[How to encourage patients to increase physical activity during their hospital stay]. / Beweeginterventies tijdens ziekenhuisopnames.

Patients are insufficiently physically active during their hospital stay. Therefore, it is important to develop, evaluate, and implement interventions that encourage patients to be physically active as much as possible. Hastings et al. studied the effect of a supervised walking program called STRIDE. This program appeared effective in terms of reducing discharges to a nursing home, however, the implementation had an exceptionally low reach. In this commentary article, we highlight multifaceted interventions that have an impact on various barriers and facilitators related to physical activity of patients during their hospital stay. We present the Dutch Moving Hospitals ('Beweegziekenhuizen') initiative and highlight three interventions: Ban Bedcentricity ('Beteruit bed'), Hospital Fit and Better by Moving ('BeterBewegen'). Now is the time for interprofessional collaboration to develop, evaluate, and implement interventions that encourage patients to be as physically active as possible during their hospital stay.

Towards a core-set of mobility measures in ageing research: The need to define mobility and its constructs.

BACKGROUND: Mobility is a key determinant and outcome of healthy ageing but its definition, conceptual framework and underlying constructs within the physical domain may need clarification for data comparison and sharing in ageing research. This study aimed to (1) review definitions and conceptual frameworks of mobility, (2) explore agreement on the definition of mobility, conceptual frameworks, constructs and measures of mobility, and (3) define, classify and identify constructs. METHODS: A three-step approach was adopted: a literature review and two rounds of expert questionnaires (n = 64, n = 31, respectively). Agreement on statements was assessed using a five-point Likert scale; the answer options 'strongly agree' or 'agree' were combined. The percentage of respondents was subsequently used to classify agreements for each statement as: strong (≥ 80%), moderate (≥ 70% and < 80%) and low (< 70%). RESULTS: A variety of definitions of mobility, conceptual frameworks and constructs were found in the literature and among respondents. Strong agreement was found on defining mobility as the ability to move, including the use of assistive devices. Multiple constructs and measures were identified, but low agreements and variability were found on definitions, classifications and identification of constructs. Strong agreements were found on defining physical capacity (what a person is maximally capable of, 'can do') and performance (what a person actually does in their daily life, 'do') as key constructs of mobility. CONCLUSION: Agreements on definitions of mobility, physical capacity and performance were found, but constructs of mobility need to be further identified, defined and classified appropriately. Clear terminology and definitions are essential to facilitate communication and interpretation in operationalising the physical domain of mobility as a prerequisite for standardisation of mobility measures.

Extended mobility scale (AMEXO) for assessing mobilization and setting goals after gastrointestinal and oncological surgery: a before-after study.

BACKGROUND: Early structured mobilization has become a key element of Enhanced Recovery After Surgery programs to improve patient outcomes and decrease length of hospital stay. With the intention to assess and improve early mobilization levels, the 8-point ordinal John Hopkins Highest Level of Mobility (JH-HLM) scale was implemented at two gastrointestinal and oncological surgery wards in the Netherlands. After the implementation, however, healthcare professionals perceived a ceiling effect in assessing mobilization after gastrointestinal and oncological surgery. This study aimed to quantify this perceived ceiling effect, and aimed to determine if extending the JH-HLM scale with four additional response categories into the AMsterdam UMC EXtension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale reduced this ceiling effect. METHODS: All patients who underwent gastrointestinal and oncological surgery and had a mobility score on the first postoperative day before (July-December 2018) or after (July-December 2019) extending the JH-HLM into the AMEXO scale were included. The primary outcome was the before-after difference in the percentage of ceiling effects on the first three postoperative days. Furthermore, the before-after changes and distributions in mobility scores were evaluated. Univariable and multivariable logistic regression analysis were used to assess these differences. RESULTS: Overall, 373 patients were included (JH-HLM n = 135; AMEXO n = 238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score before extending the JH-HLM into the AMEXO as compared to 4 (1.7%) patients after (OR = 0.021, CI = 0.007-0.059, p < 0.001). During the first three postoperative days, 118 (87.4%) patients scored the highest possible mobility score before compared to 40 (16.8%) patients after (OR = 0.028, CI = 0.013-0.060, p < 0.001). A change in mobility was observed in 88 (65.2%) patients before as compared to 225 (94.5%) patients after (OR = 9.101, CI = 4.046-20.476, p < 0.001). Of these 225 patients, the four additional response categories were used in 165 (73.3%) patients. CONCLUSIONS: A substantial ceiling effect was present in assessing early mobilization in patients after gastrointestinal and oncological surgery using the JH-HLM. Extending the JH-HLM into the AMEXO scale decreased the ceiling effect significantly, making the tool more appropriate to assess early mobilization and set daily mobilization goals after gastrointestinal and oncological surgery.

