Shadowing Stroke Patients to Explore the Rehabilitation Built Environment: Approach, Insights, and Lessons Learned.

Shadowing is a research method that combines observing events and short on-the-go interviews to investigate people's roles and behaviours in various settings. Even though it is not a widely used method in architectural research, it can be adapted to focus on the interaction of individuals with the built environment. This is especially important in healthcare environments, where people are vulnerable and more dependent on their surroundings. In this article, I reflect on the experience of adapting and using the shadowing method to explore stroke inpatients' interactions with the built environment during their recovery in rehabilitation centres. This research study was the first to employ shadowing in the stroke patient population on such a large scale. One day (12 consecutive hours) was spent with each of the 70 participating stroke inpatients, recording their interactions with the built environment in different forms - on the floor plans, as narrative descriptions, creating sketches of situations and noting down patients' remarks. This method was useful in capturing the built environment's role in patients' daily experiences in rehabilitation centres. Research in healthcare facilities includes various challenges, and close contact with the patient population of older adults with stroke introduces numerous unexpected events and ethical dilemmas in the field. At the same time, this method provides research insights that would otherwise be unobtainable. Researchers are given practical information and recommendations on how to prepare for using shadowing for architectural research and what to expect in the field.

Enriched Environments in Stroke Units: Defining Characteristics and Limitations.

BACKGROUND: Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units. OBJECTIVE: The aim of this systematic review was to compile the concept of an EE in stroke units. METHODS: The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included. RESULTS: This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements. CONCLUSIONS: To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.

Are We Speaking the Same Language? Terminology Consistency in EBD.

OBJECTIVE: The aim of this study is to analyze the consistency, variability, and potential standardization of terminology used to describe architectural variables (AVs) and health outcomes in evidence-based design (EBD) studies. BACKGROUND: In EBD research, consistent terminology is crucial for studying the effects of AVs on health outcomes. However, there is a possibility that diverse terms have been used by researchers, which could lead to potential confusion and inconsistencies. METHODS: Three recent large systematic reviews were used as a source of publications, and 105 were extracted. The analysis aimed to extract a list of the terms used to refer to the unique concepts of AVs and health outcomes, with a specific focus on people with dementia. Each term's frequency was calculated, and statistical tests, including the χ2 and the post hoc test, were employed to compare their distributions. RESULTS: The study identified representative terms for AVs and health outcomes, revealing the variability in terminology usage within EBD field for dementia-friendly design. The comparative analysis of the identified terms highlighted patterns of frequency and distribution, shedding light on potential areas for standardization. CONCLUSIONS: The findings emphasize the need for standardized terminologies in EBD to improve communication, collaboration, and knowledge synthesis. Standardization of terminology can facilitate research comparability, enhance the generalizability of findings by creating a common language across studies and practitioners, and support the development of EBD guidelines. The study contributes to the ongoing discourse on standardizing terminologies in the field and provides insights into strategies for achieving consensus among researchers, practitioners, and stakeholders in health environmental research.

Indirect Nutrition and Mobility Risks during Hospitalization: An Architectural Perspective on the nutritionDay Study Findings.

Nutrition and mobility risks include complex and interrelated physiological, medical, and social factors. A growing body of evidence demonstrates that the built environment can affect patients' well-being and recovery. Nevertheless, the relationship between the built environment, nutrition, and mobility in general hospitals is largely unexplored. This study examines the implications of the nutritionDay study's results for the architectural design of hospital wards and nutrition environments. This one-day annual cross-sectional study uses online questionnaires in 31 different languages to collect ward-specific and patient-specific variables. The main findings relevant to the design of hospital wards were: (1) 61.5% of patients (n = 48,700) could walk before hospitalization and (2) this number dropped to 56.8% on nutritionDay (p < 0.0001), while the number of bedridden patients increased from 6.5% to 11.5% (p < 0.0001), (3) patients who needed more assistance had a much longer mean LOS than mobile patients, (4) mobility was associated with changes in eating, and (5) 72% of units (n = 2793) offered additional meals or snacks, but only 30% promoted a positive eating environment. The built environment may indirectly affect hospitalized patients' mobility, independence, and nutritional intake. Possible future study directions are suggested to further investigate this relationship.

