerometer during postoperative days (PODs) 1-3. Secondary outcomes were physical capacity, functional mobility, time to readiness for discharge, complications, compliance with the ERAS protocol, and physical activity 1 month after surgery. RESULTS With the intention-to-treat analysis of 144 participants (median age 71, 58% female) 47% underwent laparoscopic-or robotic-assisted surgery. No differences in physical activity during hospital stay were found between the participants in the intervention group compared to the standard care group (adjusted mean ratio 0.97 on POD 1 [95% CI, 0.75-1.27], p = 0.84; 0.89 on POD 2 [95% CI, 0.68-1.16], p = 0.39, and 0.90 on POD 3 [95% CI, 0.69-1.17], p = 0.44); no differences were found in any of the other outcome measures. CONCLUSIONS Addition of the intervention of immediate mobilization to standard care did not make the patients more physically active during their hospital stay. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NTC 03357497.
Collapse
Affiliation(s)
| | - Anette Forsberg
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jan Stepniewski
- Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden
| | - Hans Hjelmqvist
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Rebecca Ahlstrand
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Olle Ljungqvist
- Department of Surgery, School of Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
7
|
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
|
8
|
Stephen K, Campbell A. The experiences of older adults with cognitive impairment in using falls prevention alarms in hospital: A qualitative descriptive study. Aust Occup Ther J 2024; 71:132-148. [PMID: 38016634 DOI: 10.1111/1440-1630.12917] [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: 09/27/2022] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Bed and chair sensor alarms are commonly used for falls prevention in hospitals, despite questionable efficacy. Research analysing older adults' experiences of alarms is scarce, and adults with cognitive impairment are consistently excluded. AIM The aim of this study was to explore how older adults with cognitive impairment perceive and experience falls prevention alarms in hospital. METHOD A qualitative descriptive design investigated older adults' experiences of alarms in a Geriatric Evaluation and Management ward in Melbourne. Patients were included if they had been provided an alarm. Semi-structured interviews were the primary method of data collection with two observation sessions and medical record analyses completed to enable triangulation of findings. Data were subjected to thematic analysis, and the Person-Environment-Occupation framework was chosen to add insight into the complexities of older adults' experiences of alarms. FINDINGS All 11 participants had a level of cognitive impairment with delirium, confusion, or impulsiveness recorded in their medical file. Two overarching themes were identified: communication and collaboration with staff and rationalisation of alarm use. Participants' perceived staff were focussed on falls prevention but experienced a lack of communication about the purpose of alarms. Participants wanted an individualised approach to alarms. Some were comforted with the thought of alarms alerting staff, making them feel well cared for and believed alarms were a useful 'back-up'. Others found alarms uncomfortable, frustrating, and restricting. Application of the Person-Environment-Occupation framework provided insight into how enabling and restrictive factors can impact whether the alarm is experienced positively or negatively. Seven unwitnessed falls occurred during the participants' admissions. Thirty-four per cent of alarm triggers observed were considered false alerts. CONCLUSION Older adults commonly reported negative experiences using bed/chair sensor alarms. Occupational therapists have the training to collaborate with people with cognitive impairment and assess the usefulness of alarms in reducing falls, based on how they interact with the older adult's unique person, environment, and occupation domains.
Collapse
Affiliation(s)
- Kelly Stephen
- College of Nursing and Health sciences, Flinders University, Adelaide, South Australia, Australia
- Eastern Health, Box Hill, Victoria, Australia
- School of Primary and Allied Healthcare, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Alison Campbell
- College of Nursing and Health sciences, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
9
|
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
|
10
|
Martinez M, Cerasale M, Baig M, Johnson JK, Dugan C, Brown A, Robinson M, Schram A, Greysen SR, Meltzer D, Baccile R, Arora VM. Reducing Physical Therapy Consults for Patients With High Functional Mobility in the Acute Medical Inpatient Setting: A Difference-in-Difference Analysis. Arch Phys Med Rehabil 2024; 105:125-130. [PMID: 37669704 PMCID: PMC10840724 DOI: 10.1016/j.apmr.2023.08.017] [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: 01/23/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of clinical decision support for reducing misallocation of physical therapy (PT) consults. DESIGN A prospective quasi-experimental study. Between October 2018 and November 2021, routinely documented data on functional status and physical therapy referrals were collected from electronic medical records. SETTING Hospital Medicine and General Internal Medicine service lines at a large quaternary academic medical center. PARTICIPANTS 20,810 adult patients hospitalized on any of the included treatment (hospital medicine) or control (general internal medicine) service lines. MAIN OUTCOME MEASURE The primary outcome was "change in proportion of misallocated PT consults" measured as likelihood of PT consults for patients admitted with high functional mobility scores. Changes in the primary outcome from the pre-intervention to post-intervention period were compared in the control and treatment groups using propensity score-weighted difference-in-differences multivariable logit regression adjusting for clinically relevant covariates. INTERVENTION The intervention period was measured for 20 months and consisted of a clinical decision support tool embedded in the daily note templates for hospital medicine providers. The tool provided education on patient mobility scores and their relation to need for PT consult. The tool was rolled out without any further announcements or education. RESULTS Our cohort included 20,810 unique admissions (mean age 58.9, 55% women, 83% Black). Post-intervention, the likelihood of PT referrals for patients with high baseline mobility (AM-PAC >18) decreased by 7.3% (P<.001) for the treatment group compared with control, adjusted for age, sex, race, ethnicity, length-of-stay, and mobility change. CONCLUSION Mobility score-based clinical decision support can decrease unneeded PT consults in the inpatient setting. This could help allocate therapy time for at-risk patients while also having a positive effect on health care systems.
Collapse
Affiliation(s)
- Maylyn Martinez
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL.
| | - Matthew Cerasale
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | | | - Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| | - Claire Dugan
- Section of General Internal Medicine, Department of Medicine, University of Chicago, IL
| | | | - Marla Robinson
- Inpatient Therapy Services Department, University of Chicago, Chicago, IL
| | - Andrew Schram
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - S Ryan Greysen
- Section of Hospital Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Rachel Baccile
- Center for Health and Social Sciences, University of Chicago, Chicago, IL
| | - Vineet M Arora
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
11
|
Vollman KM, Correll-Yoder N, Giuliano KK. Early and Progressive Mobility in the ICU: A Balanced Approach to Improve Outcomes for Both Patients and Staff. J Nurs Care Qual 2024; 39:7-9. [PMID: 37267114 PMCID: PMC10655907 DOI: 10.1097/ncq.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Kathleen M. Vollman
- Advancing Nursing, LLC, Northville, Michigan (Ms Vollman); NorthBay Health, Fairfield, California (Ms Correll-Yoder); Elaine Marieb Center for Nursing and Engineering Innovation, Amherst, Massachusetts (Dr Giuliano); and Institute for Applied Life Sciences & College of Nursing, University of Massachusetts Amherst (Dr Giuliano)
| | - Natalie Correll-Yoder
- Advancing Nursing, LLC, Northville, Michigan (Ms Vollman); NorthBay Health, Fairfield, California (Ms Correll-Yoder); Elaine Marieb Center for Nursing and Engineering Innovation, Amherst, Massachusetts (Dr Giuliano); and Institute for Applied Life Sciences & College of Nursing, University of Massachusetts Amherst (Dr Giuliano)
| | - Karen K. Giuliano
- Advancing Nursing, LLC, Northville, Michigan (Ms Vollman); NorthBay Health, Fairfield, California (Ms Correll-Yoder); Elaine Marieb Center for Nursing and Engineering Innovation, Amherst, Massachusetts (Dr Giuliano); and Institute for Applied Life Sciences & College of Nursing, University of Massachusetts Amherst (Dr Giuliano)
| |
Collapse
|
12
|
Yamashita M, Kamiya K, Hamazaki N, Uchida S, Noda T, Maekawa E, Ako J. Effects of Acute Phase Intensive Physical Activity (ACTIVE-PA) Monitoring and Education for Cardiac Patients: Pilot Study of a Randomized Controlled Trial. J Med Internet Res 2023; 25:e42235. [PMID: 38117552 PMCID: PMC10765285 DOI: 10.2196/42235] [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: 08/28/2022] [Revised: 12/29/2022] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Although physical activity (PA) decreases dramatically during hospitalization, an effective intervention method has not yet been established for this issue. We recently developed a multiperson PA monitoring system using information and communication technology (ICT) that can provide appropriate management and feedback about PA at the bedside or during rehabilitation. This ICT-based PA monitoring system can store accelerometer data on a tablet device within a few seconds and automatically display a graphical representation of activity trends during hospitalization. OBJECTIVE This randomized pilot study aims to estimate the feasibility and effect size of an educational PA intervention using our ICT monitoring system for in-hospital patients undergoing cardiac rehabilitation. METHODS A total of 41 patients (median age 70 years; 24 men) undergoing inpatient cardiac rehabilitation were randomly assigned to 2 groups as follows: wearing an accelerometer only (control) and using both an accelerometer and an ICT-based PA monitoring system. Patients assigned to the ICT group were instructed to gradually increase their step counts according to their conditions. Adherence to wearing the accelerometer was defined as having enough wear records for at least 2 days to allow for adequate analysis during the lending period. An analysis of covariance was performed to compare the change in average step count during hospitalization as a primary outcome and the 6-minute walking distance at discharge. RESULTS The median duration of wearing the accelerometer was 4 days in the ICT group and 6 days in the control group. Adherence was 100% (n=22) in the ICT group but 83% (n=20) in the control group. The ICT group was more active (mean difference=1370 steps, 95% CI 437-2303) and had longer 6-minute walking distances (mean difference=81.6 m, 95% CI 18.1-145.2) than the control group. CONCLUSIONS Through this study, the possibility of introducing a multiperson PA monitoring system in a hospital and promoting PA during hospitalization was demonstrated. These findings support the rationale and feasibility of a future clinical trial to test the efficacy of this educational intervention in improving the PA and physical function of in-hospital patients. TRIAL REGISTRATION University Hospital Medical Information Network UMIN000043312; http://tinyurl.com/m2bw8vkz.
