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Pedersen MM, Juul-Larsen HG, Brødsgaard RH, Jawad B, Bean JF, Petersen J, Bandholm T. Increased knee-extension strength and steps per day after a novel post-hospitalization rehabilitative program in older adults (65+): Secondary analyses of a randomized controlled single-blinded trial using an expanded sample size. Exp Gerontol 2024; 196:112582. [PMID: 39288885 DOI: 10.1016/j.exger.2024.112582] [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: 05/24/2024] [Revised: 09/09/2024] [Accepted: 09/11/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Older adults are at risk of developing new or worsened disability when hospitalized for acute medical illness. This study is a secondary analysis of the STAND-Cph trial on the effect of a simple strength training intervention initiated during hospitalization and continued after discharge. We investigated the between-group difference in change in functional performance outcomes, the characteristics of patients who experienced a relevant effect of the intervention, and the characteristics of those who were compliant with the intervention, using an expanded sample size as protocolized. METHODS The STAND-Cph was a randomized controlled trial conducted at a major Danish university hospital. Acutely admitted older adult patients (65+) from the Emergency Department were randomized to the intervention group receiving progressive strength training and a protein supplement during and after hospitalization (12 sessions over 4 weeks) or control group receiving usual care. The primary outcome was the de Morton Mobility Index assessed at baseline and 4 weeks after discharge. The secondary outcomes were 24-h mobility (assessed by ActivPAL accelerometers), isometric knee-extension strength, 30 s. sit-to-stand performance, and habitual gait speed. RESULTS Between September 2013 and September 2018, a total of 158 patients were included and randomized to either the intervention group (N = 80; mean age 79.9 ± 7.6 years) or the control group (N = 78; mean age 80.8 ± 7.4 years). We found no significant between-group difference in change in our primary outcome (p > 0.05). Both the intention-to-treat (difference in change 0.14 Nm/kg (95 % CI 0.03;0.24), p = 0.01) and the per protocol (difference in change 0.16 Nm/kg (95 % CI 0.04;0.29), p = 0.008) analyses showed that between baseline and 4 weeks, knee-extension strength increased significantly more in the intervention group than in the control group. Also, the per protocol analysis showed that the intervention group increased their daily number of steps significantly more than the control group (difference in change 1088 steps (95 % CI 44; 2132); p = 0.04). When examining subgroups of patients, we found no significant differences neither between those who experienced a clinically relevant improvement in the de Morton Mobility Index and those who did not, nor between those who were compliant and those who were not. CONCLUSION This exploratory analysis indicates that while simple progressive strength training and protein supplementation does not improve functional performance assessed by the de Morton Mobility Index, it can benefit specific facets of physical activity and muscle strength among geriatric patients.
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Affiliation(s)
- Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
| | - Rasmus Hoxer Brødsgaard
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
| | - Baker Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Jonathan F Bean
- New England GRECC, VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130, USA; Department of PM&R, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation, Boston, MA, USA.
| | - Janne Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.
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Piper KS, Oxfeldt M, Pedersen MM, Christensen J. Hospital-induced immobility - a backstage story of lack of chairs, time, and assistance. BMC Geriatr 2024; 24:704. [PMID: 39182057 PMCID: PMC11344450 DOI: 10.1186/s12877-024-05286-6] [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: 06/13/2023] [Accepted: 08/07/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Inactivity and bedrest during hospitalisation have numerous adverse consequences, and it is especially important that older patients are mobile during hospitalisation. This study aimed to identify whether the introduction of formal education of clinical staff and a Mobilisation Initiative (MI) could increase mobilisation of patients in a geriatric and a medical ward. Furthermore, to explore patients' and health care staffs' view on facilitators and barriers for mobilisation during hospitalisation. METHODS The study was a pragmatic clinical study. Both qualitative and quantitative methods were used. The patients' level of mobilisation was obtained through short interview-based surveys and observations. Focus group interviews and formal education of clinical staff was initiated to increase awareness of mobilisation along with the implementation of a MI. RESULTS 596 patient surveys were included. Of all patients, 50% in the geriatric ward and 70% in the medical ward were able to independently mobilise. The highest percentage of patients sitting in a chair for breakfast and lunch in the geriatric ward was 57% and 65%, and in the medical ward 23% and 26%, respectively. A facilitator for mobilisation was interdisciplinary collaboration, and barriers were lack of chairs and time, and the patients' lack of help transferring. CONCLUSIONS This study adds new knowledge regarding the lack of in-hospital mobilisation in geriatric and medical departments. Mealtimes are obvious mobilisation opportunities, but most patients consume their meals in bed. A potential for a MI is present, however, it must be interdisciplinarily and organisationally anchored for further investigation of effectiveness. TRIAL REGISTRATION Retrospectively registered at ClinicalTrials.gov with the trial number NCT05926908.
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Affiliation(s)
- Katrine Storm Piper
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 1-23, Glostrup, 2600, Denmark.
| | - Martin Oxfeldt
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 1-23, Glostrup, 2600, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 1-23, Glostrup, 2600, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Gilson S. Deconditioning in Hospitalized Patients with Cancer. Semin Oncol Nurs 2024; 40:151676. [PMID: 38945732 DOI: 10.1016/j.soncn.2024.151676] [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: 04/02/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Provide an overview of hospital-associated deconditioning in hospitalized patients with cancer, including risk factors and trajectory of deconditioning. Discuss interdisciplinary roles in preventing deconditioning, best practices, and oncology nursing implications. METHODS A literature search was conducted in PubMed and on Google Scholar using search terms Hospital*, Mobility, Immobility, Deconditioning, Cancer, and Oncology. Peer-reviewed research studies, review articles, and websites of professional organizations were reviewed to provide an overview on mobility concerns in hospitalized patients with cancer. RESULTS Thirty-eight references were included in this overview of hospital-associated deconditioning (HAD) in patients with cancer. HAD is a widespread phenomenon with grave consequences. Patients with cancer are particularly vulnerable to HAD due to their cancer diagnosis and treatment effects. Physical activity in hospitalized patients is one of the most important practices to prevent HAD and is achieved through standardized mobility assessment and interdisciplinary collaboration. CONCLUSIONS Promoting mobility in hospitalized patients with cancer is essential to prevent the complications of HAD. IMPLICATIONS FOR NURSING PRACTICE Nurses are leaders of the interdisciplinary approach to enhance inpatient mobility. As they are most often at the bedside, nurses assess patients' level of mobility, recognize risk factors for HAD, and implement safe mobility interventions. Nurses experience barriers to promoting mobility including workforce shortages, high workloads, and competing priorities.
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Affiliation(s)
- Savanna Gilson
- PIH Health Whittier Hospital, Clinical Nurse Specialist, Medical Oncology, Whittier, CA.
