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

Geelen, Sven J G; Giele, Boukje M; Engelbert, Raoul; Moree, Sandra de; Veenhof, Cindy; Nollet, Frans; Nes, Fenna van; Schaaf, Marike van der

doi:10.1080/09638288.2021.1879946

Cited by 11 publications

(33 citation statements)

References 39 publications

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“…Clinical staff in this study emphasised that doctors played a central role in the delivery of physical activity education because patients value doctors' advice 15 and are more likely to comply with it 16 . According to Geelen et al, physicians agree on the need to encourage physical activity participation 17 . However, they may lack the necessary time and knowledge or perceive that providing advice and encouragement is secondary to their role in managing medical illnesses 16 .…”

Section: Discussionmentioning

confidence: 95%

“… 16 According to Geelen et al, physicians agree on the need to encourage physical activity participation. 17 However, they may lack the necessary time and knowledge or perceive that providing advice and encouragement is secondary to their role in managing medical illnesses. 16 With patients more likely to engage in physical activity if advised by physicians 18 , 19 and other staff adhering to physical activity goals when they are suggested and followed up by a physician, 20 there is a need to explore how doctors can better integrate the provision of education about improving physical activity and reducing SB within their routine workflows.…”

Section: Discussionmentioning

confidence: 99%

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Exploring the perspectives of clinicians on solutions to tackling physical inactivity and sedentary behaviour in older hospital patients

Jasper

Visvanathan

Dollard

et al. 2022

Health Prom J of Aust

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Objective: Despite growing research on sedentary behaviour and physical activity among hospitalised older people, there is little evidence of effective intervention strategies. This study sought input from clinical staff from various health professions on strategies to increase physical activity and reduce sedentariness for hospitalised older people.Methods: A 60-minute focus group discussion involving two physiotherapists, two occupational therapists, one doctor, one nurse and one social worker was conducted.Participants were recruited from a subacute geriatric ward and an acute orthopaedic ward with an orthogeriatric service at a general hospital. Data were thematically analysed.Results: Six strategies to reduce sedentary behaviour and increase physical activity were identified: clear and positive communication for patients and family/carers; educating patients and family/carers; involving family/carers and volunteers; setting physical activity goals; utilising group activities and activities of daily living (ADL); and making the hospital environment activity-friendly.Conclusions: This research has revealed novel strategies to increase physical activity and reduce sedentary behaviour in hospital. The next step is to design interventions for testing.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Exploring the perspectives of clinicians on solutions to tackling physical inactivity and sedentary behaviour in older hospital patients

Jasper

Visvanathan

Dollard

et al. 2022

Health Prom J of Aust

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show abstract

“…For example, using equipment and placement that promotes mobility such as IV poles (with handles), smaller urine collection bags, and ensuring mobility assistive devices such as walkers are available and environments with adequate spaces to mobilize are provided. [26][27][28][29] Decreased mobility among patients at moderate to high fall risk could be related to the fall risk reduction strategies used for patients in these fall risk categories. For example, interventions such as bed/chair exit alarms and constant observers are more commonly used among patients categorized as high risk for falls and may discourage patients from getting out of bed or chairs to ambulate.…”

Section: Discussionmentioning

confidence: 99%

“…When equipment must be used, the patient care team should attempt to minimize the negative impact of the equipment on mobility. For example, using equipment and placement that promotes mobility such as IV poles (with handles), smaller urine collection bags, and ensuring mobility assistive devices such as walkers are available and environments with adequate spaces to mobilize are provided 26–29 …”

Section: Discussionmentioning

confidence: 99%

Revealing the tension: The relationship between high fall risk categorization and low patient mobility