Collapse
Affiliation(s)
- Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
- Division of Research, ARCE Inc, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| |
Collapse
|
13
|
Nakanishi K, Goto H. A New Index for the Quantitative Evaluation of Surgical Invasiveness Based on Perioperative Patients' Behavior Patterns: Machine Learning Approach Using Triaxial Acceleration. JMIR Perioper Med 2023; 6:e50188. [PMID: 37962919 PMCID: PMC10685283 DOI: 10.2196/50188] [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: 06/22/2023] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The minimally invasive nature of thoracoscopic surgery is well recognized; however, the absence of a reliable evaluation method remains challenging. We hypothesized that the postoperative recovery speed is closely linked to surgical invasiveness, where recovery signifies the patient's behavior transition back to their preoperative state during the perioperative period. OBJECTIVE This study aims to determine whether machine learning using triaxial acceleration data can effectively capture perioperative behavior changes and establish a quantitative index for quantifying variations in surgical invasiveness. METHODS We trained 7 distinct machine learning models using a publicly available human acceleration data set as supervised data. The 3 top-performing models were selected to predict patient actions, as determined by the Matthews correlation coefficient scores. Two patients who underwent different levels of invasive thoracoscopic surgery were selected as participants. Acceleration data were collected via chest sensors for 8 hours during the preoperative and postoperative hospitalization days. These data were categorized into 4 actions (walking, standing, sitting, and lying down) using the selected models. The actions predicted by the model with intermediate results were adopted as the actions of the participants. The daily appearance probability was calculated for each action. The 2 differences between 2 appearance probabilities (sitting vs standing and lying down vs walking) were calculated using 2 coordinates on the x- and y-axes. A 2D vector composed of coordinate values was defined as the index of behavior pattern (iBP) for the day. All daily iBPs were graphed, and the enclosed area and distance between points were calculated and compared between participants to assess the relationship between changes in the indices and invasiveness. RESULTS Patients 1 and 2 underwent lung lobectomy and incisional tumor biopsy, respectively. The selected predictive model was a light-gradient boosting model (mean Matthews correlation coefficient 0.98, SD 0.0027; accuracy: 0.98). The acceleration data yielded 548,466 points for patient 1 and 466,407 points for patient 2. The iBPs of patient 1 were [(0.32, 0.19), (-0.098, 0.46), (-0.15, 0.13), (-0.049, 0.22)] and those of patient 2 were [(0.55, 0.30), (0.77, 0.21), (0.60, 0.25), (0.61, 0.31)]. The enclosed areas were 0.077 and 0.0036 for patients 1 and 2, respectively. Notably, the distances for patient 1 were greater than those for patient 2 ({0.44, 0.46, 0.37, 0.26} vs {0.23, 0.0065, 0.059}; P=.03 [Mann-Whitney U test]). CONCLUSIONS The selected machine learning model effectively predicted the actions of the surgical patients with high accuracy. The temporal distribution of action times revealed changes in behavior patterns during the perioperative phase. The proposed index may facilitate the recognition and visualization of perioperative changes in patients and differences in surgical invasiveness.
Collapse
Affiliation(s)
- Kozo Nakanishi
- Department of General Thoracic Surgery, National Hospital Organization Saitama Hospital, Wako Saitama, Japan
| | - Hidenori Goto
- Department of General Thoracic Surgery, National Hospital Organization Saitama Hospital, Wako Saitama, Japan
| |
Collapse
|
14
|
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
|
15
|
Patel M, Gardner TA, White C, Keniston A, Maassen B, Gottenborg E. Interventions to Reduce Inappropriate Physical Therapy Consultation in the Inpatient Setting: A Quality Improvement Initiative. J Healthc Qual 2023; 45:332-339. [PMID: 37919955 DOI: 10.1097/jhq.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
ABSTRACT Physical therapy (PT) in inpatient settings is a limited and valuable resource. Inappropriate PT consultation is costly and can lead to delays in care and discharge planning. Baseline data at an academic hospital revealed that approximately one in four PT consults were inappropriate (n = 29,230) across all services, as defined by an activity measure post-acute care "6-Clicks" basic mobility score of >22. Our interdisciplinary quality improvement team used the Six Sigma methodology to address this problem. We performed a root-cause analysis that identified high-impact root causes and implemented two targeted interventions: (1) A modified electronic health record PT order with clinical-decision support, and (2) nursing role change to assume PT-ordering responsibility. The rate of inappropriate PT consults decreased from 23.9% to <10% postintervention across all inpatient units, with the nursing role change reaching statistical significance (p < .0019). Our multifaceted intervention contributed to a significant reduction in unnecessary PT consults, expediting evaluation of patients qualifying for skilled inpatient therapy.
Collapse
|
16
|
van Dijk-Huisman HC, Senden R, Smeets MHH, Marcellis RGJ, Magdelijns FJH, Lenssen AF. The Effect of a Smartphone App with an Accelerometer on the Physical Activity Behavior of Hospitalized Patients: A Randomized Controlled Trial. SENSORS (BASEL, SWITZERLAND) 2023; 23:8704. [PMID: 37960404 PMCID: PMC10648825 DOI: 10.3390/s23218704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Abstract
Inactive behavior is common in hospitalized patients. This study investigated the effectiveness of using a smartphone app with an accelerometer (Hospital Fit) in addition to usual care physiotherapy on increasing patients' physical activity (PA) behavior. A randomized controlled trial was performed at Maastricht University Medical Centre. Patients receiving physiotherapy while hospitalized at the department of Pulmonology or Internal Medicine were randomized to usual care physiotherapy or using Hospital Fit additionally. Daily time spent walking, standing, and upright (standing/walking) (min) and daily number of postural transitions were measured with an accelerometer between the first and last treatment. Multiple linear regression analysis was performed to determine the association between PA behavior and Hospital Fit use, corrected for functional independence (mILAS). Seventy-eight patients were included with a median (IQR) age of 63 (56-68) years. Although no significant effects were found, a trend was seen in favor of Hospital Fit. Effects increased with length of use. Corrected for functional independence, Hospital Fit use resulted in an average increase of 27.4 min (95% CI: -2.4-57.3) standing/walking on day five and 29.2 min (95% CI: -6.4-64.7) on day six compared to usual care. Hospital Fit appears valuable in increasing PA in functionally independent patients.
Collapse
Affiliation(s)
- Hanneke C. van Dijk-Huisman
- Department of Physical Therapy, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (H.C.v.D.-H.); (R.S.); (M.H.H.S.); (R.G.J.M.)
| | - Rachel Senden
- Department of Physical Therapy, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (H.C.v.D.-H.); (R.S.); (M.H.H.S.); (R.G.J.M.)
| | - Maud H. H. Smeets
- Department of Physical Therapy, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (H.C.v.D.-H.); (R.S.); (M.H.H.S.); (R.G.J.M.)
| | - Rik G. J. Marcellis
- Department of Physical Therapy, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (H.C.v.D.-H.); (R.S.); (M.H.H.S.); (R.G.J.M.)
| | - Fabienne J. H. Magdelijns
- Department of Internal Medicine, Division of General Medicine and Clinical Geriatric Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands;
| | - Antoine F. Lenssen
- Department of Physical Therapy, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (H.C.v.D.-H.); (R.S.); (M.H.H.S.); (R.G.J.M.)
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands
| |
Collapse
|
17
|
Shimizu T, Kanai C, Ueda K, Asakawa Y. Physical Activity and Activities of Daily Living in Older Adult Patients With Heart Failure Admitted for Subacute Musculoskeletal Disease. Ann Rehabil Med 2023; 47:426-437. [PMID: 37907233 PMCID: PMC10620488 DOI: 10.5535/arm.23031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To examine activities of daily living (ADL) and physical activity in older adults with heart failure admitted to a rehabilitation ward for subacute musculoskeletal disease. METHODS : This study included patients with musculoskeletal disease (aged ≥75 years) who were admitted to the rehabilitation ward. Data on age, ADL, and time for physical activity (metabolic equivalents [METs]) were collected. Patients were divided into groups with or without heart failure, and the differences were compared using Mann-Whitney U-test. RESULTS : This study included 84 musculoskeletal patients, including 25 with heart failure. The heart-failure group had similar levels of ADL independence compared to the without-heart-failure group (p=0.28) but had shorter duration of continuous and sustained physical activities and less total time (p<0.01) of light-intensity physical activity or higher. CONCLUSION : Older adults with subacute musculoskeletal disease with heart failure do not necessarily require a large amount of physical activity to maintain ADL at the time of discharge. But very low physical activity may increase the risk for developing hospitalization-associated disability. Physical activity in older adults with subacute musculoskeletal disease with heart failure should be monitored separately from ADL.
