Upright time during hospitalization for older inpatients: A prospective cohort study

Monitoring postures and motions of hospitalized patients using sensor technology: a scoping review

BACKGROUND

Sensor technology could provide solutions to monitor postures and motions and to help hospital patients reach their rehabilitation goals with minimal supervision. Synthesized information on device applications and methodology is lacking.

OBJECTIVES

The purpose of this scoping review was to provide an overview of device applications and methodological approaches to monitor postures and motions in hospitalized patients using sensor technology.

METHODS

A systematic search of Embase, Medline, Web of Science and Google Scholar was completed in February 2023 and updated in March 2024. Included studies described populations of hospitalized adults with short admission periods and interventions that use sensor technology to objectively monitor postures and motions. Study selection was performed by two authors independently of each other. Data extraction and narrative analysis focused on the applications and methodological approaches of included articles using a personalized standard form to extract information on device, measurement and analysis characteristics of included studies and analyse frequencies and usage.

RESULTS

A total of 15.032 articles were found and 49 articles met the inclusion criteria. Devices were most often applied in older adults (n = 14), patients awaiting or after surgery (n = 14), and stroke (n = 6). The main goals were gaining insight into patient physical behavioural patterns (n = 19) and investigating physical behaviour in relation to other parameters such as muscle strength or hospital length of stay (n = 18). The studies had heterogeneous study designs and lacked completeness in reporting on device settings, data analysis, and algorithms. Information on device settings, data analysis, and algorithms was poorly reported.

CONCLUSIONS

Studies on monitoring postures and motions are heterogeneous in their population, applications and methodological approaches. More uniformity and transparency in methodology and study reporting would improve reproducibility, interpretation and generalization of results. Clear guidelines for reporting and the collection and sharing of raw data would benefit the field by enabling study comparison and reproduction.

Using a Quality-Controlled Dataset From ViSi Mobile Monitoring for Analyzing Posture Patterns of Hospitalized Patients: Retrospective Observational Study

Background

ViSi Mobile has the capability of monitoring a patient's posture continuously during hospitalization. Analysis of ViSi telemetry data enables researchers and health care providers to quantify an individual patient's movement and investigate collective patterns of many patients. However, erroneous values can exist in routinely collected ViSi telemetry data. Data must be scrutinized to remove erroneous records before statistical analysis.

Objective

The objectives of this study were to (1) develop a data cleaning procedure for a 1-year inpatient ViSi posture dataset, (2) consolidate posture codes into categories, (3) derive concise summary statistics from the continuous monitoring data, and (4) study types of patient posture habits using summary statistics of posture duration and transition frequency.

Methods

This study examined the 2019 inpatient ViSi posture records from Atrium Health Wake Forest Baptist Medical Center. First, 2 types of errors, record overlap and time inconsistency, were identified. An automated procedure was designed to search all records for these errors. A data cleaning procedure removed erroneous records. Second, data preprocessing was conducted. Each patient's categorical time series was simplified by consolidating the 185 ViSi codes into 5 categories (Lying, Reclined, Upright, Unknown, User-defined). A majority vote process was applied to remove bursts of short duration. Third, statistical analysis was conducted. For each patient, summary statistics were generated to measure average time duration of each posture and rate of posture transitions during the whole day and separately during daytime and nighttime. A k-means clustering analysis was performed to divide the patients into subgroups objectively.

Results

The analysis used a sample of 690 patients, with a median of 3 days of extensive ViSi monitoring per patient. The median of posture durations was 10.2 hours/day for Lying, 8.0 hours/day for Reclined, and 2.5 hours/day for Upright. Lying had similar percentages of patients in low and high durations. Reclined showed a decrease in patients for higher durations. Upright had its peak at 0-2 hours, with a decrease for higher durations. Scatter plots showed that patients could be divided into several subgroups with different posture habits. This was reinforced by the k-means analysis, which identified an active subgroup and two sedentary ones with different resting styles.

Conclusions

Using a 1-year ViSi dataset from routine inpatient monitoring, we derived summary statistics of posture duration and posture transitions for each patient and analyzed the summary statistics to identify patterns in the patient population. This analysis revealed several types of patient posture habits. Before analysis, we also developed methodology to clean and preprocess routinely collected inpatient ViSi monitoring data, which is a major contribution of this study. The procedure developed for data cleaning and preprocessing can have broad application to other monitoring systems used in hospitals.

Physiotherapy in acute geriatrics wards: What (de)motivates patients? A qualitative study based on self-determination theory

BACKGROUND

While the benefits of physiotherapy for hospitalized older patients (HOPs) are well established, these patients are often considered demotivated by healthcare team members (HTMs), which is perceived as a hindrance to their rehabilitation. The quantitative data currently available on the lack of involvement of HOPs are mainly measures of mobility. Motivation as such has, to our knowledge, never been measured. Therefore, this study aims to quantify for the first time the motivation levels of HOPs in their participation in activities of daily living (ADLs) and physiotherapy, and to explore the motivating factors behind their participation in physiotherapy.