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Kobayashi S, Hasegawa S, Yamazaki S, Tsugane T, Takahashi S, Kaneko M, Usuda S. Changes in physical activity level during hospitalization in patients with stroke and those with fracture: a prospective longitudinal study. J Phys Ther Sci 2024; 36:33-43. [PMID: 38186966 PMCID: PMC10766402 DOI: 10.1589/jpts.36.33] [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: 09/25/2023] [Accepted: 10/28/2023] [Indexed: 01/09/2024] Open
Abstract
[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.
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Affiliation(s)
- Sota Kobayashi
- Department of Rehabilitation, Public Nanokaichi Hospital:
643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan
- Department of Rehabilitation Sciences, Gunma University
Graduate School of Health Sciences, Japan
| | - Satoshi Hasegawa
- Department of Rehabilitation, Public Nanokaichi Hospital:
643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan
| | - Shun Yamazaki
- Department of Rehabilitation, Tomioka General Hospital,
Japan
| | - Tsubasa Tsugane
- Department of Rehabilitation, Tomioka General Hospital,
Japan
| | - Shigeru Takahashi
- Department of Rehabilitation, Public Nanokaichi Hospital:
643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan
| | - Mieko Kaneko
- Department of Rehabilitation, Public Nanokaichi Hospital:
643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan
| | - Shigeru Usuda
- Department of Rehabilitation Sciences, Gunma University
Graduate School of Health Sciences, Japan
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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.
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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
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Gallardo-Gómez D, Del Pozo-Cruz J, Pedder H, Alfonso-Rosa RM, Álvarez-Barbosa F, Noetel M, Jasper U, Chastin S, Ramos-Munell J, Del Pozo Cruz B. Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials. Br J Sports Med 2023; 57:1272-1278. [PMID: 37536984 DOI: 10.1136/bjsports-2022-106409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. DESIGN Systematic review and Bayesian model-based network meta-analysis. DATA SOURCES Four databases were searched from inception to 20 June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models. RESULTS Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days). CONCLUSIONS This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population. TRIAL REGISTRATION NUMBER PROSPERO CRD42021271999.
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Affiliation(s)
| | - Jesús Del Pozo-Cruz
- Departamento de Educación Física y Deportes, University of Seville, Sevilla, Spain
| | - Hugo Pedder
- Bristol Medical School (PHS), University of Bristol, Bristol, UK
| | - Rosa M Alfonso-Rosa
- Motricidad Humana y Rendimiento Deportivo, University of Seville, Seville, Spain
| | | | - Michael Noetel
- School of Behavioural and Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Unyime Jasper
- University of Adelaide, South Australia, Adelaide, Australia
| | - Sebastien Chastin
- Institute for Applied Health Research, School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sports Sciences, Universiteit Gent, Gent, Belgium
| | - Javier Ramos-Munell
- Departamento de Educación Física y Deportes, University of Seville, Sevilla, Spain
| | - Borja Del Pozo Cruz
- Department of Physical Education, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz, Cádiz, Spain
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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.
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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
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D'Souza AN, Granger CL, Kay JE, Said CM. Physical activity is low before and during hospitalisation: A secondary observational study in older Australian general medical patients. Australas J Ageing 2023; 42:545-553. [PMID: 37036825 DOI: 10.1111/ajag.13186] [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: 05/23/2022] [Revised: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To quantify physical activity in patients prior to and during an acute general medical hospital admission and explore relationships between mobility, pre- and in-hospital physical activity. METHODS This was a prospective, single-site secondary observational study conducted on general medical wards at a tertiary hospital. Prehospital physical activity was measured via the Physical Activity Scale for the Elderly (PASE; scored 0-400); in-hospital physical activity was measured via accelerometry (time at metabolic equivalents [METs] > 1.5), and mobility was measured via the de Morton Mobility Index (DEMMI). Associations were determined via Spearman's correlations. RESULTS Forty-six participants were included: median age 81 [76-85] years, 59% female, DEMMI on admission 39 [30-49]. Prehospital physical activity was low (PASE median 27.1 [1.6-61.9]). In-hospital physical activity was also low (0.5 [0.2-1.5] hours per day being physically active and 54 [16-194] steps per day taken). No statistically significant relationships existed between pre- and in-hospital physical activity (Spearman's rho (ρ) 0.24, 95% CI -0.08-0.53, p = 0.07). However, physical activity levels in the pre- and in-hospital settings were positively associated with patients' mobility in-hospital (Spearman's ρ 0.44, 95% CI 0.15-0.67, p = 0.002; Spearman's ρ 0.40, 95% CI 0.08-0.645, p = 0.011 respectively). CONCLUSIONS Physical activity is low both before and during a general medical admission. Assessment of usual physical activity patterns should be part of the clinical assessment of patients in general medicine; however, the low activity levels observed indicate a need for valid and reliable tools suitable for an older, frail cohort. Findings will inform the development of physical activity guidelines during hospitalisation.
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Affiliation(s)
- Aruska N D'Souza
- Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine L Granger
- Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqueline E Kay
- Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Catherine M Said
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
- Department of Allied Health, Western Health, Melbourne, Victoria, Australia
- Australian Institute of Musculoskeletal Science, Melbourne, Victoria, Australia
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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.
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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
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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.
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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
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11
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Rojer AGM, Ramsey KA, Trappenburg MC, Meskers CGM, Twisk JWR, Goonan R, Marston C, Kay J, Lim WK, Turbić A, Island L, Denehy L, Parry SM, Reijnierse EM, Pijnappels M, Maier AB. Patterns of Objectively Measured Sedentary Behavior and Physical Activity and Their Association with Changes in Physical and Functional Performance in Geriatric Rehabilitation Inpatients. J Am Med Dir Assoc 2023; 24:629-637.e11. [PMID: 36841261 DOI: 10.1016/j.jamda.2023.01.011] [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: 10/19/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES To examine whether The Ending PyJama (PJ) Paralysis campaign, focused on increasing in-hospital physical activity, affects objectively measured sedentary behavior and physical activity patterns and if these are associated with changes in physical and functional performance in geriatric rehabilitation inpatients. DESIGN Quasi-experimental study. SETTING AND PARTICIPANTS Within the REStORing health of acutely unwell adulTs (RESORT) observational, longitudinal cohort of geriatric rehabilitation inpatients, the Ending PJ Paralysis campaign was implemented on 2 out of 4 wards. METHODS Objectively measured sedentary behavior and physical activity were measured by an inertial sensor (ActivPAL4) for 1 week, comparing control (non-PJ) and intervention (PJ) groups using linear mixed models. Mean sedentary behavior and physical activity measures and their association with physical and functional performance changes were investigated by linear regression analyses, stratified by low vs high performance at admission using the median as a cut-off. RESULTS A total of 145 (n = 68 non-PJ and n = 77 PJ) inpatients with a mean age of 83.0 (7.7) years (55.9% female inpatients) were included. The median nonupright time was 23.1 [22.1-23.6] and 23.0 [21.8-23.6] hours/day for non-PJ and PJ groups, respectively. Objectively measured sedentary behavior and physical activity measures did not significantly change over measurement days and were independent of the Ending PJ Paralysis campaign. For inpatients with low performance at admission, lower sedentary behavior [B(SE) -0.013 (0.005) to -0.157 (0.045), P < .01] and higher physical activity [B(SE) 0.033 (0.007) to 0.814 (0.200), P < .01] measures were associated with improved physical performance. In addition, lower sedentary behaviour [B(SE) = -0.058 (0.024), P < .05 and higher physical activity [B (SE) 0.060 (0.024) to 0.683 (0.182), P < .05] were associated with improved instrumental functional performance. CONCLUSIONS AND IMPLICATIONS In geriatric rehabilitation inpatients, the Ending PJ Paralysis campaign did not affect objectively measured sedentary behavior and physical activity patterns. Lower mean sedentary behaviour and higher physical activity measures were associated with improved physical and functional performance in inpatients with low performance.