Collapse
Affiliation(s)
- Tomoko Shimizu
- Department of Rehabilitation, The Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Chiaki Kanai
- Department of Rehabilitation, The Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Keisuke Ueda
- Department of Rehabilitation, The Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
| | - Yasuyoshi Asakawa
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| |
Collapse
|
18
|
Fuchita M, Ridgeway KJ, Sandridge B, Kimzey C, Abraham A, Melanson EL, Fernandez-Bustamante A. Comparison of postoperative mobilization measurements by activPAL versus Johns Hopkins Highest Level of Mobility scale after major abdominal surgery. Surgery 2023; 174:851-857. [PMID: 37580218 PMCID: PMC10530478 DOI: 10.1016/j.surg.2023.07.014] [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] [Received: 02/08/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The Johns Hopkins Highest Level of Mobility scale is a validated tool for assessing patient mobility in the hospital. It has excellent inter-rater and test-retest reliabilities, but it is unknown how accurately Johns Hopkins Highest Level of Mobility documentation reflects the patients' mobility performance in the immediate postoperative period compared to objective measures such as accelerometers. METHODS In this single-center observational study, consented adults undergoing open abdominal surgery wore a research-grade accelerometer, activPAL, starting immediately postoperatively until hospital discharge or up to 7 days. We collected the Johns Hopkins Highest Level of Mobility scores documented by hospital staff via retrospective chart review and evaluated their accuracy in describing the type, frequency, and volume of postoperative out-of-bed mobilization using the activPAL as the criterion. RESULTS We analyzed data from 56 participants. The activPAL showed that participants spent 97.7% of their time lying in bed or sitting in a chair. Meanwhile, the Johns Hopkins Highest Level of Mobility documentation of preambulatory activities (scores 1-5) was rare. The activPAL detected 4 times more out-of-bed mobilization than routine Johns Hopkins Highest Level of Mobility documentation. Whereas the frequency of activPAL-measured out-of-bed mobilization increased steadily to a median of 9 sessions by postoperative day 6, the number of Johns Hopkins Highest Level of Mobility documentation remained around twice daily. ActivPAL measurements demonstrated that Johns Hopkins Highest Level of Mobility documentation of ambulatory sessions (scores 6-8) was accurate. CONCLUSIONS We found that routine Johns Hopkins Highest Level of Mobility documentation did not accurately detect preambulatory activities or the overall frequency of out-of-bed mobility sessions, poorly reflecting the highly sedentary behaviors of the acute postoperative inpatients and highlighting the need to improve clinical documentation or use alternative methods to track postoperative mobilization.
Collapse
Affiliation(s)
- Mikita Fuchita
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Kyle J Ridgeway
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, University of Colorado Health, Aurora, CO; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO. http://www.twitter.com/Dr_Ridge_DPT
| | | | | | - Alison Abraham
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO
| | - Edward L Melanson
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Rocky Mountain Regional VA Medical Center, Aurora, CO
| | | |
Collapse
|
19
|
Alsop T, Woodforde J, Rosbergen I, Mahendran N, Brauer S, Gomersall S. Perspectives of health professionals on physical activity and sedentary behaviour in hospitalised adults: A systematic review and thematic synthesis. Clin Rehabil 2023; 37:1386-1405. [PMID: 37070142 PMCID: PMC10426259 DOI: 10.1177/02692155231170451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To explore health professionals' perspectives on physical activity and sedentary behaviour of hospitalised adults to understand factors that contribute to these behaviours in this environment. DATA SOURCES Five databases (PubMed, MEDLINE, Embase, PsycINFO and CINAHL) were searched in March 2023. REVIEW METHODS Thematic synthesis. Included studies explored perspectives of health professionals on the physical activity and/or sedentary behaviour of hospitalised adults using qualitative methods. Study eligibility was assessed independently by two reviewers and results thematically analysed. Quality was assessed using the McMaster Critical Review Form and confidence in findings assessed using GRADE-CERQual. RESULTS Findings from 40 studies explored perspectives of over 1408 health professionals from 12 health disciplines. The central theme identified was that physical activity is not a priority in this setting due to the complex interplay of multilevel influences present in the interdisciplinary inpatient landscape. Subthemes, the hospital is a place for rest, there are not enough resources to make movement a priority, everyone's job is no one's job and policy and leadership drives priorities, supported the central theme. Quality of included studies was variable; critical appraisal scores ranged from 36% to 95% on a modified scoring system. Confidence in findings was moderate to high. CONCLUSION Physical activity in the inpatient setting is not a priority, even in rehabilitation units where optimising function is the key. A shift in focus towards functional recovery and returning home may promote a positive movement culture that is supported by appropriate resources, leadership, policy, and the interdisciplinary team.
Collapse
Affiliation(s)
- Tahlia Alsop
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - James Woodforde
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Ingrid Rosbergen
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Department of Physiotherapy & Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Niruthikha Mahendran
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sandra Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sjaan Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
20
|
Zisberg A. Defensive Nursing and Patient Mobility: Balancing Safety and Autonomy. Res Gerontol Nurs 2023; 16:162-164. [PMID: 37526631 DOI: 10.3928/19404921-20230629-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing, Chair of the Center of Research & Study of Aging, University of Haifa, Mount Carmel, Israel
| |
Collapse
|
21
|
Gil E, Zisberg A, Shadmi E, Gur-Yaish N, Shulyaev K, Chayat Y, Agmon M. Still WALKing-FOR: 2-year sustainability of the 'WALK FOR' intervention. Age Ageing 2023; 52:afad115. [PMID: 37390475 DOI: 10.1093/ageing/afad115] [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: 10/02/2022] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND low mobility of hospitalised older adults is associated with adverse outcomes and imposes a significant burden on healthcare and welfare systems. Various interventions have been developed to reduce this problem; at present, however, their methodologies and outcomes vary and information is lacking about their long-term sustainability. This study aimed to evaluate the 2-year sustainability of the WALK-FOR (walking for better outcomes and recovery) intervention implemented by teams in acute care medical units. METHODS a quasi-experimental three-group comparative design (N = 366): pre-implementation, i.e. control group (n = 150), immediate post-implementation (n = 144) and 2-year post-implementation (n = 72). RESULTS mean participant age was 77.6 years (± 6 standard deviation [SD]) and 45.3% were females. We conducted an analysis of variance test to evaluate the differences in primary outcomes: number of daily steps and self-reported mobility. Levels of mobility improved significantly from the pre-implementation (control) group to the immediate and 2-year post-implementation groups. Daily step count: pre-implementation (median: 1,081, mean: 1,530 SD = 1,506), immediate post-implementation (median: 2,225, mean: 2,724. SD = 1,827) and 2-year post-implementation (median: 1,439, mean: 2,582, SD = 2,390) F = 15.778 P < 0.01. Self-reported mobility: pre-implementation (mean:10.9, SD = 3.5), immediate post-implementation (mean: 12.4, SD = 2.2), 2-year post-implementation (mean: 12.7, SD = 2.2), F = 16.250, P < 0.01. CONCLUSIONS the WALK-FOR intervention demonstrates 2-year sustainability. The theory-driven adaptation and reliance on local personnel produce an effective infrastructure for long-lasting intervention. Future studies should evaluate sustainability from a wider perspective to inform further in-hospital intervention development and implementation.
Collapse
Affiliation(s)
- Efrat Gil
- Haemek Medical Center, Afula, Israel
- Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa
| | - Nurit Gur-Yaish
- Faculty of Graduate Studies and Continuing Education , Oranim Academic College of Education, The Center for Research and Study of Aging, University of Haifa, Tivon, Israel
| | - Ksenya Shulyaev
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa
| | | | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa
| |
Collapse
|
22
|
Szeto K, Arnold J, Singh B, Gower B, Simpson CEM, Maher C. Interventions Using Wearable Activity Trackers to Improve Patient Physical Activity and Other Outcomes in Adults Who Are Hospitalized: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2318478. [PMID: 37318806 PMCID: PMC10273021 DOI: 10.1001/jamanetworkopen.2023.18478] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
Abstract
Importance Low levels of physical activity during hospitalization are thought to contribute to a range of poor outcomes for patients. Using wearable activity trackers during hospitalization may help improve patient activity, sedentary behavior, and other outcomes. Objective To evaluate the association of interventions that use wearable activity trackers during hospitalization with patient physical activity, sedentary behavior, clinical outcomes, and hospital efficiency outcomes. Data Sources OVID MEDLINE, CINAHL, Embase, EmCare, PEDro, SportDiscuss, and Scopus databases were searched from inception to March 2022. The Cochrane Central Register for Controlled trials, ClinicalTrials.gov, and World Health Organization Clinical Trials Registry were also searched for registered protocols. No language restrictions were imposed. Study Selection Randomized clinical trials and nonrandomized clinical trials of interventions that used wearable activity trackers to increase physical activity or reduce sedentary behavior in adults (aged 18 years or older) who were hospitalized were included. Data Extraction and Synthesis Study selection, data extraction, and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Main Outcomes and Measures The primary outcomes were objectively measured physical activity or sedentary behavior. Secondary outcomes included clinical outcomes (eg, physical function, pain, mental health), and hospital efficiency outcomes (eg, length of stay, readmission). Results Fifteen studies with a total of 1911 participants were included, representing various surgical cohorts (4 studies), stroke rehabilitation (3 studies), orthopedic rehabilitation (3 studies), mixed rehabilitation (3 studies), and mixed medical (2 studies). All studies were included in meta-analyses. There was a significant association between wearable activity tracker interventions with higher overall physical activity (standardized mean difference, 0.35; 95% CI, 0.15 to 0.54; I2 = 72%; P < .002) and less sedentary behavior (mean difference, -35.46 min/d; 95% CI, -57.43 to -13.48 min/d; I2 = 0; P = .002), and a significant association between wearable activity tracker interventions with improvements in physical function (standardized mean difference, 0.27; 95% CI, 0.08 to 0.46; I2 = 0; P = .006) compared with usual care. There was no significant association between wearable activity tracker interventions with pain, mental health, length of stay, or readmission risk. Conclusions and Relevance In this systematic review and meta-analysis, interventions that used wearable activity trackers with patients who are hospitalized were associated with higher physical activity levels, less sedentary behavior, and better physical functioning compared with usual care.