METHODS

The motivation of 60 older patients hospitalized in an acute geriatrics ward was quantified using the Scale of Demotivation Assessment (SDA). Out of these participants, 14 were interrogated through individual semi-structured face-to-face interviews. After transcription, data were analyzed according to Self-Determination Theory, which has been proven effective in the understanding of motivational mechanisms.

RESULTS

The prevalence of demotivation was 47% (95% CI: [0.34;0.6]) for ADLs and 35% (95% CI: [0.23;0.48]) for physiotherapy. The main demotivating factors were the feeling of external control (lack of autonomy) and dependance experienced by HOPs, as well as the limited availability of staff during hospitalization. Conversely, feelings of competence, security, respect for limits, and commitment from the HTMs were important motivating factors.

CONCLUSION

A large number of relational factors have an impact on the motivation of HOPs regarding their participation in ADLs and in physiotherapy sessions. Appropriate time and space organizing and the provision of suitable equipment, combined with a genuine caring and respectful attitude from the HTMs, could considerably encourage the expression of intrinsic motivation and thus the involvement of HOPs in their own care program.

Changes in physical activity level during hospitalization in patients with stroke and those with fracture: a prospective longitudinal study

[Purpose] To examine changes in physical activity levels between admission and discharge in patients hospitalized after stroke and fracture. [Participants and Methods] Patients with stroke (n=36) or fracture (n=41) wore an accelerometer during the daytime for three days after admission and before discharge. Physical activity was divided into sedentary behavior (SB), light-intensity (LIPA), and moderate-to-vigorous (MVPA), and then compared between hospital admission and discharge using the Wilcoxon signed-rank test. The characteristics of patients with or without changes in SB during hospitalization were compared using the Mann-Whitney U test. [Results] The median LIPA time in patients after stroke and fracture increased from 107.5 and 106.7 minutes on admission to 122.0 and 127.3 minutes at discharge, and the median MVPA time increased from 2.7 and 0.7 minutes on admission to 4.2 and 2.7 minutes at discharge, respectively. In particular, LIPA in non-therapy time increased for patients both after stroke and fracture. No differences in characteristics were observed between with or without changes in SB regardless of differences in diagnoses. [Conclusion] These findings indicate that while physical activity levels increased during hospitalization, they remained below World Health Organization recommendations for MVPA, and patient characteristics alone may not account for increased activity levels.

Effects of Acute Phase Intensive Physical Activity (ACTIVE-PA) Monitoring and Education for Cardiac Patients: Pilot Study of a Randomized Controlled Trial

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.

Diminished Physical Activity in Older Hospitalised Patients with and without COVID-19

Acute viral respiratory infections have proven to be a major health threat, even after the Corona Virus Disease 2019 (COVID-19) pandemic. We aimed to check whether the presence or absence of an acute respiratory infection such as COVID-19 can influence the physical activity of older hospitalised patients. We cross-sectionally studied patients aged ≥60 years, hospitalized during the pandemic in the non-COVID-19 and COVID-19 ward at the University Hospital, Kraków, Poland. Using activPAL3® technology, we assessed physical activity for 24 h upon admission and discharge. In addition, we applied the sarcopenia screening tool (SARC-F); measured the hand grip strength and calf circumference; and assessed the Modified Early Warning Score (MEWS), age-adjusted Charlson Index, SpO2%, and length of stay (LoS). Data were analysed using SAS 9.4. The mean (min, max) age of the 31 (58% women, eight with COVID-19) consecutive patients was 79.0 (62, 101, respectively) years. The daily time (activPAL3®, median [p5, p95], in hours) spent sitting or reclining was 23.7 [17.2, 24] upon admission and 23.5 [17.8, 24] at discharge. The time spent standing was 0.23 [0.0, 5.0] upon admission and 0.4 [0.0, 4.6] at discharge. The corresponding values for walking were 0.0 [0.0, 0.4] and 0.1 [0.0, 0.5]. SARC-F, admission hand grip strength, calf circumference, and LoS were correlated with physical activity upon admission and discharge (all p < 0.04). For every unit increase in SARC-F, there was a 0.07 h shorter walking time upon discharge. None of the above results differed between patients with and without COVID-19. The level of physical activity in older patients hospitalised during the pandemic was low, and was dependent on muscular function upon admission but not on COVID-19 status. This has ramifications for scenarios other than pandemic clinical scenarios.

Interrupting bedtime to reverse frailty levels in acute care: a study protocol for the Breaking Bad Rest randomized controlled trial

BACKGROUND

Hospitalized older patients spend most of the waking hours in bed, even if they can walk independently. Excessive bedrest contributes to the development of frailty and worse hospital outcomes. We describe the study protocol for the Breaking Bad Rest Study, a randomized clinical trial aimed to promoting more movement in acute care using a novel device-based approach that could mitigate the impact of too much bedrest on frailty.

