Exploring barriers to physical activity of patients at the internal medicine and surgical wards: a retrospective analysis of continuously collected data

Abstract

Purpose: To analyse physical activity of patients during their hospital stay and to explore the relationship between physical activity and barriers to physical activity. Methods: This was a secondary analysis of physical activity data for patients admitted to the internal medicine and surgical wards. Physical activity data, collected with a wireless patch sensor, was operationalized as time spent lying, sitting/standing, and walking. Barriers to physical activity included patients' pain levels, the use of urinary catheters, intravenous tubing, oxygen lines, drains, and level of dependence. Regression analysis explored the relationship between physical activity and barriers to physical activity. Results: Physical activity data were collected in 39 patients (aged 27-88, mean 54 years) during hospital stay. Patients were admitted for a median of 10 d (interquartile range [IQR]: 7-15 d). These patients were lying for a median of 12.1 h (7.6-17.7), sitting/standing 11.8 h (6.3-15.7), and walking 0.1 h (0-0.3) per day. Time lying during the day related to pain levels (b ¼ 0.4 h per unit increase in pain, p < 0.01) and drain use (b ¼ 3.1 h, p < 0.01). Conclusions: Patients spent the most time during the hospital stay lying in bed. Improved pain management and decreased drain use may be worth exploring to increase inpatient physical activity. ä IMPLICATIONS FOR REHABILITATIONContinuous monitoring of physical activity in patients during hospital stay is an important tool for health care professionals to improve multidisciplinary care and rehabilitation. Health care professionals should be aware of the necessity of adequate pain management and critically review the use of drains in order to improve physical activity of patients during hospital stay. Patients need extra support of health care professionals to increase physical activity during consecutive days of their hospital stay.

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

“…Several studies showed that early mobilization and increasing physical activity in surgical and nonsurgical patients reduces hospital length of stay and improves independence in daily activities and discharge destination [ 11 - 13 ]. Yet, despite the knowledge that increasing physical activity contributes to the prevention of in-hospital functional decline, many studies continue to report on very low physical activity levels among hospitalized patients [ 14 , 15 ].…”

A one touch clamp and rack smart pump reduces mobilisation time and perceived burden of clinical staff members in charge of acute phase rehabilitation

“…As patient monitoring and ventilation equipment may influence the handling of the pumps, this may be considered a limitation of the study. However, patient monitoring equipment and a ventilator are additional barriers of early mobilisation [7][8][9] and by reducing the required time and perceived burden on staff members with the one touch clamp and rack pump, time is freed to focus on patient monitoring and ventilation. Finally, the studied sample did not include nurses.…”

“…Intravenous infusion management is one of the barriers for early mobilisation of critically ill patients [7][8][9][10]. Therefore, it is expected that the one touch clamp and rack smart pump will lead to improvements in clinical practice by reducing the required time for pump replacement and the burden on staff.…”

“…Therefore, in addition to barriers associated with patients disease and injury, the management and handling of equipment is an additional factor that may limit the use of early mobilisation during acute phase rehabilitation. Indeed, several reports have indicated that the handling of medical devices and intravenous infusion lines form a major barrier to early mobilisation [7][8][9]. Therefore, Fuest et al [10] state that while early mobilisation improves the outcome of postoperative patients in the ICU, early mobilisation can be difficult to implement and strategies to overcome this barrier need to be explored.…”

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

“…Previous studies have identified a history of falls [13], use of medical equipment [19], use of walking aids [19], low level of preadmission mobility [13], low level of pre-admission cognitive function [18], and low level of physical function during admission [16,18] to be associated with physical inactivity in hospitalized patients; however, these studies solely focused on older hospitalized patients. Two recent studies quantified the physical activity levels of hospitalized adults of all ages admitted to a variety of hospital wards [17,21], and only one of those studies also examined the factors associated with physical inactivity in adults [21]. This study identified in a sample of n ¼ 39 that pain levels, functional independence and functional restraints are related to time lying in bed during the day [21].…”