Collapse
Affiliation(s)
- Kimberley Szeto
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - John Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Ben Singh
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Bethany Gower
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Catherine E. M. Simpson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
23
|
Skains RM, Zhang Y, Osborne JD, O'Leary T, Fowler ME, Markland A, Buford TW, Brown CJ, Kennedy RE. Hospital-associated disability due to avoidable hospitalizations among older adults. J Am Geriatr Soc 2023; 71:1395-1405. [PMID: 36661192 PMCID: PMC10976455 DOI: 10.1111/jgs.18238] [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: 04/22/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hospital-associated disability (HAD) is a common complication during the course of acute care hospitalizations in older adults. Many admissions are for ambulatory care sensitive conditions (ACSCs), considered potentially avoidable hospitalizations-conditions that might be treated in outpatient settings to prevent hospitalization and HAD. We compared the incidence of HAD between older adults hospitalized for ACSCs versus those hospitalized for other diagnoses. METHODS We conducted a retrospective cohort study in inpatient (non-ICU) medical and surgical units of a large southeastern regional academic medical center. Participants were 38,960 older adults ≥ 65 years of age admitted from January 1, 2015, to December 31, 2019. The primary outcome was HAD, defined as decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. We used generalized linear mixed models to examine differences in HAD between hospitalizations with a primary diagnosis for an ACSC using standard definitions versus primary diagnosis for other conditions, adjusting for covariates and repeated observations for individuals with multiple hospitalizations. RESULTS We found that 10% of older adults were admitted for an ACSC, with rates of HAD in those admitted for ACSCs lower than those admitted for other conditions (16% vs. 20.7%, p < 0.001). Age, comorbidity, admission functional status, and admission cognitive impairment were significant predictors for development of HAD. ACSC admissions to medical and medical/surgical services had lower odds of HAD compared with admissions for other conditions, with no significant differences between ACSC and non-ACSC admissions to surgical services. CONCLUSIONS Rates of HAD among older adults hospitalized for ACSCs are substantial, though lower than rates of HAD with hospitalization for other conditions, reflecting that acute care hospitalization is not a benign event in this population. Treatment of ACSCs in the outpatient setting could be an important component of efforts to reduce HAD.
Collapse
Affiliation(s)
- Rachel M. Skains
- Departments of Emergency Medicine and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yue Zhang
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John D. Osborne
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tobias O'Leary
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Alayne Markland
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama, USA
| | - Thomas W. Buford
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama, USA
| | - Cynthia J. Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | | |
Collapse
|
24
|
Hoyer EH, Friedman M, Lavezza A, Flanagan E, Kumble S, D'Alessandro M, Gutierrez M, Colantuoni E, Brotman DJ, Young DL. A unit-based, multi-center evaluation of adopting mobility measures and daily mobility goals in the hospital setting. Appl Nurs Res 2023; 70:151655. [PMID: 36933900 DOI: 10.1016/j.apnr.2022.151655] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/10/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Promoting patient mobility helps improve patient outcomes, but mobility status is not widely tracked nor do patients have specific individualized mobility goals. PURPOSE We evaluated nursing adoption of mobility measures and daily mobility goal achievement using the Johns Hopkins Mobility Goal Calculator (JH-MGC), a tool to guide an individualized patient mobility goal based on the level of mobility capacity. METHOD Built on a translating research into practice framework, the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program was the vehicle to promote use of the mobility measures and the JH-MGC. We evaluated a large-scale implementation effort of this program on 23 units across two medical centers. FINDINGS Units significantly improved documentation compliance to mobility measures and achieving daily mobility goals. Units with the highest documentation compliance rates had higher rates of daily mobility goal achievement, especially for longer distance ambulation goals. DISCUSSION The JH-AMP program improved adoption of mobility status tracking and higher nursing inpatient mobility levels.
Collapse
Affiliation(s)
- Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eleni Flanagan
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Morning Gutierrez
- Department of Nursing, The Johns Hopkins Bayview Medical Campus, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel L Young
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
| |
Collapse
|
25
|
Freeman H, Martin RC, Whittington C, Zhang Y, Osborne JD, O'Leary T, Vickers JK, Flood KL, Skains RM, Markland AD, Buford TW, Brown CJ, Kennedy RE. Delirium Mediates Incidence of Hospital-Associated Disability Among Older Adults. J Am Med Dir Assoc 2023; 24:533-540.e9. [PMID: 36931323 PMCID: PMC10370492 DOI: 10.1016/j.jamda.2023.02.006] [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: 05/08/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To examine whether delirium predicts occurrence of hospital-associated disability (HAD), or functional decline after admission, among hospitalized older adults. DESIGN Retrospective cross-sectional study. SETTING AND PARTICIPANTS General inpatient (non-ICU) units of a large regional Southeastern US academic medical center, involving 33,111 older adults ≥65 years of age admitted from January 1, 2015, to December 31, 2019. METHODS Delirium was defined as a score ≥2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission. HAD was defined as a decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations with multiple admissions. We performed multivariate and mediation analyses to examine strength and direction of association between delirium and HAD. RESULTS One-fifth (21.6%) of older adults developed HAD during hospitalization and experienced higher delirium rates compared to those not developing HAD (24.3% vs 14.3%, P < .001). Age, presence of delirium, Elixhauser Comorbidity Score, admission cognitive status, admission ADL function, and length of stay were associated (all P < .001) with incident HAD. Mediational analyses found 46.7% of the effect of dementia and 16.7% of the effect of comorbidity was due to delirium (P < .001). CONCLUSIONS AND IMPLICATIONS Delirium significantly increased the likelihood of HAD within a multivariate predictor model that included comorbidity, demographics, and length of stay. For dementia and comorbidity, mediation analysis showed a significant portion of their effect attributable to delirium. Overall, these findings suggest that reducing delirium rates may diminish HAD rates.
Collapse
Affiliation(s)
- Hyun Freeman
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline Whittington
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John D Osborne
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tobias O'Leary
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jasmine K Vickers
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kellie L Flood
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel M Skains
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, USA
| | - Thomas W Buford
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Richard E Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
26
|
Immobility and the High Risk of Not Recovering Function in Older Adults: A Focused Ethnography. Rehabil Nurs 2023; 48:40-46. [PMID: 36649591 DOI: 10.1097/rnj.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The objective of the study was to explore the experiences of older adults with immobility posthospitalization. DESIGN We conducted a focused ethnography qualitative study. METHODS Data collection included in-depth interviews with 10 individuals ages 69-82 years who had been hospitalized for at least 1 week, field notes, and observations of mobility. An inductive approach was used to analyze the data. FINDINGS Older adults believe mobility is a central element in their life. Hospitalizations lasting 1 week or longer often result in a loss of the older adult's ability to function as before, a pattern that we identified as The Crushing Assault: Consequences of Immobility. Rehabilitation involves a Rocky Road to Regaining Mobility that is challenging but possible. CONCLUSIONS Immobility after hospitalization has unexpected and profound consequences that are life-changing and distressing for older adults at home. Recovering function is prolonged and difficult. An individualized training program that includes flexibility and progressive resistance exercises is recommended over longer periods and with extended medical follow-up. CLINICAL RELEVANCE Lingering problems with immobility at home are frequently overlooked. Active programming promoting preservation of function and an optimistic attitude as well as focusing on milestones to reach are key to optimal function.
Collapse
|
27
|
Fuchita M, Ridgeway KJ, Kimzey C, Melanson EL, Fernandez-Bustamante A. Accelerometer-measured Inpatient Physical Activity and Associated Outcomes after Major Abdominal Surgery: A Systematic Review (Preprint). Interact J Med Res 2023; 12:e46629. [PMID: 37184924 DOI: 10.2196/46629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND It remains unclear how inpatient physical activity after major abdominal surgery affects outcomes. Accelerometer research may provide further evidence for postoperative mobilization. OBJECTIVE We aimed to summarize the current literature evaluating the impact of accelerometer-measured postoperative physical activity on outcomes after major abdominal surgery. METHODS We searched PubMed and Google Scholar in October 2021 to conduct a systematic review. Studies were included if they used accelerometers to measure inpatient physical behaviors immediately after major abdominal surgery, defined as any nonobstetric procedures performed under general anesthesia requiring hospital admission. Studies were eligible only if they evaluated the effects of physical activity on postoperative outcomes such as postoperative complications, return of gastrointestinal function, hospital length of stay, discharge destination, and readmissions. We excluded studies involving participants aged <18 years. Risk of bias was assessed using the risk-of-bias assessment tool for nonrandomized studies (RoBANS) for observational studies and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled trials (RCTs). Findings were summarized by qualitative synthesis. RESULTS We identified 15 studies. Risk of bias was high in 14 (93%) of the 15 studies. Most of the studies (11/15, 73%) had sample sizes of <100. Of the 15 studies, 13 (87%) included the general surgery population, 1 (7%) was a study of patients who had undergone gynecologic surgery, and 1 (7%) included a mixed (abdominal, thoracic, gynecologic, and orthopedic) surgical population. Of the 15 studies, 12 (80%) used consumer-grade accelerometers to measure physical behaviors. Step count was the most commonly reported physical activity outcome (12/15, 80%). In the observational studies (9/15, 60%), increased physical activity during the immediate postoperative period was associated with earlier return of gastrointestinal function, fewer surgical and pulmonary complications, shorter hospital length of stay, and fewer readmissions. In the RCTs (6/15, 40%), only 1 (17%) of the 6 studies demonstrated improved outcomes (shorter time to flatus and hospital length of stay) when a mobility-enhancing intervention was compared with usual care. Notably, mobility-enhancing interventions used in 4 (67%) of the 6 RCTs did not result in increased postoperative physical activity. CONCLUSIONS Although observational studies show strong associations between postoperative physical activity and outcomes after major abdominal surgery, RCTs have not proved the benefit of mobility-enhancing interventions compared with usual care. The overall risk of bias was high, and we could not synthesize specific recommendations for postoperative mobilization. Future research would benefit from improving study design, increasing methodologic rigor, and measuring physical behaviors beyond step counts to understand the impact of postoperative mobilization on outcomes after major abdominal surgery.