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Affiliation(s)
- Anna G M Rojer
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - Keenan A Ramsey
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - Marijke C Trappenburg
- Department of Internal Medicine, Amstelland Hospital, Amstelveen, the Netherlands; Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Carel G M Meskers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - Rose Goonan
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Celia Marston
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Jacqui Kay
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Alisa Turbić
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Louis Island
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia
| | - Selina M Parry
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Healthy Longevity Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Center for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore.
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12
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Arkkukangas M, Strömqvist Bååthe K, Ekholm A, Tonkonogi M. Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15140. [PMID: 36429859 PMCID: PMC9690656 DOI: 10.3390/ijerph192215140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
This study investigated whether strength, balance, body mass index, falls self-efficacy, activity levels, self-rated health, and participation in a multicomponent exercise intervention could predict physical activity levels after 5 months of self-quarantine due to the COVID-19 pandemic. This study included baseline data of 200 community-dwelling older adults (79% women, 21% men) with a mean age of 72 years who participated in a randomized controlled trial investigating a multicomponent exercise program, with 7-month follow-up survey data of their physical activity levels. The results showed significant associations with the activity levels at the 7-month follow-up. The activity levels (odds ratio (OR): 2.83, 95% CI: 1.20-6.71), the self-rated health score (2.80, 1.42-5.53), and being allocated to a specific multicomponent group-based exercise program (2.04, 1.04-4.00) showed a significant association with the activity habits at the 7-month follow-up. As this study suggests, besides the physical activity levels and the self-rated health score, participation in a high challenge multicomponent exercise program was significantly associated with physical activity levels at the 7-month follow-up. This study indicates that a relatively short multicomponent group exercise program (6-9 weeks) can motivate individuals to sustain their own training and activity levels even several months after the program has been paused or terminated. Identifying older adults' physical activity levels and self-rated health scores and prescribing multicomponent group-based exercise programs to promote sustained physical activity habits may be a successful alternative to provide for older adults in the future.
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Affiliation(s)
- Marina Arkkukangas
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
- School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, 721 23 Vasteras, Sweden
- Research and Development in Sörmland, Region Sörmland, 632 17 Eskilstuna, Sweden
| | - Karin Strömqvist Bååthe
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
| | - Anna Ekholm
- Research and Development in Sörmland, Region Sörmland, 632 17 Eskilstuna, Sweden
| | - Michail Tonkonogi
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
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Kalu ME, Dal Bello-Haas V, Griffin M, Ploeg J, Richardson J. A comprehensive mobility discharge assessment framework for older adults transitioning from hospital-to-home in the community—What mobility factors are critical to include? Protocol for an international e-Delphi study. PLoS One 2022; 17:e0267470. [PMID: 36137073 PMCID: PMC9499191 DOI: 10.1371/journal.pone.0267470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Mobility deficits have been identified as an independent risk factor for hospital readmission for adults ≥65 years. Despite evidence indicating how determinants additively influence and predict mobility, no hospital-to-home care transition models comprehensively assess all seven mobility determinants, cognitive, financial, environmental, personal, physical, psychological, and social. There is currently a lack of clarity regarding what factors clinicians and researchers should evaluate for each mobility determinant. The purpose of this e-Delphi study is to prioritize and reach consensus on the factors for each mobility determinant that are critical to assess as part of the Comprehensive Mobility Discharge Assessment Framework (CMDAF) when older adults are discharged from hospital-to-home.
Methods
This protocol paper is an international modified e-Delphi study following the Recommendations for the Conducting and Reporting of Delphi Studies. International researchers, clinicians, older adults and family caregivers residing in a country with universal or near-universal health coverage will be invited to participate as ‘experts’ in three e-Delphi rounds administered through DelphiManager©. The e-Delphi Round 1 questionnaire will be developed based on scoping review findings and will be pilot tested. For each round, experts will be asked to rate factors for each determinant that are critical to assess as part of the CMDAF using a 9-point scale: Not Important (1–3), Important but Not Critical (4–6), and Critical (7–9). The scale will include a selection option of "unable to score" and experts will also be asked to provide a rationale for their scoring and suggest missing factors. Experts will receive feedback summaries in Rounds 2 and 3 to guide them in reflecting on their initial responses and re-rating of factors that have not reached consensus. The criteria for reaching consensus will be if ≥70% of experts rate a factor as "critical" (scores ≥7) and ≤ 15% of experts rate a factor as "not important" (scores≤ 3). Quantitative data will be analyzed using median values, frequencies, percentages, interquartile range, and bar graphs; Wilcoxon matched-pairs signed-rank test will be used to assess the stability of participants’ responses. Rationale (qualitative data) provided in the open-ended comments section will be analyzed using content analysis.
Conclusion
This study is a first step in developing the CMDAF and will be used to guide a subsequent e-Delphi survey to decide on the tools that should be used to measure the examples of each factor included in our framework.
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Affiliation(s)
- Michael E. Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evaluation and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
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14
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Kaizu Y, Kasuga T, Takahashi Y, Otani T, Miyata K. Sleep Should Be Focused on When Analyzing Physical Activity in Hospitalized Older Adults after Trunk and Lower Extremity Fractures-A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10081429. [PMID: 36011086 PMCID: PMC9408561 DOI: 10.3390/healthcare10081429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Although the importance of resting in bed for hospitalized older adults is known, current methods of interpreting physical activity (PA) recommend the use of a broad definition of sedentary behavior (SB) that includes 0−1.5 metabolic equivalents (METs) of sleep (SL) and sitting. We investigated the characteristics of PA by conducting a cross-sectional study of 25 older adults with trunk and lower extremity fractures. The intensity of their PA was interpreted as SL (0−0.9 METs), SB (1−1.5 METs), low-intensity PA (LIPA: 1.6−2.9 METs), and moderate-to-vigorous PA (MVPA: >3.0 METs). We calculated the correlation coefficients to clarify the relationship between each PA intensity level. Our analyses revealed that the PA time (min/day) was accounted for by SB (53.5%), SL (23.2%), LIPA (22.8%), and MVPA (0.5%). We observed negative correlations between SL and SB (r = −0.837) and between SL and LIPA (r = −0.705), and positive correlations between SB and LIPA (r = 0.346) and between LIPA and MVPA (r = 0.429). SL and SB were also found to have different trends in relation to physical function. These results indicate that SL and SB are trade-offs for PA during the day. Separate interpretations of the SL and SB of older hospitalized adults are thus recommended.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma 370-0001, Japan; (Y.K.); (Y.T.)
| | - Takeaki Kasuga
- Department of Rehabilitation Center, Hidaka Rehabilitation Hospital, 2204 Yoshii-machi Maniwa, Takasaki, Gunma 370-2104, Japan;
| | - Yu Takahashi
- Department of Rehabilitation Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma 370-0001, Japan; (Y.K.); (Y.T.)
