Advice about activity for older inpatients
Adriana Lunardi gives insights on how physiotherapist advice to older inpatients about the importance of staying physically active during hospitalisation reduces sedentary time, increases daily steps and preserves mobility.
Some of the facts and figures about sedentary behaviour during hospitalisation are quite shocking. Can you summarise a few of these?
Loss of mobility is probably the most common adverse effect caused by hospitalisation, affecting one in three older adult patients. The consequent decrease in self-care skills and increased rate of new hospitalisations and mortality remain detectable until one year after hospital discharge. Regardless of the cause of hospitalisation, patients lose muscle mass and strength after a few days because they spend 80 per cent of their time inactive. In an attempt to reduce this loss of mobility and ability to perform daily life activities, strategies such as the one we have created have been tested for future implementation in hospitals.
How did you tackle this problem with your study?
We conducted a randomised controlled trial with 68 older patients who had been hospitalised for clinical reasons—all patients received usual care. The experimental group also received a booklet and verbal advice from a physiotherapist advising them to stay active. The intervention model we created explained why downtime is dangerous (loss of muscle strength and mobility, with possible damage up
to one year after discharge) and how the patient could stay active during hospitalisation; for example, walking more often in the corridor, preferring to sit longer in the armchair than lying in bed, moving arms and legs more often and taking advantage of the presence of the companion or visitor to go up and down the stairs.
Did this help?
Yes. We have shown that patients from the counselling group walked more during hospitalisation, losing less function at discharge compared to the control group. We were excited by the results of such a simple and cheap intervention, but this is the ﬁrst such study. Further studies need to be conducted to conﬁrm the beneﬁts found. Adaptations to other populations may be necessary, for example, surgical patients may need the addition of analgesia to our intervention to beneﬁt from it.
You also interviewed the patients after their admission to ask about barriers to remaining physically active. What did those interviews discover?
In our results, we detected that the hospital’s infrastructure is a problem. The use of intravenous medications was one of the barriers reported by patients. They also reported they have no space for slightly longer walks because hospital corridors are busy and sometimes wheelchairs and stretchers also take up space. The need for the use of continuous oxygen therapy and dyspnoea were also taken into consideration. What was striking, however, was that, disappointingly, physicians and nurses often give unhelpful advice or impose restrictions on physical activity for no reason.
Presumably, sedentary behaviour of older inpatients could decrease if health teams increased their attention to keep runners free of extraneous equipment, bought mobile oxygen therapy equipment, and engaged in a more integrated multidisciplinary approach. This would probably avoid the deleterious effects of lack of mobility. We believe these are modiﬁable short-term factors, and we hope our study will help in this type of education and advice for all hospital staff.
This seems like it would be a fairly cost-effective intervention. Did you analyse costs?
No, but for the cost of printing a booklet and half an hour of physiotherapist time, the risk of losing mobility was reduced by four- ﬁfths, so it looks quite interesting and promising. We believe that a formal cost-effectiveness analysis would be an appropriate path to follow in future research.
Click here to read the research in the Journal of Physiotherapy.
Adriana Lunardi has a PhD in rehabilitation sciences and currently is a professor in the masters and doctorate program in physiotherapy at the Universidade Cidade de São Paulo. Adriana is also a physical therapist at the School of Medicine, University of São Paulo and her research fields are hospitalisation and perioperative care and functionality and measuring instruments.
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