Barriers to and solutions for improving physical activity in adults during hospital stay: a mixed-methods study among healthcare professionals.

PURPOSE: To identify healthcare professionals' perspectives on key barriers to improving physical activity in hospitalized adult patients, and to identify solutions to overcome these barriers. METHODS: We used an explanatory sequential mixed-methods study design in a Dutch university hospital. A survey exploring 39 potential barriers was completed by 15 physicians/physician assistants, 106 nurses, four nursing assistants, and four physical therapists working on surgery, internal medicine, and cardiology wards. Next, three in-depth semi-structured focus groups - comprising 30 healthcare professionals - discussed the survey findings to identify key barriers and solutions. Focus group discussions were analyzed using thematic analysis. RESULTS: Five themes were identified that described both the key barriers and the solutions to overcome these barriers. Healthcare professionals proposed several solutions, including clarifying the definition of physical activity, empowering patients to take responsibility for physical activity, giving physical therapists or physicians a prominent role in encouraging physical activity, and changing the hospital ward to entice patients to become physically active. CONCLUSIONS: Healthcare professionals need clear guidelines, roles, and responsibilities when it comes to physical activity. They also need personalized interventions that empower patients in physical activity. Finally, hospital wards should be designed and furnished so that patients are encouraged to be active.IMPLICATIONS FOR REHABILITATIONMany healthcare professionals want to sustainably improve physical activity in hospitalized adults.For this they need clear guidelines that not only define physical activity, but also describe the roles and responsibilities of all members of the medical team.Healthcare professionals need interventions that help to empower patients to take an active role in physical activity during hospital stay.Hospital wards should be designed and furnished so that patients are encouraged to be physically active.

Physical dependence and urinary catheters both strongly relate to physical inactivity in adults during hospital stay: a cross-sectional, observational study.

PURPOSE: To determine which factors are associated with physical inactivity in hospitalized adults of all ages. METHODS: A cross-sectional sample of 114 adults admitted to a gastrointestinal surgery, internal medicine or cardiology hospital ward (median age 60, length of stay 13 days) were observed during one random day from 8 am to 8 pm using wireless accelerometers and behavioral mapping protocols. Factors (e.g., comorbidities, self-efficacy, independence in mobility, functional restraints) were collected from medical records, surveys, and observations. RESULTS: Patients were physically active for median(IQR) 26 (13-52.3) min and were observed to lie in bed for 67.3%, sit for 25.2%, stand for 2.5%, and walk for 5.0% of the time. Multivariable regression analysis revealed that physical inactivity was 159.87% (CI = 89.84; 255.73) higher in patients dependent in basic mobility, and 58.88% (CI = 10.08; 129.33) higher in patients with a urinary catheter (adjusted R2 = 0.52). The fit of our multivariable regression analysis did not improve after adding hospital ward to the analysis (p > 0.05). CONCLUSIONS: Independence in mobility and urine catheter presence are two important factors associated with physical inactivity in hospitalized adults of all ages, and these associations do not differ between hospital wards. Routine assessments of both factors may therefore help to identify physically inactive patients throughout the hospital.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be aware that physical inactivity during hospital stay may result into functional decline.Regardless of which hospital ward patients are admitted to, once patients require assistance in basic mobility or have a urinary catheter they are at risk of physical inactivity during hospital stay.Implementing routine assessments on the independence of basic mobility and urine catheter presence may therefore assist healthcare professionals in identifying physically inactive patients before they experience functional decline.

Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study.

BACKGROUND: Admission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity. OBJECTIVE: This protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge. METHODS: The Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers. RESULTS: This study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021. CONCLUSIONS: This study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients. TRIAL REGISTRATION: Netherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19000.