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology, 1373 Higashinagaoka-cho, Ota, Gunma 373-0812, Japan;
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, 4669-2 Ami-Machi, Inashiki-gun, Ibaraki 300-0394, Japan
- Correspondence: ; Tel.: +81-29-888-4000
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15
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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.
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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
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Schulte LE, Fleiner T, Trumpf R, Wirtz D, Schnorr T, Zijlstra W, Haussermann P. 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] [MESH Headings] [Grants] [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.
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Affiliation(s)
- Laura Elani Schulte
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany.
- Department of Geriatric Psychiatry & Psychotherapy, LVR Hospital Cologne, Wilhelm-Griesinger Straße 23, 51109, Cologne, Germany.
| | - Tim Fleiner
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
- Department of Geriatric Psychiatry & Psychotherapy, LVR Hospital Cologne, Wilhelm-Griesinger Straße 23, 51109, Cologne, Germany
| | - Rieke Trumpf
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
- Department of Geriatric Psychiatry & Psychotherapy, LVR Hospital Cologne, Wilhelm-Griesinger Straße 23, 51109, Cologne, Germany
| | - Daria Wirtz
- Department of Geriatric Psychiatry & Psychotherapy, LVR Hospital Cologne, Wilhelm-Griesinger Straße 23, 51109, Cologne, Germany
| | - Thiemo Schnorr
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
- Department of Geriatric Psychiatry & Psychotherapy, LVR Hospital Cologne, Wilhelm-Griesinger Straße 23, 51109, Cologne, Germany
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Peter Haussermann
- Department of Geriatric Psychiatry & Psychotherapy, LVR Hospital Cologne, Wilhelm-Griesinger Straße 23, 51109, Cologne, Germany
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17
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Karapınar M, Kırdı N, Fırat T. Effectiveness of supervised and functional level-based exercise program in elderly inpatients: Randomised controlled trial. Clin Rehabil 2022; 36:1623-1634. [PMID: 35880264 DOI: 10.1177/02692155221116818] [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
OBJECTIVE The aim of this study was to compare the effectiveness of supervised and unsupervised functional level-based exercises program for elderly inpatients on physical activity, mobility, health-related quality of life and depression status. DESIGN A single-blinded randomised controlled trial. SETTING Internal medicine service. SUBJECTS Patients aged 65 years or older. INTERVENTIONS A supervised functional level-based exercise program was applied to the intervention group by a physiotherapist, for 40 min 5 times a week during their hospitalisation. Patients in the control group were asked to perform an unsupervised functional level-based exercise program which was described by the physiotherapist during the first visit. MAIN MEASURES Mobility, physical activity level and health-related quality of life were assessed at admission and discharge in both groups. Depression status was evaluated at admission and 3 months after discharge. RESULTS Sociodemographic features between intervention group (n = 62) and control group (n = 62) were similar. The intervention group showed a higher increment in mobility, physical activity level and quality of life scores than the control group (d = 0.62, p < 0.05; d = 0.57, p < 0.05; d = 1.12, p < 0.05 respectively). Inpatients in the intervention group, depression scores were lower 3 months after discharge (d = 0.42, p < 0.05). The length of stay in the hospital was not different between the groups. CONCLUSIONS A supervised functional level-based exercise program is more effective than an unsupervised functional level-based exercise program for mobility, physical activity, depression and quality of life in elderly inpatients. These positive contributions are seen within a short period like a 5 to 10 days stay in hospital. TRIAL REGISTRATION ClinicalTrials.gov(NCT03516032).
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Affiliation(s)
- Merve Karapınar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, 52994Suleyman Demirel University, Isparta, Turkey
| | - Nuray Kırdı
- Faculty of Physical Therapy and Rehabilitation, 37515Hacettepe University, Ankara, Turkey
| | - Tüzün Fırat
- Faculty of Physical Therapy and Rehabilitation, 37515Hacettepe University, Ankara, Turkey
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18
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Islam SMS, Nourse R, Uddin R, Rawstorn JC, Maddison R. Consensus on Recommended Functions of a Smart Home System to Improve Self-Management Behaviors in People With Heart Failure: A Modified Delphi Approach. Front Cardiovasc Med 2022; 9:896249. [PMID: 35845075 PMCID: PMC9276993 DOI: 10.3389/fcvm.2022.896249] [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: 03/14/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Smart home systems could enhance clinical and self-management of chronic heart failure by supporting health monitoring and remote support, but evidence to guide the design of smart home system functionalities is lacking. Objective To identify consensus-based recommendations for functions of a smart home system that could augment clinical and self-management for people living with chronic heart failure in the community. Methods Healthcare professionals caring for people living with chronic heart failure participated in a two-round modified Delphi survey and a consensus workshop. Thirty survey items spanning eight chronic health failure categories were derived from international guidelines for the management of heart failure. In survey Round 1, participants rated the importance of all items using a 9-point Liket scale and suggested new functions to support people with chronic heart failure in their homes using a smart home system. The Likert scale scores ranged from 0 (not important) to 9 (very important) and scores were categorized into three groups: 1-3 = not important, 4-6 = important, and 7-9 = very important. Consensus agreement was defined a priori as ≥70% of respondents rating a score of ≥7 and ≤ 15% rating a score ≤ 3. In survey Round 2, panel members re-rated items where consensus was not reached, and rated the new items proposed in earlier round. Panel members were invited to an online consensus workshop to discuss items that had not reached consensus after Round 2 and agree on a set of recommendations for a smart home system. Results In Round 1, 15 experts agreed 24/30 items were "very important", and suggested six new items. In Round 2, experts agreed 2/6 original items and 6/6 new items were "very important". During the consensus workshop, experts endorsed 2/4 remaining items. Finally, the expert panel recommended 34 items as "very important" for a smart home system including, healthy eating, body weight and fluid intake, physical activity and sedentary behavior, heart failure symptoms, tobacco cessation and alcohol reduction, medication adherence, physiological monitoring, interaction with healthcare professionals, and mental health among others. Conclusion A panel of healthcare professional experts recommended 34-item core functions in smart home systems designed to support people with chronic heart failure for self-management and clinical support. Results of this study will help researchers to co-design and protyping solutions with consumers and healthcare providers to achieve these core functions to improve self-management and clinical outcomes in people with chronic heart failure.
