L.M.M. van Delft1,2, P. Bor1,2, K. Valkenet1, C. Veenhof1,3
1University Medical Center Utrecht, Department of Rehabilitation, Physiotherapy Science and Sport, Utrecht, Netherlands, 2University Medical Center Utrecht, Brain Center, Utrecht, Netherlands, 3HU University of Applied Sciences, Research Group Innovation of Human Movement Care, Utrecht, Netherlands
Background: Although there is extensive literature describing the detrimental effects of immobility, bedrest and inactivity are still deeply rooted in the hospital culture. To overcome this culture and create more sustainable changes, there is a need for effective interventions that integrate physical activity in usual care. Multi-component interventions focusing on patients, health care providers (HCP) and environment have proven to be more effective than single or mono-disciplinary interventions. Therefore, Hospital in Motion, a multidimensional and multidisciplinary implementation project to improve movement behavior during hospitalization was developed.
Purpose: The primary purpose of this study was to investigate the effectiveness of the Hospital in Motion project on movement behavior. Secondary outcomes were length of hospital stay, discharge destination, 30-days readmission, mortality and immobility-related complications. Furthermore, reach and adoption of the implemented interventions and the project itself was evaluated.
Methods: Hospital in Motion was implemented at four wards of an Academic Hospital in the Netherlands. Per ward, multidisciplinary teams followed a step-by-step approach for the development and implementation of a ward-specific action plan with multiple interventions. The interventions were classified into five topics: education of staff and patients, integration of physical activity in daily care, involvement of third parties such as family members or volunteers, creation of a stimulating environment and mobilization milestones & technology support. A prospective pre-post design was used. Inpatients’ movement behavior was assessed using the behavioral mapping method, where patients were observed for one day between 9AM and 4PM. The reach and adoption were evaluated using surveys among HCPs. Differences before and after implementation were analyzed using the chi-square test for dichotomized variables, the Mann Whitney test, or independent samples t-test for continuous data.
Results: Patient-observations (n=171 and n=163) demonstrated that the time spent lying decreased from 60.1% to 52.2% (p=0.01). The time sitting increased from 31.6% to 38.3% (p=0.01) and the number of discharges to a rehabilitation setting reduced from 6 (4.4%) to 1 (0.7%) (p=0.04). No statistical differences were found in the other secondary outcome measures. In total 15 interventions were included within the implemented actions plans. The familiarity of HCPs per intervention ranged from 54% to 84%. The results from the HCP survey (n=94 and n=83) showed significant increases in the number of HCPs reporting the level of physical function (60% to 74%), Furthermore, significantly more HCPs stated to discuss the importance of physical activity with inpatients and during the daily doctors visit (54% to 69% and 51 to 56%, respectively). Significantly more patients stated to have performed exercises by themselves.
Conclusion(s): Despite the large range in the familiarity of HCPs with the single interventions included in the action plans, the implementation of the multidimensional project Hospital in Motion was associated with less time spent in bed by patients. However, more effort is needed to increase the time spent moving by patients.
Implications: Implementation of interventions to promote physical activity in daily care is challenging but possible. To increase the familiarity of interventions, not to many interventions should be implemented at the same time. Per intervention, the implementation should comprise multiple dimensions.
Funding, acknowledgements: None
Keywords: Movement behavior, Implementation project, Process evaluation
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? Yes
Institution: University Medical Center Utrecht, Utrecht, the Netherlands
Committee: The Local Medical Ethics Committee
Ethics number: study protocol number 16-250
All authors, affiliations and abstracts have been published as submitted.