Collapse
|
28
|
Dikkema Y, Mouton N, Gerrits K, Valk T, van der Steen-Diepenrink M, Eshuis H, Houdijk H, van der Schans C, Niemeijer A, Nieuwenhuis M. Identification and Quantification of Activities Common to Intensive Care Patients; Development and Validation of a Dual-Accelerometer-Based Algorithm. SENSORS (BASEL, SWITZERLAND) 2023; 23:1720. [PMID: 36772755 PMCID: PMC9919179 DOI: 10.3390/s23031720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to develop and validate an algorithm that can identify the type, frequency, and duration of activities common to intensive care (IC) patients. Ten healthy participants wore two accelerometers on their chest and leg while performing 14 activities clustered into four protocols (i.e., natural, strict, healthcare provider, and bed cycling). A video served as the reference standard, with two raters classifying the type and duration of all activities. This classification was reliable as intraclass correlations were all above 0.76 except for walking in the healthcare provider protocol, (0.29). The data of four participants were used to develop and optimize the algorithm by adjusting body-segment angles and rest-activity-threshold values based on percentage agreement (%Agr) with the reference. The validity of the algorithm was subsequently assessed using the data from the remaining six participants. %Agr of the algorithm versus the reference standard regarding lying, sitting activities, and transitions was 95%, 74%, and 80%, respectively, for all protocols except transitions with the help of a healthcare provider, which was 14-18%. For bed cycling, %Agr was 57-76%. This study demonstrated that the developed algorithm is suitable for identifying and quantifying activities common for intensive care patients. Knowledge on the (in)activity of these patients and their impact will optimize mobilization.
Collapse
Affiliation(s)
- Yvonne Dikkema
- Association of Dutch Burn Centers, Burn Center Martini Hospital Groningen, 9728 NT Groningen, The Netherlands
- Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences Groningen, 9714 CA Groningen, The Netherlands
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9700 GZ Groningen, The Netherlands
| | - Noor Mouton
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9700 GZ Groningen, The Netherlands
| | - Koen Gerrits
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9700 GZ Groningen, The Netherlands
| | - Tim Valk
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, 9700 GZ Groningen, The Netherlands
| | | | - Hans Eshuis
- Burn Center, Martini Hospital, 9728 NT Groningen, The Netherlands
| | - Han Houdijk
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9700 GZ Groningen, The Netherlands
| | - Cees van der Schans
- Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences Groningen, 9714 CA Groningen, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, 9700 GZ Groningen, The Netherlands
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, 9700 GZ Groningen, The Netherlands
| | - Anuschka Niemeijer
- Association of Dutch Burn Centers, Burn Center Martini Hospital Groningen, 9728 NT Groningen, The Netherlands
| | - Marianne Nieuwenhuis
- Association of Dutch Burn Centers, Burn Center Martini Hospital Groningen, 9728 NT Groningen, The Netherlands
- Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences Groningen, 9714 CA Groningen, The Netherlands
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9700 GZ Groningen, The Netherlands
| |
Collapse
|
29
|
Zisberg A, Shadmi E, Andersen O, Shulyaev K, Petersen J, Agmon M, Gil E, Gur-Yaish N, Pedersen MM. Shared and distinct factors underlying in-hospital mobility of older adults in Israel and Denmark (97/100). BMC Geriatr 2023; 23:68. [PMID: 36737687 PMCID: PMC9896765 DOI: 10.1186/s12877-022-03636-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Low in-hospital mobility is widely acknowledged as a major risk factor in acquiring hospital-associated disabilities. Various predictors of in-hospital low mobility have been suggested, among them older age, disabling admission diagnosis, poor cognitive and physical functioning, and pre-hospitalization mobility. However, the universalism of the phenomena is not well studied, as similar risk factors to low in-hospital mobility have not been tested. METHODS The study was a secondary analysis of data on in-hospital mobility that investigated the relationship between in-hospital mobility and a set of similar risk factors in independently mobile prior to hospitalization older adults, hospitalized in acute care settings in Israel (N = 206) and Denmark (N = 113). In Israel, mobility was measured via ActiGraph GT9X and in Denmark by ActivPal3 for up to seven hospital days. RESULTS Parallel multivariate analyses revealed that a higher level of community mobility prior to hospitalization and higher mobility ability status on admission were common predictors of a higher number of in-hospital steps, whereas the longer length of hospital stay was significantly correlated with a lower number of steps in both samples. The risk of malnutrition on admission was associated with a lower number of steps, but only in the Israeli sample. CONCLUSIONS Despite different assessment methods, older adults' low in-hospital mobility has similar risk factors in Israel and Denmark. Pre-hospitalization and admission mobility ability are robust and constant risk factors across the two studies. This information can encourage the development of both international standard risk evaluations and tailored country-based approaches.
Collapse
Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, 31905, Israel. .,Center of Research & Study of Aging, University of Haifa, Haifa, Israel.
| | - Efrat Shadmi
- grid.18098.380000 0004 1937 0562The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, 31905 Israel
| | - Ove Andersen
- grid.413660.60000 0004 0646 7437The Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark ,grid.413660.60000 0004 0646 7437Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ksenya Shulyaev
- grid.18098.380000 0004 1937 0562Center of Research & Study of Aging, University of Haifa, Haifa, Israel ,grid.18098.380000 0004 1937 0562The Minerva Center On Intersectionality in Aging (MCIA), Faculty of Social Welfare and Health Studies University of Haifa, Haifa, Israel
| | - Janne Petersen
- grid.411702.10000 0000 9350 8874Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Maayan Agmon
- grid.18098.380000 0004 1937 0562The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, 31905 Israel
| | - Efrat Gil
- grid.414553.20000 0004 0575 3597Geriatric Unit, Clalit Health Services, Haifa and West Galilee, Faculty of Medicine, Technion, Haifa, Israel
| | - Nurit Gur-Yaish
- grid.18098.380000 0004 1937 0562Center of Research & Study of Aging, University of Haifa, Haifa, Israel ,grid.443189.30000 0004 0604 9577Oranim Academic College of Education, Kiryat Tivon, Israel
| | - Mette Merete Pedersen
- grid.413660.60000 0004 0646 7437Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.411905.80000 0004 0646 8202Physical Medicine and Rehabilitation Research-Copenhagen, Copenhagen University Hospital, Hvidovre, Hvidovre, Danmark
| |
Collapse
|
30
|
Valkenet K, Bor P, Reijneveld E, Veenhof C, Dronkers J. Physical activity monitoring during hospital stay: a validation study. Disabil Rehabil 2023; 45:449-454. [PMID: 35175168 DOI: 10.1080/09638288.2022.2034995] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The primary aim of this study was to investigate the concurrent validity of the PAM AM400 accelerometer for measuring physical activity in usual care in hospitalized patients by comparing it with the ActiGraph wGT3X-BT accelerometer. MATERIALS AND METHODS This was a prospective single centre observational study performed at the University Medical Centre Utrecht in The Netherlands. Patients admitted to different clinical wards were included. Intraclass Correlation Coefficients (ICCs) were computed using a two-way mixed model with random subjects. Additionally, Bland-Altman plots were made to visualize the level of agreement of the PAM with the ActiGraph. To test for proportional bias, a regression analysis was performed. RESULTS In total 17 patients from different clinical wards were included in the analyses. The level of agreement between the PAM and ActiGraph was found strong with an ICC of 0.955. The Bland-Altman analyses showed a mean difference of 1.12 min between the two accelerometers and no proportional bias (p = 0.511). CONCLUSIONS The PAM is a suitable movement sensor to validly measure the active minutes of hospitalized patients. Implementation of this device in daily care might be helpful to change the immobility culture in hospitals.IMPLICATIONS FOR REHABILITATIONPhysical inactivity is common during hospital admission and the main cause of loss of muscle mass and physical fitness.The PAM AM400 is a suitable movement sensor to validly measure the active minutes of hospitalized patients.Implementation of this device in daily care might be helpful to change the immobility culture in hospitals.
Collapse
Affiliation(s)
- Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Petra Bor
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Elja Reijneveld
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, The Netherlands
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| | - Jaap Dronkers
- University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht, The Netherlands
| |
Collapse
|
31
|
Showing Our Value. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Association of the nutritional risk index for Japanese hemodialysis with mortality and dietary nutritional intake in patients undergoing hemodialysis during long-term hospitalization. Clin Exp Nephrol 2022; 26:1200-1207. [PMID: 36040556 DOI: 10.1007/s10157-022-02259-0] [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: 03/23/2022] [Accepted: 07/24/2022] [Indexed: 11/03/2022]
Abstract
AIM The nutritional risk index for Japanese hemodialysis (NRI-JH) is a nutritional screening tool for predicting mortality in patients undergoing hemodialysis; however, its utility in patients undergoing hemodialysis during long-term hospitalization who have a high risk of protein-energy wasting, is unclear. METHODS This retrospective study assessed hospitalized patients undergoing hemodialysis during long-term care at a single hospital. The NRI-JH was calculated using body mass index, serum albumin level, total cholesterol level, and serum creatinine level. The patients were categorized into three risk groups-low, medium, and high. Dietary energy and protein intake were evaluated by dietitians. The association of NRI-JH risk with nutritional intake and mortality were examined. RESULTS In total, 133 patients were analyzed. The NRI-JH risk was low in 24%, medium in 26%, and high in 50% of the patients. The patients in the high-risk group were older and had lower energy and protein intakes than those in the low- and medium-risk groups. High-risk patients showed shorter survival times than low- and medium-risk patients, and a high NRI-JH risk was associated with a high mortality rate (hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.08-4.77; p < 0.05). The association weakened when protein intake and C-reactive protein level were added as covariates (HR, 2.01; 95% CI, 0.95-4.28, p = 0.07). CONCLUSIONS High NRI-JH risk was associated with low dietary nutritional intake and poor survival in patients undergoing hemodialysis during long-term hospitalization. Nutritional status evaluation and nutritional interventions may improve prognosis in this population.