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High Challenge Exercise and Learning Safe Landing Strategies among Community-Dwelling Older Adults: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127370. [PMID: 35742618 PMCID: PMC9223480 DOI: 10.3390/ijerph19127370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
There is limited research on optimal exercise programs that effectively decrease falls and fall-related injuries in older populations. This randomized controlled trial (RCT) aimed to explore the effects of a 12-week Judo4Balance program on falling techniques, physical and psychological functions, health status, and physical activity levels among 200 community-dwelling older adults (79% women and 21% men) with a mean age of 72 years. The 200 participants were randomly allocated for the Judo4Balce program (n = 100) or control group (n = 100). The RCT intervention started in mid-January 2020 and was abruptly interrupted because of the COVID-19 pandemic. A restart of the RCT was initiated in September 2021, and the 12-week intervention was offered to two groups. This study reports the results from three points of assessment: baseline, 20-month follow-up, and 12-week postintervention. At 20 months follow-up, the control group had significantly decreased physical activity levels (summer p = 0.002 and winter p = 0.003); similar changes were not seen in the exercise group. In the exercise group, learning falling techniques in 6−9 weeks led to sustained fall competence at 20 months follow-up. Further, significant improvements in physical function (exercise group p = 0.009 and control group p < 0.001) and learning falling techniques (p < 0.001 for both groups) were noted in both groups after the 12-week intervention. This effective, supervised, group-based, high-challenge multicomponent exercise program needs to be further evaluated for possible impact on falls and fall-related injuries.
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van Dijk-Huisman HC, Welters MHP, Bijnens W, van Kuijk SMJ, Magdelijns FJH, de Bie RA, Lenssen AF. Development and internal validation of a prediction model to identify older adults at risk of low physical activity levels during hospitalisation: a prospective cohort study. BMC Geriatr 2022; 22:479. [PMID: 35659569 PMCID: PMC9164480 DOI: 10.1186/s12877-022-03146-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Inactive behaviour is common in older adults during hospitalisation and associated with poor health outcomes. If patients at high risk of spending little time standing/walking could be identified early after admission, they could be given interventions aimed at increasing their time spent standing/walking. This study aims to identify older adults at high risk of low physical activity (PA) levels during hospitalisation. Methods Prospective cohort study of 165 older adults (≥ 70 years) admitted to the department of Internal Medicine of Maastricht University Medical Centre for acute medical illness. Two prediction models were developed to predict the probability of low PA levels during hospitalisation. Time spent standing/walking per day was measured with an accelerometer until discharge (≤ 12 days). The average time standing/walking per day between inclusion and discharge was dichotomized into low/high PA levels by dividing the cohort at the median (50.0%) in model 1, and lowest tertile (33.3%) in model 2. Potential predictors—Short Physical Performance Battery (SPPB), Activity Measure for Post-Acute Care (AM-PAC), age, sex, walking aid use, and disabilities in activities of daily living—were selected based on literature and analysed using logistic regression analysis. Models were internally validated using bootstrapping. Model performance was quantified using measures of discrimination (area under the receiver operating characteristic curve (AUC)) and calibration (Hosmer and Lemeshow (H–L) goodness-of-fit test and calibration plots). Results Model 1 predicts a probability of spending ≤ 64.4 min standing/walking and holds the predictors SPPB, AM-PAC and sex. Model 2 predicts a probability of spending ≤ 47.2 min standing/walking and holds the predictors SPPB, AM-PAC, age and walking aid use. AUCs of models 1 and 2 were .80 (95% confidence interval (CI) = .73—.87) and .86 (95%CI = .79—.92), respectively, indicating good discriminative ability. Both models demonstrate near perfect calibration of the predicted probabilities and good overall performance, with model 2 performing slightly better. Conclusions The developed and internally validated prediction models may enable clinicians to identify older adults at high risk of low PA levels during hospitalisation. External validation and determining the clinical impact are needed before applying the models in clinical practise. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03146-9.
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21
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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.
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22
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van Dijk - Huisman HC, Raeven-Eijkenboom PH, Magdelijns FJH, Sieben JM, de Bie RA, Lenssen AF. Barriers and enablers to physical activity behaviour in older adults during hospital stay: a qualitative study guided by the theoretical domains framework. BMC Geriatr 2022; 22:314. [PMID: 35399054 PMCID: PMC8994876 DOI: 10.1186/s12877-022-02887-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Older adults admitted with an acute medical illness spent little time active during hospitalisation and this has been associated with negative health outcomes. Understanding which barriers and enablers influence the physical activity behaviour of hospitalised older adults is a first step towards identifying potentially modifiable factors and developing, evaluating and implementing targeted interventions aimed at increasing their physical activity behaviour. Using a theoretical framework has been found to be more successful in changing behaviour than using a non-theory driven approach. This study aimed to explore barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness, as perceived by patients and healthcare professionals, and to categorise them using the Theoretical Domains Framework (TDF).
Methods
A qualitative study was conducted at a combined university and regional hospital in the Netherlands between January 2019 and February 2020. Older adults (≥70 years) admitted with an acute medical illness, and healthcare professionals (nurses, physicians, physiotherapists) were recruited using purposive sampling. Semi-structured interviews were audiotaped, transcribed and analysed using directed qualitative content analysis. Barriers and enablers to physical activity behaviour during hospitalisation were identified and coded using the TDF.
Results
Meaning saturation was determined after interviews with 12 patients and 16 healthcare professionals. A large number of barriers and enablers were identified and each categorised to 11 of the 14 domains of the TDF. The ‘Environmental Context and Resources’ domain in particular yielded many examples, and revealed that the hospital environment exerts an inactivating influence on patients.
Conclusions
The large number of identified barriers and enablers highlights the complexity of influencing older adults’ physical activity behaviour during hospitalisation. This overview of barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness represents an initial step towards developing, evaluating and implementing theory-informed behaviour change interventions to improve hospitalised older adults’ physical activity levels. It can assist clinicians and researchers in selecting modifiable factors that can be targeted in future interventions.
