van Delft LMM1, Bor P1, Valkenet K2, Veenhof C2
1University Medical Centre Utrecht, Department of Rehabilitation, Physcial Therapy Science and Sport, Rudolf Magnus Institute of Neurosciences, Utrecht, Netherlands, 2University Medical Centre Utrecht, Department of Rehabilitation, Physcial Therapy Science and Sport, Utrecht, Netherlands
Background: Despite the evidence of the adverse consequences of immobility during hospitalization, patients spend most of the time in bed. While physical activity is a modifiable factor which can prevent in-hospital functional decline, bedrest is deep rooted in the hospital culture. To attack this physical behaviour, Hospital in Motion, a multidimensional and multidisciplinary implementation project, was designed.
Purpose: The purpose of Hospital in Motion is improving patients physical behaviour; reducing the time in bed and improving physical activity. The primary objective of this study is to investigate the effectiveness of the Hospital in Motion on physical behaviour. The secondary objective is to monitor the implementation process, evaluating factors influencing the implementation.
Methods: For this study Hospital in Motion was implemented within two specialisms (cardiology and oncology), with both 2 wards, in a Dutch University Medical Centre. Per ward, multidisciplinary teams were composed and a step-by-step multidimensional implementation approach was followed which included the development and implementation of tailored action plans with multiple interventions to stimulate mobilization and physical activity in daily care of that specific ward. A pre-post observational study was used to evaluate the effectiveness, including 80 patients per time point per specialism. Physical behaviour was measured with the behavioural mapping method (from 9 AM to 4 PM), before, halfway and one year after start of the project. The primary outcome is the percentage of time lying in bed. In addition, the process evaluation was measured, using patient statements (pre/post), a caregivers survey (pre/post) and semi-structured interviews (post) with caregivers.
Results: Prior to the start of Hospital in Motion, 172 patients were observed (cardiology n=86, oncology n=86). Mean age was 60.6 (SD 15.8) and 63.7% was men. These measurements demonstrated that patients spend most of the time lying in bed (cardiology 52,8% and oncology 67,4%), are sitting 31,6% of the time (cardiology 38,1% and oncology 25,1%) and are only 8.3% of the time active (cardiology 9,1% and oncology 7,5%). Patient statements showed that 60% of these patients received information by caregivers about the purpose of mobilization and physical activity. Fifty-eight percent of the patients (cardiology 60,2% and oncology 56,8%) indicated that they were stimulated to go out of bed or be active. The caregivers survey (cardiology n=60, oncology n=40) showed that caregivers inform around 50% (oncology) to 60% (cardiology) of new admissions about the importance of mobilization and physical activity. Halfway measurements were performed in July (cardiology n=43 and oncology n=35) and demonstrated that the time spend in bed decreased (cardiology -4% and oncology -8%) and the time sitting increased (cardiology +4% and oncology +8,5%). The post evaluation will be performed in December 2018.
Conclusion(s): For the congress in May 2019 all analyses will be finished and results will be presented.
Implications:This study will provide information about both the effectiveness of the Hospital in Motion project on physical behaviour as in the procedures of an implementation process aimed to incorporate physical activity in usual care, which will be useful for others interested in changing physical behaviour during hospitalization.
Keywords: Physical behaviour, interdisciplinary care, implementation
Funding acknowledgements: Not applicable
Purpose: The purpose of Hospital in Motion is improving patients physical behaviour; reducing the time in bed and improving physical activity. The primary objective of this study is to investigate the effectiveness of the Hospital in Motion on physical behaviour. The secondary objective is to monitor the implementation process, evaluating factors influencing the implementation.
Methods: For this study Hospital in Motion was implemented within two specialisms (cardiology and oncology), with both 2 wards, in a Dutch University Medical Centre. Per ward, multidisciplinary teams were composed and a step-by-step multidimensional implementation approach was followed which included the development and implementation of tailored action plans with multiple interventions to stimulate mobilization and physical activity in daily care of that specific ward. A pre-post observational study was used to evaluate the effectiveness, including 80 patients per time point per specialism. Physical behaviour was measured with the behavioural mapping method (from 9 AM to 4 PM), before, halfway and one year after start of the project. The primary outcome is the percentage of time lying in bed. In addition, the process evaluation was measured, using patient statements (pre/post), a caregivers survey (pre/post) and semi-structured interviews (post) with caregivers.
Results: Prior to the start of Hospital in Motion, 172 patients were observed (cardiology n=86, oncology n=86). Mean age was 60.6 (SD 15.8) and 63.7% was men. These measurements demonstrated that patients spend most of the time lying in bed (cardiology 52,8% and oncology 67,4%), are sitting 31,6% of the time (cardiology 38,1% and oncology 25,1%) and are only 8.3% of the time active (cardiology 9,1% and oncology 7,5%). Patient statements showed that 60% of these patients received information by caregivers about the purpose of mobilization and physical activity. Fifty-eight percent of the patients (cardiology 60,2% and oncology 56,8%) indicated that they were stimulated to go out of bed or be active. The caregivers survey (cardiology n=60, oncology n=40) showed that caregivers inform around 50% (oncology) to 60% (cardiology) of new admissions about the importance of mobilization and physical activity. Halfway measurements were performed in July (cardiology n=43 and oncology n=35) and demonstrated that the time spend in bed decreased (cardiology -4% and oncology -8%) and the time sitting increased (cardiology +4% and oncology +8,5%). The post evaluation will be performed in December 2018.
Conclusion(s): For the congress in May 2019 all analyses will be finished and results will be presented.
Implications:This study will provide information about both the effectiveness of the Hospital in Motion project on physical behaviour as in the procedures of an implementation process aimed to incorporate physical activity in usual care, which will be useful for others interested in changing physical behaviour during hospitalization.
Keywords: Physical behaviour, interdisciplinary care, implementation
Funding acknowledgements: Not applicable
Topic: Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: UMC Utrecht, the Netherlands
Ethics committee: medical ethics committee (METC)
Ethics number: study protocol number 16-250
All authors, affiliations and abstracts have been published as submitted.