Collapse
|
33
|
Dijkstra F, van der Sluis G, Jager-Wittenaar H, Hempenius L, Hobbelen JSM, Finnema E. Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review. Int J Behav Nutr Phys Act 2022; 19:99. [PMID: 35908056 PMCID: PMC9338465 DOI: 10.1186/s12966-022-01330-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/06/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To improve older patients' physical activity (PA) behavior, it is important to identify facilitators and barriers to enhancing PA in older patients (≥ 65 years) during hospitalization from the perspectives of patients, caregivers, and healthcare professionals (HCPs). METHODS In this systematic review, a search of PubMed, CINAHL, PsycINFO, EMBASE, and Web of Science (January 2000-May 2021) was performed, and quantitative, qualitative, and mixed-methods studies were included. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Identified facilitators and barriers were categorized using the social ecological model at the intrapersonal, interpersonal, and institutional levels. RESULTS The 48 included articles identified 230 facilitators and 342 barriers. The main facilitators at the intrapersonal level included: knowledge, awareness, and attitudes; interpersonal level: social support, including encouragement and interdisciplinary collaboration; and institutional level: stimulating physical environment, patient activities and schedules, and PA protocols. The main barriers at the intrapersonal level included: physical health status, having lines or drains, patients' fear, and HCPs' safety concerns; interpersonal level: patient-HCP relation and HCPs' unclear roles; and institutional level: lack of space and resources, including time and equipment. Best evidence synthesis provided moderate level of evidence for three barriers: patients' unwillingness or refusal to move, patients having symptoms, and patients having lines or drains. No moderate level of evidence was found for facilitators. CONCLUSION The PA behavior of older adults during hospitalization is multidimensional. Our overview highlights facilitators and barriers on multilevel scale (intrapersonal, interpersonal, and institutional levels) that guides patients, caregivers, HCPs, and researchers in future clinical practice, and intervention development and implementation.
Collapse
Affiliation(s)
- F Dijkstra
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, P.O. Box 1080, 8900, CB, Leeuwarden, The Netherlands.
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
- Department of Health Science, Section of Nursing Research & Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- FAITH research, Groningen/Leeuwarden, The Netherlands.
| | - G van der Sluis
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Department of Health Strategy and Innovation, Nij Smellinghe Hospital Drachten, Drachten, The Netherlands
| | - H Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Hempenius
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - J S M Hobbelen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, P.O. Box 1080, 8900, CB, Leeuwarden, The Netherlands
- Department of Health Science, Section of Nursing Research & Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands
| |
Collapse
|
34
|
Short-term aerobic exercise for depression in acute geriatric psychiatry: study protocol for a randomized controlled trial. Trials 2022; 23:615. [PMID: 35908008 PMCID: PMC9338474 DOI: 10.1186/s13063-022-06567-4] [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: 03/04/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Major depression is one of the main mental illnesses in old age, with acute exacerbated episodes requiring treatment in geriatric psychiatry. A meta-analysis showed that aerobic exercise in moderate intensity has large effects in older adults with major depression, but there is no evidence of aerobic exercise in geriatric psychiatry. Therefore, this study aims to analyze the feasibility and effects of an ergometer-based aerobic exercise on depressive symptoms. Methods A single-center randomized controlled trial will be conducted in an acute geriatric psychiatric hospital. Inpatients allocated to the intervention group will receive a 2-week aerobic ergometer program. The control group will receive seated flexibility exercise in addition to usual care. The overall effects on the patients’ depressive symptoms will be measured by clinical global impression of change (CGI) as the primary outcome. Changes in depressive symptom domains, physical (in)activity, and aerobic performance as well as the dosage of applied antidepressants will be examined as secondary outcomes. Discussion This short-term aerobic exercise program is expected to decrease depressive symptoms in acute exacerbated periods in older adults. The results may increase the evidence for implementing physical activity interventions in acute hospital settings. The disease-related motivation for exercise in acute exacerbated depressive periods will be the most challenging aspect. The treatment of depression requires new cost-effective approaches, especially in acute geriatric psychiatry with potential benefits for patients, family members, and clinicians. Trial registration German Clinical Trial Register ID: DRKS00026117 Trial status Protocol Version 1.2 dated February 23, 2022. By February 23, 2022, the trial had recruited a total of 15 participants in two wards at the Department of Geriatric Psychiatry at the LVR-Hospital Cologne. Recruitment started on November 12, 2021. The recruitment is expected to continue for at least 12 months.
Collapse
|
35
|
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
|
36
|
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
|
37
|
Validation of Two Activity Monitors in Slow and Fast Walking Hospitalized Patients. Rehabil Res Pract 2022; 2022:9230081. [PMID: 35615755 PMCID: PMC9126721 DOI: 10.1155/2022/9230081] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 12/30/2022] Open
Abstract
To evaluate interventions to promote physical activity, valid outcome measures are important. This study evaluated the validity and reliability of the ActivPAL3™ and the SENS motion® activity monitors with regard to the number of steps taken, walking, and sedentary behavior in hospitalized patients (
) (older medical patients (+65 years) (
), older patients (+65) with acute hip fracture (
), and patients (+18) who underwent acute high-risk abdominal surgery (
)). Both monitors showed good (≥60%) percentage agreement with direct observation for standing and no. of steps (all gait speeds) and high agreement (≥80%) for lying. For walking, ActivPAL3™ showed moderate percentage agreement, whereas SENS motion® reached high percentage agreement. The relative reliability was moderate for sedentary behavior for both monitors. The ActivPAL3™ showed poor (walking) to moderate (steps) reliability for walking and steps, whereas SENS motion® showed moderate reliability for both activities. For slow walkers, the relative reliability was moderate for SENS motion® and poor for ActivPAL3™. This trial is registered with the ClinicalTrials.gov identifier NCT04120740.
Collapse
|
38
|
Smichenko J, Shochat T, Zisberg A. Assessment of Sleep Duration and Number of Awakenings Based on Ankle and Wrist Actigraphy in Medical Hospitalized Older Patients. Biol Res Nurs 2022; 24:448-458. [PMID: 35512136 DOI: 10.1177/10998004221095567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most studies performed in the hospital assess sleep using self-reports; few rely on actigraphy. Although wrist actigraphy is commonly used for sleep assessment in field studies, in-hospital assessment may be challenging and cumbersome because other more necessary monitoring devices are often attached to patients' upper limbs; these may affect interpretation of wrist activity data. Placement on the ankle may be a viable solution. OBJECTIVE To compare total sleep time (TST) and number of awakenings (NOA) using concomitant wrist and ankle actigraphy, as well as self-reports in a sample of older adult patients hospitalized in medical units. METHODS This was a prospective observational study. Objective sleep data were collected using ankle and wrist actigraphy, and subjective data using sleep diary. Repeated measures mixed model analysis was performed, adjusting for age, gender, sleep medications, symptoms severity, interaction between types of measure, and night number. RESULTS Twenty-one older adults (65+) wore ankle and wrist actigraphy devices and subjectively estimated sleep parameters for an average of (2.15 ± 1.01) nights, with 40 nights available for analysis. TST was lower for wrist than ankle actigraphy (F(2,87) = 7.92, p = .0007). Neither differed from self-reports. NOA differed between all types of measure (ankle, 8.58 ± 6.66; wrist, 15.49 ± 7.47; self-report, 1.81 ± 1.83; F(2,85) = 47.66, p < .001). No significant within-subject variations and no interaction between devices and repeated measures were found. CONCLUSIONS Despite differences between ankle and wrist assessments, all three methods provided consistent TST estimation within participants. Findings provide preliminary support for the use of ankle actigraphy for sleep assessment in hospital settings.