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Pedersen BS, Kirk JW, Olesen MK, Grønfeldt BM, Stefánsdóttir NT, Brødsgaard R, Tjørnhøj-Thomsen T, Nilsen P, Andersen O, Bandholm T, Pedersen MM. Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients-the WALK-Copenhagen project (WALK-Cph). Pilot Feasibility Stud 2022; 8:80. [PMID: 35397574 PMCID: PMC8994315 DOI: 10.1186/s40814-022-01033-z] [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] [Received: 03/22/2021] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mobility interventions can prevent functional decline among older patients, but implementation of such interventions may be complicated by barriers in the clinical setting. The WALK-Copenhagen project (WALK-Cph) is aimed at promoting a 24-h mobility among older medical patients during hospitalization. The WALK-Cph intervention was co-designed by researchers and stakeholders to tailor the intervention to the clinical context. The aim of this study was to investigate the feasibility and implementation fidelity of the WALK-Cph intervention before evaluating clinical effectiveness in a randomized controlled trial (ClinicalTrials.gov NCT03825497). METHODS The WALK-Cph intervention consisted of six components: a welcome folder explaining the importance of in-hospital activity, a WALK-plan prescribing up to three daily walking sessions during and after hospitalization, a WALK-path in the hallway that patients were motivated to use daily, exercise posters in the hallways and bedrooms, self-service on beverages and clothes, and discharge with a WALK-plan. The present study reports on phase 2 of WALK-Cph and consists of a feasibility and a fidelity component. The study was conducted at the two WALK-Cph intervention departments after the initiation of the WALK-Cph intervention. A cohort of older medical patients (+65) was recruited for the feasibility study to assess recruitment and data collection procedures and the method for assessment of activity. Simultaneously, implementation fidelity was assessed by observing clinical practice and intervention delivery at the intervention departments. RESULTS A feasibility cohort of 48 patients was included. Inclusion was considered feasible with recruitment rates between 62% and 70% of all eligible patients. Also, data collection was conducted without obstacles, and all patients accepted to wear activity monitors. The fidelity observations showed that three of the six intervention components were partially implemented as planned whereas three components were not implemented as planned. CONCLUSION The WALK-Cph intervention was found feasible, and although the intervention was not implemented with fidelity, the level of fidelity was considered sufficient to continue with further testing of the WALK-Cph intervention in a large-scale trial. TRIAL REGISTRATION ClinicalTrials.gov NCT03825497 (retrospectively registered). Protocol PubMed ID (PMID): 29523569.
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Affiliation(s)
- Britt Stævnsbo Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Maren Kathrine Olesen
- Department of Endocrinology, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Birk Mygind Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Nina Thórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Rasmus Brødsgaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark.,The Emergency Department, Copenhagen University Hospital, Amager and Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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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.
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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
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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.
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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
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Levin C, Rand D, Gil E, Agmon M. The relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults - A systematic review. J Clin Nurs 2021. [PMID: 34741360 DOI: 10.1111/jocn.16085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Although low ambulation among older adults has been linked to a broad range of adverse outcomes during and after acute hospitalisation, a systematic inquiry of the link between step count and these consequences is required. Therefore, the main purpose of this study is to systematically review the relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults. METHODS The electronic databases MEDLINE, CINAHL, and Embase were searched for studies including older adults (above age 65) hospitalised in acute internal wards. The search included the following key terms: 'accelerometer', 'step count', 'hospital', 'internal ward', and 'older adults'. Step count measurement linked to short- and/or long-term outcome(s) during and/or after hospitalisation. All types of articles (except reviews) in English from 1990 to May 2020 were considered. The Newcastle-Ottawa Scale was used to assess the quality of the included observational studies. Randomised controlled trials (RCT) were evaluated using the PEDro scale. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed. RESULTS The search yielded 1340 articles, and of those, the inclusion criteria were met by 12 studies: eight prospective, three interventional (one randomised controlled trial), and one case-control. These studies included three major adverse hospitalisation outcomes associated with step count: functional decline, longer length of stay, and higher re-hospitalisation rate; however, the large heterogeneity in the studies' methodology makes meta-analysis impossible. CONCLUSIONS Daily step count during hospitalisation of older adults is negatively associated with adverse outcomes, but causation cannot be inferred due to inconsistent outcomes and various methodological limitations. More studies are needed to illuminate causal pathways and mechanisms underlying these relationships, especially to differentiate between the relative contribution of personal versus environmental factors.
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Affiliation(s)
- Chedva Levin
- Nursing Department, Faculty of School of Life and Health Sciences, The Jerusalem College of Technology-Lev Academic Center, Jerusalem, Israel
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Debbie Rand
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Gil
- Clalit Health Services, Faculty of Medicine, Haifa and West Galilee and Carmel Hospital, Technion, Haifa, Israel
| | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Elías MN, Munro CL, Liang Z. Graphic Representation of Hourly Activity Counts May Identify Discharge Outcomes for Older Adults After Critical Illness. Rehabil Nurs 2021; 46:247-252. [PMID: 33492069 PMCID: PMC11073790 DOI: 10.1097/rnj.0000000000000312] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE After transitioning from an intensive care unit (ICU), hospitalized older adults are inactive, which may affect discharge outcomes. We examined trends between post-ICU hourly activity counts and discharge disposition among hospitalized older ICU survivors. DESIGN A prospective, exploratory research design was used in this study. METHODS We enrolled older ICU survivors within 24-48 hours of ICU discharge. Actigraphy measured post-ICU hourly activity counts (0:00 a.m.-23:59 p.m.). Chart review provided discharge disposition. Analyses were conducted to illustrate trends between post-ICU hourly activity counts and discharge disposition. FINDINGS Mean hourly activity was about 2,233 ± 569 counts/hour. Graphs revealed trends between hourly activity counts and discharge disposition. Participants with lower post-ICU activity counts, especially during daytime hours, tended to be discharged to a care facility. CONCLUSIONS Future nursing research should determine whether post-ICU inactivity during hospitalization is a modifiable risk factor for worse discharge outcomes. CLINICAL RELEVANCE Activity could be a prognostic indicator of discharge disposition for older ICU survivors.
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Affiliation(s)
- Maya N Elías
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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Ramsey KA, Loveland P, Rojer AGM, Denehy L, Goonan R, Marston C, Kay JE, Brenan J, Trappenburg MC, Lim WK, Reijnierse EM, Meskers CGM, Maier AB. Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings. J Am Med Dir Assoc 2021; 22:2432-2439.e1. [PMID: 34022152 DOI: 10.1016/j.jamda.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to describe objectively measured physical activity and sedentary behavior in geriatric rehabilitation patients receiving care in the home-based compared to the hospital-based setting. DESIGN Observational matched cohort study. SETTING AND PARTICIPANTS Home-based (patient's home) or hospital-based (ward) geriatric rehabilitation was delivered to inpatients within the REStORing health of acutely unwell adulTs (RESORT) observational, longitudinal cohort of the Royal Melbourne Hospital (Melbourne, Victoria, Australia). METHODS Patients were asked to wear ActivPAL4 accelerometers for 1 week and were assessed by a comprehensive geriatric assessment at admission, discharge, and followed up after 3 months. Hospital-based patients were matched to home-based patients for sex and baseline physical function [Short Physical Performance Battery (SPPB), activities (instrumental) of daily living, and Clinical Frailty Scale]. Differences in patient characteristics and physical activity (total, standing and walking durations, number of steps and sit-to stand transitions) and sedentary behavior (total, sitting and lying durations) were assessed. RESULTS A total of 159 patients were included: 18 home-based [mean age: 81.9 ± 8.6 years, 38.9% female, median (interquartile range [IQR]) SPPB: 7.0 (5.0-9.0)] and 141 hospital-based [mean age: 82.9 ± 7.8 years, 57.4% female, median (IQR) SPPB: 1.0 (0.0-4.0)] patients, of whom 18 were matched [mean age: 80.1 ± 7.4 years, 38.9% female, median (IQR) SPPB: 6.5 (4.8-10.0)]. Median physical activity measures were consistently higher in home-based patients compared to the total group of hospital-based patients. After matching, physical activity measures remained >2.4 times higher and were significantly different for all measures (total physical activity, standing and walking durations, and steps) except for sit-to-stand transitions. Sedentary behaviors were similar with home-based patients spending non-significantly more time sitting but significantly less time lying than hospital-based patients (matched and total). CONCLUSIONS AND IMPLICATIONS Home-based inpatients are more physically active than hospital-based inpatients independent of matching for sex and baseline physical function, which supports home-based geriatric rehabilitation.
