99 Safer Mobility: Practice vs Preach

Abstract Background Activity levels in older people undergoing inpatient rehabilitation are low. Intervention by the rehabilitation team amounts to 2% of a patient’s day. Interdisciplinary working helps to ensure that therapy continues beyond the physiotherapy gym. However, safe handling is required. Aims Examine the awareness of ward staff of the mobility status of their patients. Investigate if staff on a general geriatric rehabilitation ward are compliant with physiotherapy mobility recommendations. Methods Data collection took place on a general geriatric rehabilitation ward from February to March 2019. Staff Awareness was assessed by individually asking ward staff (Nurses and Health Care Assistants) to identify the mobility status of their patients. Their responses were recorded and compared with the physiotherapy mobility recommendations as per the MDT (multi-disciplinary) communication whiteboard. The mobility status of each patient was observed by means of random visual audits. Observations were recorded and subsequently compared to the physiotherapy mobility recommendations as above for compliance. Results For the staff awareness audit, 95 responses were obtained from 10 different staff members. 50.5% of responses (n=48) correctly identified patients’ mobility status. 49.5% (n=47) incorrectly identified patients’ mobility status. From 10 visual audits, a total of 196 patient observations were recorded. In 37.2% (n=73) of observations, patients were not mobilising as per physiotherapy recommendations. 39.3% (n=77) of observations were as recommended. In 23.5% (n=46) of observations, patients were not mobilised at all. Conclusion There was limited awareness among ward staff of the mobility status of their patients. Over 1/3 of patients were not mobilised as per physiotherapy recommendations. These findings can compromise both patient and staff safety. The visual audit also highlighted low physical activity levels in some patients. Implications for clinical practice include the need for education on safer mobility and the promotion of patient physical activity at ward level. Physiotherapy led educational and practical handling sessions for ward staff have proven to be beneficial in this regard.

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Observations of Activity Levels in a Purpose-Built, Inpatient, Rehabilitation Facility

HERD Health Environments Research & Design Journal ◽

10.1177/1937586718823519 ◽

2019 ◽

Vol 12 (4) ◽

pp. 26-38 ◽

Cited By ~ 2

Author(s):

Katharine Scrivener ◽

Natasha Pocovi ◽

Taryn Jones ◽

Bridget Dean ◽

Shaun Gallagher ◽

...

Keyword(s):

Physical Activity ◽

Body Position ◽

Social Activity ◽

Cognitive Activity ◽

Inpatient Rehabilitation ◽

Multidisciplinary Care ◽

Activity Levels ◽

Rehabilitation Facility ◽

Mapping Techniques ◽

The Impact

Background: Effective rehabilitation should include high levels of physical activity. The impact of the environmental design on activity levels has had minimal consideration. Purpose: This study investigates activity levels of inpatients undergoing rehabilitation in a new rehabilitation facility with innovative design and multidisciplinary care, comparing weekday and weekend activity levels, as well as changes over a 12-month period. Method: An observational study reporting participants’ location, people present, body position, and activity type on 2 weekdays and 1 weekend day using behavior mapping techniques. Fifteen participants were observed in a mixed rehabilitation unit with neurological, orthopedic, and other health conditions. Results: Results were calculated as the proportion of observations participants spent in each location, position, and performing activities (physical, cognitive, social), and time spent alone and inactive. On average, participants were engaged in activity for 86% (standard deviation [ SD] = 9) of the day, with physical activity accounting for 51% ( SD = 11), cognitive activity 28% ( SD = 10), and social activity 42% ( SD = 16). There was more physical activity (mean difference [ MD] 8% absolute, confidence interval [CI] = [4, 12], p < .01) and less social activity ( MD −6% absolute, CI [−11, −1], p = .02) on weekdays compared to weekends. Overall, participants were alone and inactive for 12% ( SD = 9) of the day. Participants observed in 2016 displayed similar results to those observed in 2015. Conclusion: High levels of activity were achieved in this facility that underwent environmental redesign, construction of new facilities, and implementation of evidence-based strategies.

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A Prospective Study on Physical Activity Levels After Spinal Cord Injury During Inpatient Rehabilitation and the Year After Discharge

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2008.04.024 ◽

2008 ◽

Vol 89 (11) ◽

pp. 2094-2101 ◽

Cited By ~ 111

Author(s):

Rita J. van den Berg-Emons ◽

Johannes B. Bussmann ◽

Janneke A. Haisma ◽

Tebbe A. Sluis ◽

Lucas H. van der Woude ◽

...