Collapse
Affiliation(s)
- Juliana Smichenko
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, 61196University of Haifa, Haifa, Israel.,Clalit Health Services, Carmel Hospital, Israel
| | - Tamar Shochat
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, 61196University of Haifa, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, 61196University of Haifa, Haifa, Israel
| |
Collapse
|
39
|
Jawad BN, Petersen J, Andersen O, Pedersen MM. Variations in physical activity and sedentary behavior during and after hospitalization in acutely admitted older medical patients: a longitudinal study. BMC Geriatr 2022; 22:209. [PMID: 35291952 PMCID: PMC8925078 DOI: 10.1186/s12877-022-02917-8] [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: 09/01/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inactivity is frequent among older patients during hospitalization. It is unknown how patients' daily activity pattern (diurnal profile) vary between hospitalization and after discharge. This study aims to describe and compare the distribution of physical activity and sedentary behavior in acutely hospitalized older patients during hospitalization and after discharge. METHODS We included data on 80 patients (+65 years) admitted with acute medical illness from the STAND-Cph trial. Physical activity and sedentary behavior were measured as daily number of steps, uptime (walking/standing) and sedentary behavior (lying/sitting) with an activity monitor (activPAL3, PAL Technologies Ltd). The patients wore the monitor for three periods of one week: during hospitalization, after discharge, and four weeks after discharge. RESULTS The patients' median age was 80 years [IQR: 75;88], 68% were female and the median De Morton Mobility Index (DEMMI) was 57 [IQR: 48;67]. The daily median uptime was 1.7 h [IQR: 1;2.8] during hospitalization, 4.0 h [IQR: 2.7;5.4] after discharge and 4.0 h [IQR: 2.8;5.8] four weeks after discharge. The daily median number of steps was 728 [IQR: 176;2089], 2207 [IQR: 1433;3148], and 2622 [IQR: 1714;3865], respectively, and median daily sedentary behavior was 21.4 h (IQR: 20.7;22.4), 19.5 h (IQR: 18.1;21.0) and 19.6 h (IQR: 18.0;20.8), respectively. During hospitalization, a small activity peak was observed between 9-11 AM without any notable variation after. At discharge and four weeks after discharge, a peak in physical activity was seen between 9-12 AM and at 5 PM. CONCLUSION Older hospitalized patients spend most of their time being sedentary with their highest activity between 9-11 AM. Daily activity doubles after discharge with one extra peak in the afternoon. Daily routines might be disrupted, and older patients have the potential to be more physically active during hospitalization. Interventions that encourage physical activity during hospitalization are warranted.
Collapse
Affiliation(s)
- Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark. .,The Emergency Department, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Nørre Allé 20, DK-2200, Copenhagen-N, Denmark.
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark.,The Emergency Department, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Nørre Allé 20, DK-2200, Copenhagen-N, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Nørre Allé 20, DK-2200, Copenhagen-N, Denmark
| |
Collapse
|
40
|
Motives and Barriers to Exercise Training during Hospitalization in Patients with Type 2 Diabetes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031035. [PMID: 35162066 PMCID: PMC8834091 DOI: 10.3390/ijerph19031035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Abstract
Background: Exercise training during hospitalization may prevent loss of physical function and hyperglycemia in patients with type 2 diabetes. The aim of this study was to assess motives and barriers to exercise training in hospitalized patients with type 2 diabetes. Methods: Data were collected using a questionnaire about motives and barriers to exercise training during hospitalization. Additional data for clinical characteristics of the participants were collected from patient records. Results: 79 patients participated (mean ± SD age 72 ± 12 years; 42% women), of whom 25% had a low level of education and 46% lived alone. The median (IQR) length of the stay was 6 (4–10) days. A total of 67% of the participants wished to be more physically active. Walking as exercise was preferred by 51%. The most frequently reported barriers to exercise training were bodily pain (48%) and dizziness (42%). Low vs. high level of education, and living alone vs. being married/living with a partner were associated with reduced odds of a wish to be more physically active, odds ratio (OR) 0.15 [95% CI 0.03; 0.76], p = 0.022, and 0.21 [0.05; 0.82], p = 0.025, respectively. Conclusion: Two out of three hospitalized patients with type 2 diabetes wished to be more physically active during admission. Bodily pain was a barrier to exercise training and needs attention in training programs. As a low level of education was associated with reduced odds of a wish to be more active, a strategy to include all patients in training programs which considers social inequality is needed.
Collapse
|
41
|
Thivel D, Corteval A, Favreau JM, Bergeret E, Samalin L, Costes F, Toumani F, Dualé C, Pereira B, Eschalier A, Fearnbach N, Duclos M, Tournadre A. Fine Detection of Human Motion During Activities of Daily Living as a Clinical Indicator for the Detection and Early Treatment of Chronic Diseases: The E-Mob Project. J Med Internet Res 2022; 24:e32362. [PMID: 35029537 PMCID: PMC8800083 DOI: 10.2196/32362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 12/16/2022] Open
Abstract
Methods to measure physical activity and sedentary behaviors typically quantify the amount of time devoted to these activities. Among patients with chronic diseases, these methods can provide interesting behavioral information, but generally do not capture detailed body motion and fine movement behaviors. Fine detection of motion may provide additional information about functional decline that is of clinical interest in chronic diseases. This perspective paper highlights the need for more developed and sophisticated tools to better identify and track the decomposition, structuration, and sequencing of the daily movements of humans. The primary goal is to provide a reliable and useful clinical diagnostic and predictive indicator of the stage and evolution of chronic diseases, in order to prevent related comorbidities and complications among patients.
Collapse
Affiliation(s)
| | | | | | | | - Ludovic Samalin
- Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | - Frédéric Costes
- Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Christian Dualé
- Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | - Alain Eschalier
- Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | - Nicole Fearnbach
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Martine Duclos
- Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | - Anne Tournadre
- Clermont Ferrand University Hospital, Clermont-Ferrand, France
| |
Collapse
|
42
|
Taylor NF, Harding KE, Dennett AM, Febrey S, Warmoth K, Hall AJ, Prendergast LA, Goodwin VA. Behaviour change interventions to increase physical activity in hospitalised patients: a systematic review, meta-analysis and meta-regression. Age Ageing 2022; 51:6326506. [PMID: 34304267 PMCID: PMC8753032 DOI: 10.1093/ageing/afab154] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. OBJECTIVE This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients. METHODS Randomised controlled trials of behaviour change interventions to increase physical activity in hospitalised patients were selected from a database search, supplemented by reference list checking and citation tracking. Data were synthesised with random-effects meta-analyses and meta-regression analyses, applying Grades of Recommendation, Assessment, Development and Evaluation criteria. The primary outcome was objectively measured physical activity. Secondary measures were patient-related outcomes (e.g. mobility), service level outcomes (e.g. length of stay), adverse events and patient satisfaction. RESULTS Twenty randomised controlled trials of behaviour change interventions involving 2,568 participants (weighted mean age 67 years) included six trials with a high risk of bias. There was moderate-certainty evidence that behaviour change interventions increased physical activity levels (SMD 0.34, 95% CI 0.14-0.55). Findings in relation to mobility and length of stay were inconclusive. Adverse events were poorly reported. Meta-regression found behaviour change techniques of goal setting (SMD 0.29, 95% CI 0.05-0.53) and feedback (excluding high risk of bias trials) (SMD 0.35, 95% CI 0.11-0.60) were independently associated with increased physical activity. CONCLUSIONS Targeted behaviour change interventions were associated with increases in physical activity in hospitalised patients. The trials in this review were inconclusive in relation to the patient-related or health service benefits of increasing physical activity in hospital.
Collapse
Affiliation(s)
- Nicholas F Taylor
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health Clinical Research Office, Box Hill, Victoria 3128, Australia
| | - Katherine E Harding
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health Clinical Research Office, Box Hill, Victoria 3128, Australia
| | - Amy M Dennett
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health Clinical Research Office, Box Hill, Victoria 3128, Australia
| | - Samantha Febrey
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Krystal Warmoth
- NIHR ARC East of England, University of Hertfordshire, Centre for Research In Public Health And Community Care (CRIPACC), Hatfield AL10 9AB, UK
| | - Abi J Hall
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Luke A Prendergast
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Victoria A Goodwin
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| |
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
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: 23] [Impact Index Per Article: 7.7] [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
|
45
|
Kirk JW, Nilsen P, Andersen O, Stefánsdóttir NT, Grønfeldt B, Brødsgaard R, Pedersen BS, Bandholm T, Tjørnhøj-Thomsen T, Pedersen MM. Adaptations and modifications to a co-designed intervention and its clinical implementation: a qualitative study in Denmark. BMC Health Serv Res 2021; 21:1108. [PMID: 34656126 PMCID: PMC8520628 DOI: 10.1186/s12913-021-07142-4] [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: 01/19/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a long-standing debate in implementation research on whether adaptations to evidence-based interventions (EBIs) are desirable in health care. If an intervention is adapted and not delivered as conceived and planned, it is said to have low fidelity. The WALK-Cph project was developed based on the assumption that involving stakeholders in co-design processes would facilitate the fidelity of an intervention to increase the mobility of acutely admitted older medical patients and its implementation in two hospitals in Denmark. The purpose of this study is to describe and analyse adaptations and modifications that were made to the co-designed WALK-Cph intervention and its implementation. METHODS This study used a qualitative design. An ethnographic field study was performed using participant observations, workshops and semi-structured interviews. Data were analysed twice using the Framework Method. The first analysis was based on the frameworks from Stirman, Moore and Proctor. The second analysis, a retrospective modifications analysis, was based on the Adaptation-Impact Framework. RESULTS Many different types of adaptations and modifications were made to the WALK-Cph intervention and its implementation plan. Most of the modifications were made on the contents of the intervention. In total, 44 adaptations and modifications were made, of which 21 were planned (adaptations) and 23 were made haphazardly (modifications). Most of the content and context adaptations and modifications made on the intervention had a mixed result regarding enhanced fidelity. The retrospective modifications analysis showed that modifications were ongoing and both situationally and contextually shaped. CONCLUSIONS Although an extensive co-design process was carried out to facilitate the fidelity of the WALK-Cph intervention, this study showed that many adaptations and modifications were still made to both the intervention and its implementation plan. It could indicate that the co-design process had a small effect or that adaptations and modifications are ongoing and both situationally and contextually shaped, which challenge the assumption and the desire to be able to plan and control changes.
Collapse
Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark. .,Department of Public Health, Nursing, Aarhus University, Nordre Ringgade 1, 8000, Aarhus, Denmark.