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Affiliation(s)
- Keenan A Ramsey
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Paula Loveland
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anna G M Rojer
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia
| | - Rose Goonan
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Celia Marston
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jacqueline E Kay
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jacinta Brenan
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Marijke C Trappenburg
- Department of Internal Medicine, Amstelland Hospital, Amstelveen, the Netherlands; Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Carel G M Meskers
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Centre for Healthy Longevity, National University Health System, Singapore.
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Scott J, Abaraogu UO, Ellis G, Giné-Garriga M, Skelton DA. A systematic review of the physical activity levels of acutely ill older adults in Hospital At Home settings: an under-researched field. Eur Geriatr Med 2021; 12:227-238. [PMID: 33058019 PMCID: PMC7557152 DOI: 10.1007/s41999-020-00414-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this review was to identify, evaluate and synthesise existing evidence reporting the physical activity levels of acutely ill older patients in a 'Hospital At Home' setting and compare this to patients with similar characteristics treated in a traditional hospital inpatient setting. Functional changes and any adverse outcomes due to physical activity (e.g. falls) in both settings where PA was reported or recorded were also evaluated as secondary outcomes. METHODS A search strategy was devised for the MEDLINE, CINAHL, AMed, PEDRO, OT Seeker and Cochrane databases. Search results were title, abstract and full-text reviewed by two independent researchers. Data were extracted from included articles using a custom form and assessed for quality and risk of bias using the Appraisal Tool for Cross-Sectional Studies. RESULTS No studies set in the Hospital at Home environments were identified. 16 hospital inpatient studies met the criteria for inclusion. Older patients managed in inpatient settings that would be eligible for Hospital at Home services spent 6.6% of their day active and undertook only 881.8 daily steps. Functional change was reported in four studies with both improvement and decline during admission reported. CONCLUSION There is a lack of published research on the physical activity levels of acutely-ill older adults in Hospital at Home settings. This review has identified a baseline level of activity for older acutely ill patients that would be suitable for Hospital at Home treatment. This data could be used as a basis of comparison in future hospital at home studies, which should also include functional change outcomes to further explore the relationship between physical inactivity and functional decline.
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Affiliation(s)
- Jennifer Scott
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Ukachukwu O Abaraogu
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Medical Rehabilitation, University of Nigeria, Enugu, Nigeria
| | - Graham Ellis
- NHS Lanarkshire, Monklands Hospital, Monkscourt Ave, Airdrie, UK
| | - Maria Giné-Garriga
- Blanquerna Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, Barcelona, Spain
- Blanquerna Faculty of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Dawn A Skelton
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Martínez-Velilla N, Sáez de Asteasu ML, Ramírez-Vélez R, Zambom-Ferraresi F, García-Hermoso A, Izquierdo M. Recovery of the Decline in Activities of Daily Living After Hospitalization Through an Individualized Exercise Program: Secondary Analysis of a Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2021; 76:1519-1523. [PMID: 33522565 DOI: 10.1093/gerona/glab032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND During the period of hospitalization, patients can develop functional decline. The main aim of our study was to assess the natural trajectory of each activity of daily living (ADL) and to assess how in-hospital exercise could influence short-term trajectory of ADLs. METHOD Acutely hospitalized patients (n = 297, 56.5% women) were randomly assigned to the intervention or control (usual care) group within the first 48 hours of admission. An exercise training program was prescribed in 2 daily sessions (morning and evening) of 20 minutes duration during 5-7 consecutive days for the intervention group. The primary endpoint was the change in every ADL (assessed with the Barthel Index) from 2 weeks before admission to hospital discharge. RESULTS Acute hospitalization per se led to significant in-patient's functional ability impairment in ADLs during hospitalization, whereas the exercise intervention reversed this trend (3.7 points; 95% CI: 0.5-6.8 points). After analyzing the trajectory of each one of the ADLs, patients in the control group significantly worsened all activities, but with a different degree of loss. For the between-group analysis, significant differences were obtained in many ADLs including bathing, dressing, grooming, bladder control, toilet use, transfers, mobility, and climbing stairs (p < .05). The control group had the greatest impairment in all domains analyzed (ie, feeding, bathing, dressing, grooming, bowel control, bladder control, toilet use, transfers, mobility, and climbing stairs; p < .05). CONCLUSIONS An individualized multicomponent exercise training program in older adults is effective to reverse the loss of specific ADLs that frequently occurs during hospitalization. Each patient profile should receive an individualized prescription of exercise during hospitalizations. CLINICAL TRIALS REGISTRATION NUMBER NCT02300896.
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Affiliation(s)
- Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Department of Geriatric Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Elías MN, Munro CL, Liang Z. Daytime Activity Is Associated With Discharge to Home in Older Adults Recovering From Critical Illness. J Gerontol Nurs 2021; 47:13-19. [PMID: 33497446 PMCID: PMC10467819 DOI: 10.3928/00989134-20210107-03] [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: 06/24/2020] [Accepted: 10/02/2020] [Indexed: 11/20/2022]
Abstract
Hospitalized older adults recovering from critical illness after transition of care out of an intensive care unit (ICU) are often inactive, which may affect discharge disposition and hospital length of stay (LOS). The current study explored relationships between early post-ICU activity, discharge disposition, and LOS. Actigraphy measured post-ICU daytime and nighttime activity (mean activity counts/min). Prospective chart review provided discharge disposition and LOS (days). Independent samples t tests compared post-ICU daytime activity by discharge disposition. Multivariate regression examined associations between post-ICU activity and LOS. Post-ICU daytime activity was greater among those discharged home (54.42 [SD = 29.3 counts/min]) than those discharged to a facility (33.26 [SD = 24.26 counts/min]): t(26) = 2.054, p = 0.050). Lower post-ICU daytime activity was associated with longer LOS (β = -0.322, p = 0.041). Future research should investigate whether post-ICU daytime inactivity during hospitalization is a modifiable risk factor for worse outcomes among older adults discharged from the ICU. [Journal of Gerontological Nursing, 47(2), 13-19.].
