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

• Published in: Physical therapy Vol. 100; no. 12; pp. 2090 - 2098
• Main Authors: van Delft, Lotte M M, Bor, Petra, Valkenet, Karin, Slooter, Arjen J C, Veenhof, Cindy
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.12.2020
• Subjects: Bed Rest - statistics & numerical data; Behavior; Care and treatment; Chi-Square Distribution; Exercise therapy; Female; Hospital patients; Hospitalization; Humans; Male; Middle Aged; Movement; Movement therapy; Netherlands; Original Research; Patient Discharge - statistics & numerical data; Patient Participation; Prospective Studies; Psychological aspects; Rehabilitation; Rehabilitation Centers - statistics & numerical data; Reproducibility of Results; Sitting Position; Statistics, Nonparametric; Time Factors; Netherlands; United States; Physical Behavior; Hospitalization; Implementation Project; Multidisciplinary
• ISSN: 0031-9023; 1538-6724
• DOI: 10.1093/ptj/pzaa160

Abstract Objective Hospital in Motion is a multidimensional implementation project aiming to improve movement behavior during hospitalization. The purpose of this study was to investigate the effectiveness of Hospital in Motion on movement behavior. Methods This prospective study used a pre-implementation and post-implementation design. Hospital in Motion was conducted at 4 wards of an academic hospital in the Netherlands. In each ward, multidisciplinary teams followed a 10-month step-by-step approach, including the development and implementation of a ward-specific action plan with multiple interventions to improve movement behavior. Inpatient movement behavior was assessed before the start of the project and 1 year later using a behavioral mapping method in which patients were observed between 9:00 am and 4:00 pm. The primary outcome was the percentage of time spent lying down. In addition, sitting and moving, immobility-related complications, length of stay, discharge destination home, discharge destination rehabilitation setting, mortality, and 30-day readmissions were investigated. Differences between pre-implementation and post-implementation conditions were analyzed using the chi-square test for dichotomized variables, the Mann Whitney test for non-normal distributed data, or independent samples t test for normally distributed data. Results Patient observations demonstrated that the primary outcome, the time spent lying down, changed from 60.1% to 52.2%. For secondary outcomes, the time spent sitting increased from 31.6% to 38.3%, and discharges to a rehabilitation setting reduced from 6 (4.4%) to 1 (0.7%). No statistical differences were found in the other secondary outcome measures. Conclusion The implementation of the multidimensional project Hospital in Motion was associated with patients who were hospitalized spending less time lying in bed and with a reduced number of discharges to a rehabilitation setting. Impact Inpatient movement behavior can be influenced by multidimensional interventions. Programs implementing interventions that specifically focus on improving time spent moving, in addition to decreasing time spent lying, are recommended.