Keyword(s):

Physical Activity ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Prospective Study ◽

Inpatient Rehabilitation ◽

Activity Levels ◽

Cord Injury ◽

Physical Activity Levels ◽

A Prospective Study

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Physical activity dimensions after stroke: patterns and relation with lower limb motor function

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00960-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Hanneke E. M. Braakhuis ◽

Monique A. M. Berger ◽

Ruben G. R. H. Regterschot ◽

Erwin E. H. van Wegen ◽

Ruud W. Selles ◽

...

Keyword(s):

Physical Activity ◽

Motor Function ◽

Lower Limb ◽

Inpatient Rehabilitation ◽

Individual Variability ◽

Motor Recovery ◽

Stroke Survivors ◽

Activity Levels ◽

Significant Interaction Effect ◽

Physical Activity Levels

Abstract Background Stroke survivors show deteriorated physical functioning and physical activity levels. Physical activity levels of stroke survivors are generally low. It is increasingly recognized that physical activity is a multidimensional construct that cannot be captured in a single outcome. In-depth insight into multidimensional physical activity patterns may guide the development and timing of targeted rehabilitation interventions. This longitudinal cohort study explored how multidimensional physical activity outcomes develop during recovery in the subacute phase after stroke and if changes in physical activity were correlated to recovery of lower limb motor function. Methods Patients were recruited during inpatient rehabilitation. At 3, 12, and 26 weeks post-onset, motor function was measured by the Fugl-Meyer Lower Extremity Assessment (FMA-LE). Physical activity was measured with the Activ8 accelerometer in multiple outcomes: counts per minute during walking (CPMwalking; a measure of Intensity), number of active bouts (Frequency), mean length of active bouts (Distribution) and % of waking time in upright positions (Duration). Generalized estimating equations (GEE) were used to study changes in physical activity over time and the relation with the change in lower limb motor recovery. Results Thirty-nine patients (age 56 ± 9, 77% male, 89% ischemic stroke) were included. GEE models showed a significant main effect of time for PA Intensity (+ 13%, p = 0.007) and Duration (+ 64%, p = 0.012) between 3 and 12 weeks. Motor function did not show a significant effect in all PA models across the 3 timepoints (p > 0.020). A significant interaction effect of time × motor function was observed (p < 0.001). Conclusions Patterns of PA recovery depend on the PA dimensions: PA Intensity and Duration increased mostly between 3 and 12 weeks post-stroke, whereas Frequency and Distribution did not show substantial changes. Further, no strong associations with motor recovery and high inter-individual variability were documented, which underlies the need to consider factors specific to the disease, the individual patient and the context.

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Modifiable Factors Associated With Poststroke Physical Activity at Discharge From Rehabilitation: Prospective Cohort Study

Physical Therapy ◽

10.1093/ptj/pzaa022 ◽

2020 ◽

Vol 100 (5) ◽

pp. 818-828 ◽

Cited By ~ 1

Author(s):

Shamala Thilarajah ◽

Kelly J Bower ◽

Yong-Hao Pua ◽

Dawn Tan ◽

Gavin Williams ◽

...

Keyword(s):

Physical Activity ◽

Regression Models ◽

Inpatient Rehabilitation ◽

Physical Activity Participation ◽

Activity Participation ◽

Activity Levels ◽

Factors Associated ◽

Modifiable Factors ◽

Physical Activity Levels

Abstract Background People with stroke are not meeting recommended levels of physical activity. The modifiable factors associated with poststroke physical activity levels need to be identified to develop targeted interventions. Objective The objective of this study was to investigate the factors at discharge from inpatient rehabilitation that are associated with physical activity levels at 3 months following discharge. Design This was a prospective cohort study. Methods Sixty-four people with stroke completed baseline assessments at discharge from inpatient rehabilitation and 55 completed the follow-up 3 months later. The candidate factors (ie, gait speed, balance, strength, cognition, mood, and motivation) were measured at discharge. The primary outcome measure at follow-up was walking-related activity (measured by wrist-worn accelerometer). Secondary outcome measures were physical activity participation (Activity Card Sort) and intensity of physical activity (International Physical Activity Questionnaire–Short 7 days). Adjusted separate multivariable linear regression models or proportional odds regression models were used to evaluate the associations between candidate factors and physical activity. Results Gait speed and balance were associated with all aspects of physical activity. Higher level of intrinsic motivation was also associated with higher physical activity participation. Anxiety demonstrated a significant nonlinear relationship with physical activity participation. Limitations Inclusion of fatigue and individual muscle strength could have provided further insights into associations with steps per day. Conclusion The results demonstrated that better physical function at discharge from inpatient rehabilitation was associated with future increased levels of physical activity. Additionally, higher levels of motivation impacted on increased physical activity participation. The influence of anxiety on physical activity participation requires further exploration. Mixed-method study designs can be utilized to further understand the factors associated with poststroke physical activity.

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