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Virgara R, Phillips A, Lewis L, Richardson M, Maher C. Development of Australian physical activity and screen time guidelines for outside school hours care: an international Delphi study. Int J Behav Nutr Phys Act 2021; 18:3. [PMID: 33407628 PMCID: PMC7789289 DOI: 10.1186/s12966-020-01061-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children's activity patterns in the periods before and after school make a key contribution to achieving 24-h movement guidelines. There are currently no national-level guidelines informing physical activity and screen time practices in Outside School Hours Care (OSHC) programs anywhere in the world. This study aimed to work with industry, government and academic stakeholders to develop draft physical activity and screen time guidelines for use in Australian OSHC. METHODS A 4-round online Delphi survey was conducted from May 2019 to January 2020. The Delphi participants included national and international experts and stakeholders from academia, education, government, health and the OSHC sectors. Round 1 consisted of open-ended questions exploring physical activity, screen time and sedentary behaviour in various periods of OSHC (before school, after school and vacation care). In rounds 2 and 3, participants rated the importance of items generated from the first round for inclusion in national guidelines using a Likert scale (1-9). Consensus was defined a priori as ≥80% of respondents rating an item as "critically important" (score 7-9). Between rounds 3 and 4, the guideline development panel used the consensus items, systematic review evidence, and followed the GRADE process, to draft the guidelines. In round 4, participants were invited to provide feedback on the draft guidelines and comment on barriers and enablers to implementation. RESULTS Sixty-seven stakeholders agreed to participate, with response rates 61, 81, 54 and 72% for the four rounds respectively. Of the 123 items generated across the three rounds, 48 statements achieved consensus agreement as critically important for inclusion in the guidelines. These included offering a variety of physical activities (free play, playground and equipment) and restriction of screen time. The final round provided feedback on the draft guidelines. The wording of the guidelines was found to be appropriate and preliminary enablers and barriers to implementation were identified. CONCLUSIONS This world-first expert and stakeholder consultation has underpinned the development of the draft Australian guidelines for physical activity and screen time in OSHC. Ongoing work is needed to further refine the guidelines, determine current rates of compliance with the guidelines and implement the guidelines into practice.
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Affiliation(s)
- Rosa Virgara
- Allied Health and Human Performance, University of South Australia, c/o GPO Box 2471, SA, 5001, Adelaide, Australia.
| | - Anna Phillips
- Allied Health and Human Performance, University of South Australia, c/o GPO Box 2471, SA, 5001, Adelaide, Australia
| | - Lucy Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Carol Maher
- Allied Health and Human Performance, University of South Australia, c/o GPO Box 2471, SA, 5001, Adelaide, Australia
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Arkkukangas M. Keep on and keep up the fall prevention work: older adults need evidence-based fall prevention actions now more than ever! EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1864160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Marina Arkkukangas
- Research and Development in Sörmland, Sörmland, Sweden
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Levels of Physical Activity and Sedentary Behavior During and After Hospitalization: A Systematic Review. Arch Phys Med Rehabil 2020; 102:1368-1378. [PMID: 33347891 DOI: 10.1016/j.apmr.2020.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To systematically review and synthesize the evidence on physical activity and sedentary behavior during and after hospitalization. DATA SOURCES Electronic databases and reference lists of relevant articles were searched from 2000 to April 2020. STUDY SELECTION Studies which continuously monitored physical activity and/or sedentary behavior in hospitalized adults across 2 settings (ie, without a break in measurement between settings). Monitoring could occur from an acute to a subacute or rehabilitation hospital setting, an acute setting to home, or from a subacute or rehabilitation setting to home. DATE EXTRACTION Data extraction and methodological quality assessments were independently performed by 2 reviewers using standardized checklists. DATA SYNTHESIS A total of 15 of the 5579 studies identified were included. The studies were composed of heterogenous patient populations. All studies monitored patients with either an accelerometer and/or pedometer and reported a variety of measures, including steps per day, sedentary time, and activity counts. The majority of studies (12 of 15) showed that patients engaged in 1.3 to 5.9 times more physical activity and up to 67% less daily sedentary behavior at home after discharge from acute or subacute settings. CONCLUSIONS Patients engaged in more physical activity and less sedentary behavior at home compared to both the acute and subacute hospital settings. This may reflect the natural course of recovery or the effect of setting on activity levels. Enabling early discharge home through the implementation of home-hospitalization models may result in increased patient physical activity and reduced sedentary behavior. Further experimental studies are required investigating the effect of home-based models of care on physical activity and sedentary behavior.
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Baldwin CE, Phillips AC, Edney SM, Lewis LK. Core Domains for Research on Hospital Inactivity in Acutely Ill Older Adults: A Delphi Consensus Study. Arch Phys Med Rehabil 2020; 102:664-674. [PMID: 33253693 DOI: 10.1016/j.apmr.2020.10.136] [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: 05/26/2020] [Revised: 08/24/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify core domains for research studies of physical activity and sedentary behavior during hospitalization for older adults with an acute medical illness. DESIGN A 4-Round Delphi consensus process. Round 1 invited responses to open-ended questions to generate items for the core domains research. In rounds 2-4, participants were invited to use a Likert scale (1-9) to rate the importance of each core domain for research studies of physical activity and/or sedentary behavior in hospitalized older adults with an acute medical illness. SETTING Online surveys. PARTICIPANTS A total of 49 participants were invited to each round (international researchers, clinicians, policy makers and patients). Response rates across rounds 1-4 were 94%, 88%, 83% and 81%, respectively. INTERVENTIONS None. MAIN OUTCOME MEASURES Consensus was defined a priori as ≥70% of respondents rating an item as "critical" (score≥7) and ≤15% of respondents rating an item as "not important" (score≤3). RESULTS In round 2, a total of 9 of 25 core domains reached consensus agreement (physical functioning, general, role functioning, emotional functioning, global quality of life, hospital, psychiatric, cognitive functioning, carer burden). In round 3, an additional 8 reached consensus (adverse events, perceived health status, musculoskeletal, social functioning, vascular, cardiac, mortality, economic). Round 4 participants provided further review and a final rating of all 17 core domains that met consensus in previous rounds. Four core domains were rated as "critically important" to evaluate: physical functioning, social functioning, emotional functioning, and hospital outcomes. CONCLUSIONS This preliminary work provides international and expert consensus-based core domains for development toward a core-outcome set for research, with the ultimate goal of fostering consistency in outcomes and reporting to accelerate research on effective strategies to address physical activity and/or sedentary behavior in older adults while hospitalized.
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Affiliation(s)
- Claire E Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Anna C Phillips
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah M Edney
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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