Capó-Lugo

Young

Farley

et al. 2023

J American Geriatrics Society

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Background Using an inpatient fall risk assessment tool helps categorize patients into risk groups which can then be targeted with fall prevention strategies. While potentially important in preventing patient injury, fall risk assessment may unintentionally lead to reduced mobility among hospitalized patients. Here we examined the relationship between fall risk assessment and ambulatory status among hospitalized patients. Methods We conducted a retrospective cohort study of consecutively admitted adult patients (n = 48,271) to a quaternary urban hospital that provides care for patients of broad socioeconomic and demographic backgrounds. Non‐ambulatory status, the primary outcome, was defined as a median Johns Hopkins Highest Level of Mobility <6 (i.e., patient walks less than 10 steps) throughout hospitalization. The primary exposure variable was the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) category (Low, Moderate, High). The capacity to ambulate was assessed using the Activity Measure for Post‐Acute Care (AM‐PAC). Multivariable regression analysis controlled for clinical demographics, JHFRAT items, AM‐PAC, comorbidity count, and length of stay. Results 8% of patients at low risk for falls were non‐ambulatory, compared to 25% and 54% of patients at moderate and high risk for falls, respectively. Patients categorized as high risk and moderate risk for falls were 4.6 (95% CI: 3.9–5.5) and 2.6 (95% CI: 2.4–2.9) times more likely to be non‐ambulatory compared to patients categorized as low risk, respectively. For patients with high ambulatory potential (AM‐PAC 18–24), those categorized as high risk for falls were 4.3 (95% CI: 3.5–5.3) times more likely to be non‐ambulatory compared to patients categorized as low risk. Conclusions Patients categorized into higher fall risk groups had decreased mobility throughout their hospitalization, even when they had the functional capacity to ambulate.

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“…21 The results have recently been published. 12,22 Having established the barriers and enablers, the Behaviour Change Wheel 23 was used to select intervention components (e.g. learning how to assist patients in physical activity) and implementation strategies (e.g.…”

Section: The 'Better By Moving' Multifaceted Interventionmentioning

confidence: 99%

The Better By Moving study: A multifaceted intervention to improve physical activity in adults during hospital stay

et al. 2022

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Objective ‘Better By Moving’ is a multifaceted intervention developed and implemented in collaboration with patients and healthcare professionals to improve physical activity in hospitalized adults. This study aimed to understand if, how and why ‘Better By Moving’ resulted in higher levels of physical activity by evaluating both outcomes and implementation process. Design Mixed-methods study informed by the Medical Research Council guidance. Setting Tertiary hospital. Participants Adult patients admitted to surgery, haematology, infectious diseases and cardiology wards, and healthcare professionals. Measures Physical activity was evaluated before and after implementation using the Physical Activity Monitor AM400 on one random day during hospital stay between 8 am and 8 pm. Furthermore, the time spent lying on bed, length of stay and discharge destination was investigated. The implementation process was evaluated using an audit trail, surveys and interviews. Results There was no significant difference observed in physical activity (median [IQR] 23 [12–51] vs 27 [17–55] minutes, P = 0.107) and secondary outcomes before-after implementation. The intervention components’ reach was moderate and adoption was low among patients and healthcare professionals. Patients indicated they perceived more encouragement from the environment and performed exercises more frequently, and healthcare professionals signalled increased awareness and confidence among colleagues. Support (priority, resources and involvement) was perceived a key contextual factor influencing the implementation and outcomes. Conclusion Although implementing ‘Better By Moving’ did not result in significant improvements in outcomes at our centre, the process evaluation yielded important insights that may improve the effectiveness of implementing multifaceted interventions aiming to improve physical activity during hospital stay.

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

Cited by 11 publications

References 39 publications

Exploring the perspectives of clinicians on solutions to tackling physical inactivity and sedentary behaviour in older hospital patients

Exploring the perspectives of clinicians on solutions to tackling physical inactivity and sedentary behaviour in older hospital patients

Revealing the tension: The relationship between high fall risk categorization and low patient mobility

The Better By Moving study: A multifaceted intervention to improve physical activity in adults during hospital stay

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