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, Sandbäcksgatan 7, 582 25, Linköping, Sweden
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Nina Thórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Birk Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Rasmus Brødsgaard
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Britt Stævnsbo Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Copenhagen Neuromuscular Center, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen Ø, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Department of Orthopedic Surgery, and Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| |
Collapse
|
46
|
Maher C, Szeto K, Arnold J. The use of accelerometer-based wearable activity monitors in clinical settings: current practice, barriers, enablers, and future opportunities. BMC Health Serv Res 2021; 21:1064. [PMID: 34625076 PMCID: PMC8501528 DOI: 10.1186/s12913-021-07096-7] [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: 05/20/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Wearable activity monitors (WAMs, e.g. Fitbits and research accelerometers) show promise for helping health care professionals (HCPs) measure and intervene on patients’ activity patterns. This study aimed to describe the clinical use of WAMs within South Australia, barriers and enablers, and future opportunities for large-scale clinical use. Methods A descriptive qualitative study was undertaken using semi-structured interviews. Participants were HCPs with experience using WAMs in South Australian clinical settings. Commencing with participants identified through the research team’s professional networks, snowball recruitment continued until all identified eligible HCPs had been invited. Semi-structured interviews were used to explore the research aims, with quantitative data analysed descriptively, and qualitative data analysed thematically. Results 18 participants (physiotherapists n = 8, exercise physiologists n = 6, medical consultants n = 2, and research personnel recommended by medical consultants n = 2), represented 12 discrete “hubs” of WAM use in clinical practice, spanning rehabilitation, orthopaedics, geriatrics, intensive care, and various inpatient-, outpatient-, community-based hospital and private-practice settings. Across the 12 hubs, five primarily used Fitbits® (various models), four used research-grade accelerometers (e.g. GENEActiv, ActivPAL and StepWatch accelerometers), one used Whoop Bands® and another used smartphone-based step counters. In three hubs, WAMs were used to observe natural activity levels without intervention, while in nine they were used to increase (i.e. intervene on) activity. Device selection was typically based on ease of availability (e.g. devices borrowed from another department) and cost-economy (e.g. Fitbits® are relatively affordable compared with research-grade devices). Enablers included device characteristics (e.g. accuracy, long battery life, simple metrics such as step count) and patient characteristics (e.g. motivation, rehabilitation population, tech-savvy), whilst barriers included the HCPs’ time to download and interpret the data, multidisciplinary team attitudes and lack of protocols for managing the devices. Conclusions At present, the use of WAMs in clinical practice appears to be fragmented and ad hoc, though holds promise for understanding patient outcomes and enhancing therapy. Future work may focus on developing protocols for optimal use, system-level approaches, and generating cost-benefit data to underpin continued health service funding for ongoing/wide-spread WAM use. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07096-7.
Collapse
Affiliation(s)
- Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, GPO Box 2471, SA, 5001, Adelaide, Australia.
| | - Kimberley Szeto
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, GPO Box 2471, SA, 5001, Adelaide, Australia
| | - John Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, GPO Box 2471, SA, 5001, Adelaide, Australia.,Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), Allied Health & Human Performance, University of South Australia, SA, Adelaide, Australia
| |
Collapse
|
47
|
Abstract
ABSTRACT Injurious falls remain among the most common, dangerous, and costly adverse events in hospitals, despite the widespread implementation of fall prevention programs. Many current health care system policies and nursing practices oversimplify fall prevention by focusing on limiting the person's mobility and making the environment safer, or simply documenting a fall risk score. But most falls are caused by factors intrinsic to that individual; merely limiting their mobility can increase preventable hospital complications and readmissions, and still leaves them at risk for falls. This article proposes a new approach to reducing injurious falls in older adults-one grounded in evidence-based protocols known to positively impact the health of older adults. The approach, called by the acronym ERA-Electronic health record integration, Risk factors that matter, Assessment and care plans-allows nurses to use a validated fall risk assessment tool to reframe fall risk factors as part of the comprehensive care plan, and to map modifiable risk factors to interventions that address the underlying causes of falls and promote safer mobility. The ERA approach can help nurses use their time more effectively by focusing on targeted actions that improve patient outcomes, working in coordination with an interprofessional, cross-continuum care team.
Collapse
Affiliation(s)
- Ann L Hendrich
- Ann L. Hendrich is the builder of the Hendrich II Fall Risk Model and a trustee of AHI of Indiana, Inc., St. Louis. She was a founding cochair of the Age-Friendly Health Systems initiative and currently serves as an adviser, mentors fellowship recipients of the American Hospital Association (AHA), and often speaks at national clinical and patient safety and AHA meetings. The author has received speaking honoraria from the New Jersey Hospital Association, The John A. Hartford Foundation, and the AHA. She receives a percentage of consultant fees from AHI. The author acknowledges Susan Duhig, PhD, for assistance with manuscript development. Contact author: . The author and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the author is available at www.ajnonline.com
| |
Collapse
|
48
|
Martinez M, Cerasale M, Baig M, Dugan C, Robinson M, Sweis M, Prochaska M, Schram A, Meltzer D, Arora VM. Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services. J Hosp Med 2021; 16:jhm.3673. [PMID: 34424191 DOI: 10.12788/jhm.3673] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/24/2021] [Indexed: 11/20/2022]
Abstract
Appropriate use of inpatient physical therapy services is important for preventing hospital-associated disability (HAD). We assessed potential overutilization of physical therapy consults on hospital medicine services using the Activity Measure-Post Acute Care (AM-PAC) score. Our sample included 3592 unique admissions (mean age, 66 years; 48% women) at a large academic medical center. Based on an AM-PAC cutoff of >43.63 (raw score, 18) in patients who were discharged to home, 38% of physical therapy consults were considered "potential overutilization." Combined with age <65 years, 18% of consults remained "potential overutilization." After adjustment for age, sex, and length of stay, patients admitted with high mobility scores were 5.38 times more likely to be discharged to home (95% CI, 4.36-2.89) compared with those with low mobility scores. Being more judicious with physical therapy consults and reserving skilled therapy for at-risk patients could help prevent HAD while also having a positive impact on healthcare systems.
Collapse
Affiliation(s)
- Maylyn Martinez
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Matthew Cerasale
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Claire Dugan
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Marla Robinson
- Inpatient Therapy Services Department, University of Chicago, Chicago, Illinois
| | - Meghan Sweis
- Department of Nursing Administration and Patient Services, University of Chicago, Chicago, Illinois
| | - Micah Prochaska
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Andrew Schram
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - David Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Vineet M Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| |
Collapse
|
49
|
Tonkikh O, Zisberg A, Shadmi E. The role of nurse staffing in the performance of function-preserving processes during acute hospitalization: A cross-sectional study. Int J Nurs Stud 2021; 121:103999. [PMID: 34242978 DOI: 10.1016/j.ijnurstu.2021.103999] [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: 10/31/2020] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Performance of function-preserving hospitalization processes related to patient mobility, use of continence aids and food intake is significantly associated with outcomes in older adults. Nurses are the front-line personnel responsible for promoting performance of such processes. The degree to which nurse staffing is related to this performance is unclear. OBJECTIVE To identify nurse-staffing characteristics and nursing-related care needs associated with older patients' mobility, continence care and food intake during acute hospitalization. DESIGN Cross-sectional study using survey data from the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR) cohort study combined with day-level administrative nurse staffing data and clinical day-level aggregated data for all patients hospitalized during the HoPE-FOR study period. SETTING Internal medicine units in two medical centers in Israel. PARTICIPANTS Eight hundred seventy-three older adults. METHODS Mobility, continence care and food intake were assessed within 2 days of admission using validated questionnaires. Nurse-to-patient ratios and nursing-skill mix (i.e. registered nurses (RNs), nurse aides, nurses with advanced clinical training and RNs with an academic degree) were assessed using administrative data. Decision trees were developed for mobility, continence care and food intake, applying classification and regression-tree analysis. RESULTS The mobility decision tree identified three characteristics subdividing patients into six nodes: pre-admission functioning, pre-admission activity level and percentage of nurses with advanced training. The percentage of nurses with advanced training classified low-functioning patients into those walking in corridors versus walking or sitting only inside the room. The continence-care classification decision tree identified two characteristics that subdivided the patients into four nodes: pre-admission functioning and bladder control. Nurse-to-patient-ratio variables and patients' nursing-related care needs did not contribute to this classification. The food-intake decision tree identified four characteristics-pre-admission functioning, gender, percentage of nurses with advanced training and percentage of nurse aides-subdividing patients into eight nodes. Low-functioning patients exposed to a higher percentage of nurses with advanced training had food-intake scores 14% higher than patients exposed to a lower percentage of nurses with advanced training. Independent men exposed to a higher percentage of nurse aides had a 14% higher habitual daily in-hospital food-intake score than independent men exposed to a lower percentage of nurse aides. CONCLUSIONS A higher percentage of nurses with post-graduate education is associated with better performance of mobility and food intake of hospitalized older adults. To maintain the potential benefits of highly trained staff, education levels should be considered in scheduling and assignment decision-making processes in internal medicine units. Tweetable abstract: A higher percentage of nurses with post-graduate education is associated with better mobility and food intake of hospitalized older adults.
Collapse
Affiliation(s)
- Orly Tonkikh
- The Cheryl Spencer Department of Nursing, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
| |
Collapse
|
50
|
D'Souza S, Godecke E, Ciccone N, Hersh D, Janssen H, Armstrong E. Hospital staff, volunteers' and patients' perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study. BMJ Open 2021; 11:e043897. [PMID: 33952543 PMCID: PMC8103362 DOI: 10.1136/bmjopen-2020-043897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke. DESIGN A qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward. SETTING A metropolitan Australian private hospital. PARTICIPANTS Focus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted. RESULTS The key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients' functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients. CONCLUSIONS Barriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers.
Collapse
Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
- Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
- Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Victoria, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
| | - Heidi Janssen
- School of Health Sciences, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
| |
Collapse
|