Hospital in Motion, a Multidimensional Implementation Project to Improve Patients’ Physical Behavior During Hospitalization: Protocol for a Mixed-Methods Study

Abstract

Background Despite the evidence of the adverse consequences of immobility during hospitalization, patients spend most of the time in bed. Although physical activity is a modifiable factor that can prevent in-hospital functional decline, bed rest is deeply rooted in the hospital culture. To attack this, a multidimensional approach is needed. Therefore, Hospital in Motion, a multidimensional implementation project, was designed to improve physical behavior during hospitalization. Objective The primary objective of this study is to investigate the effectiveness of Hospital in Motion on inpatient physical behavior. Secondary objectives are to investigate the effectiveness on length of hospital stay and immobility-related complications of patients during hospitalization and to monitor the implementation process. Methods For this study, Hospital in Motion will be implemented within 4 wards (cardiology, cardiothoracic surgery, medical oncology, and hematology) in a Dutch University Medical Center. Per ward, multidisciplinary teams will be composed who follow a step-by-step multidimensional implementation approach including the development and implementation of tailored action plans with multiple interventions to stimulate physical activity in daily care. A prepost observational study design will be used to evaluate the difference in physical behavior before and 1 year after the start of the project, including 40 patients per time point per ward (160 patients in total). The primary outcome measure is the percentage of time spent lying, measured with the behavioral mapping method. In addition, a process evaluation will be performed per ward using caregivers’ and patient surveys and semistructured interviews with patients and caregivers. Results This study is ongoing. The first participant was enrolled in October 2017 for the premeasurement. The postmeasurements are planned for the end of 2018. The first results are expected to be submitted for publication in autumn 2019. Conclusions This study will provide information about the effectiveness of the Hospital in Motion project on physical behavior and about the procedures of the followed implementation process aimed to incorporate physical activity in usual care. These insights will be useful for others interested in changing physical behavior during hospitalization. Trial Registration Netherlands Trial Register NTR7109; https://www.trialregister.nl/trial/6914 (Archived by WebCite at http://www.webcitation.org/76dyhdjdd) International Registered Report Identifier (IRRID) DERR1-10.2196/11341

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

“…The Eat Walk Engage program of Mudge et al describes an approach using multiple interventions, which demonstrated a reduced length of stay after implementation in older hospitalized patients [ 9 ]. In addition, the currently ongoing Hospital in Motion study of van Delft et al describes the usage of multiple interventions tailored to tackle the numerous described barriers perceived by health care professionals and hospitalized patients [ 29 ]. The Better By Moving study will contribute to this research by providing more insight into the effectiveness of interventions that are developed bottom-up and in cocreation with the target population and by thoroughly analyzing the process of cocreation.…”

“…The patient surveys identify the perceived barriers and enablers to physical activity using two open-ended questions, the level of encouragement patients perceive from health care professionals and context using six questions with a 5-point scale based on the questions of van Delft et al [ 29 ], and their perceived self-efficacy in performing basic mobility activities independently using seven standardized questions with a 5-point scale based on the Short Falls Efficacy Scale-International [ 30 ]. Patients participating in the baseline cross-sectional audit will be asked to complete the survey.…”

The Effectiveness of Hospital in Motion, a Multidimensional Implementation Project to Improve Patients’ Movement Behavior During Hospitalization

“…For more detailed information about the design and timeline, we refer readers to our published study protocol. 26 …”

“…Eligible patients were asked in random order and inclusion stopped when 8 patients wanted to participate or when no more eligible patients were available. 26 …”

“…For more detailed information about the interventions and the followed approach, see Supplementary Appendices 1 and 2 and our published study protocol. 26 …”