Stroke Patients' Free-Time Activities and Spatial Preferences During Inpatient Recovery in Rehabilitation Centers.

OBJECTIVES: To investigate which spaces stroke patients visit in their free time while undergoing inpatient recovery in rehabilitation centers, what activities they engage in, and what kind of spaces they want. BACKGROUND: Research studies consistently show that stroke patients are highly inactive during rehabilitation. Much remains unknown about what patients do in their free time and how the built environment might affect their behavior and activities. METHODS: Patients' free-time activities were recorded via patient shadowing (n = 70, 840 hr), and their spatial preferences were collected using a survey (n = 60) in seven rehabilitation centers. Each participant was observed over one typical day (12 consecutive hours). Their activities, durations, and locations were recorded using floor plans and time log sheets. RESULTS: Six main themes emerged from the analysis of shadowing data and patient surveys: (1) spending most free time in their room, (2) corridor as the overlooked activity hub, (3) food and beverage stations as triggers of activity, (4) wanting to socialize, (5) variety of common spaces for different activities is desired, and (6) common room's atmosphere, comfort, style, and view are important. Even though socializing with other patients was mentioned as a primary reason for visiting common spaces in the survey, patients spent most of their free time alone. CONCLUSIONS: Corridor emerged as a space with great potential to motivate and support various activities of patients. Patients' free-time activities could contribute to their recovery, and the built environment may play a role in facilitating and supporting these activities.

"Everything looks the same": wayfinding behaviour and experiences of stroke inpatients in rehabilitation clinics.

PURPOSE: To examine stroke inpatients' real-life wayfinding behaviour and how the built environment of rehabilitation clinics might influence their behaviour and experiences. METHODS: Stroke inpatients in seven rehabilitation clinics were observed (n = 70), each over the course of 12 consecutive hours. Their paths through the clinic and the locations of encountered wayfinding-related events were mapped on the floor plans and described in the written notes. The observations were supplemented by a survey asking patients about their wayfinding experiences. RESULTS: For a third of observed patients, at least one wayfinding-related event was observed on the observation day, and 50% of patients reported getting lost in their clinic at least once. Most wayfinding-related events occurred between patient rooms and therapy rooms, and patients frequently relied on backtracking or the help of the staff to find their way. Clinics' layout organization was found to play a role in the wayfinding behaviour of patients. CONCLUSIONS: Wayfinding is a common challenge that stroke inpatients encounter in rehabilitation clinics. Avoiding multiple decision nodes on the paths between patient rooms and therapy rooms and creating distinct identities for corridor segments in the decision nodes and the areas in front of elevators would likely improve wayfinding performance.

Stroke patients' nonscheduled activity during inpatient rehabilitation and its relationship with the architectural layout: A multicenter shadowing study.

BACKGROUND: Recovery from stroke aims at regaining mobility through performing activities. However, research studies on time use in rehabilitation environments consistently show low activity levels of stroke patients outside their scheduled therapies. It is not clear whether the architectural layout of clinics is related to patients' activity. OBJECTIVES: This study examined the nonscheduled (voluntary) activities of stroke patients during an ordinary day in a rehabilitation clinic to investigate whether and how the built environment contributes to stroke patients' independent activities. METHODS: Patient shadowing was used in seven neurological rehabilitation clinics. Ten patients were observed per clinic (n = 70), each patient for 12 consecutive hours (total 840 hours). Their paths, activities, locations and traveled distances were recorded in relation to the clinics' layouts. RESULTS: Patients spent around 50% of the observed time in their rooms. The frequency of nonscheduled activity was low in all participating clinics (Mdn = 21,2%, IQR 6,5%-21%) compared to the scheduled activity. The median length of the nonscheduled paths for all patients was 43,42 m (average 46,97 m), with significantly longer scheduled paths (average 89,11 m, Mdn = 77,06 m, Mann-Whitney U = 536, n1 = 762, n2 = 225, p < .001, two-tailed). Corridors and seating areas in the corridors were the most frequent destinations of patients' nonscheduled paths. The clinic with the most frequent nonscheduled activity had a distinctive spatial distribution of dining and living spaces. CONCLUSIONS: There is a need to change the architectural layout of rehabilitation clinics to better support patients' nonscheduled activity.