METHODS

Fifty patients in a geriatric unit will be randomized into an intervention or usual care control group. Both groups will be equipped with an activPAL (a measure of posture) and StepWatch (a measure of step counts) to wear throughout their entire hospital stay to capture their physical activity levels and posture. Frailty will be assessed via a multi-item questionnaire assessing health deficits at admission, weekly for the first month, then monthly thereafter, and at 1-month post-discharge. Secondary measures including geriatric assessments, cognitive function, falls, and hospital re-admissions will be assessed. Mixed models for repeated measures will determine whether daily activity differed between groups, changed over the course of their hospital stay, and impacted frailty levels.

DISCUSSION

This randomized clinical trial will add to the evidence base on addressing frailty in older adults in acute care settings through a devices-based movement intervention. The findings of this trial may inform guidelines for limiting time spent sedentary or in bed during a patient's stay in geriatric units, with the intention of scaling up this study model to other acute care sites if successful.

TRIAL REGISTRATION

The protocol has been registered at clinicaltrials.gov (identifier: NCT03682523).

The Role of Wearable Sensors to Monitor Physical Activity and Sleep Patterns in Older Adult Inpatients: A Structured Review

Low levels of physical activity (PA) and sleep disruption are commonly seen in older adult inpatients and are associated with poor health outcomes. Wearable sensors allow for objective continuous monitoring; however, there is no consensus as to how wearable sensors should be implemented. This review aimed to provide an overview of the use of wearable sensors in older adult inpatient populations, including models used, body placement and outcome measures. Five databases were searched; 89 articles met inclusion criteria. We found that studies used heterogenous methods, including a variety of sensor models, placement and outcome measures. Most studies reported the use of only one sensor, with either the wrist or thigh being the preferred location in PA studies and the wrist for sleep outcomes. The reported PA measures can be mostly characterised as the frequency and duration of PA (Volume) with fewer measures relating to intensity (rate of magnitude) and pattern of activity (distribution per day/week). Sleep and circadian rhythm measures were reported less frequently with a limited number of studies providing both physical activity and sleep/circadian rhythm outcomes concurrently. This review provides recommendations for future research in older adult inpatient populations. With protocols of best practice, wearable sensors could facilitate the monitoring of inpatient recovery and provide measures to inform participant stratification and establish common objective endpoints across clinical trials.

Use of a Multi-Sensor Monitoring Device in an Early Post-operative Mobilization Program

BACKGROUND

The current study aimed to evaluate the validity and feasibility of using a multi-sensor device to monitor patient mobility in a large postoperative population.

METHODS

In this IRB-approved study, postoperative patient posture was recorded using a multi-sensor monitoring device (ViSi Mobile®) and compared with direct observations of patient physical activity. Retrospective cohort analysis of postoperative patient posture data from January to December 2019 was then performed. Patterns of postoperative mobilization were evaluated.

RESULTS

Multi-sensor real-time posture monitoring with the ViSi Mobile® system consistently differentiate between rest and upright posture (sensitivity and specificity, both 100%). During observation of ambulatory events, ViSi Mobile® system correctly recorded a patient's position as upright at each validation time point in 72.7% (8 of 11) of walks. Clinical data from 562 postoperative patients were linked with posture monitoring data. Median duration of posture monitoring was 64 hours (IQR 52.5) and median number of posture positions recorded per patient was 15,370 (IQR 12,685). Median duration of upright position per day was 148.6 minutes (IQR 192.8). Duration in active upright position per day was not associated with risk of readmission (P > .05).

CONCLUSION

Real-time posture data from a multi-sensor monitoring device (ViSi Mobile®) was shown to consistently differentiate rest and active upright position. This novel technology can provide useful insight into adherence and clinical benefit of early mobilization programs.

The impact of an exercise intervention on frailty levels in hospitalised older adults: secondary analysis of a randomised controlled trial

BACKGROUND

physical activity reduces frailty in community-dwelling older adults. How exercise influences frailty in hospitalised older adults requires additional investigation.

OBJECTIVES

(i) to examine the impact of an exercise intervention on frailty in older adults admitted to an acute care ward, and (ii) to determine the impact of baseline frailty on the effectiveness of this intervention.

SETTING/PARTICIPANTS

this is a secondary analysis of a randomised controlled clinical trial that tested an intensive exercise intervention in ≥75-year-old adults admitted to an acute care ward.

METHODS

the intervention included two daily sessions of moderate-intensity exercises (control received usual care). A 63-item Frailty Index (FI) was constructed, and three groups were formed: <0.2, 0.2-0.29 and ≥0.3. Other outcomes included Short Physical Performance Battery (SPPB) and Barthel Index (BI).

RESULTS

a total of 323 individuals were included. The mean age was 87.1 years (± 4.8 standard deviation [SD]) and 56.3% were females. The intervention group improved FI from 0.26 (± 0.10 SD) to 0.20 (± 0.10 SD), whereas the control group FI worsened from 0.25 (± 0.1 SD) to 0.27 (± 0.10 SD). After stratifying by baseline FI, SPPB and depression improved in the intervention group across all levels of frailty; FI, BI and quality of life only improved in individuals with a baseline FI ≥ 0.2.

CONCLUSIONS

frailty improves with an intensive individualised exercise intervention, especially in those with high baseline levels of frailty. In addition, frailty is a useful outcome when examining the impact of an intervention of hospitalised older adults.