PAPER OF THE YEAR: Research suggesting that verbal and written advice to remain active during hospitalisation improves physical activity levels among older inpatients is deemed the best of 2019.

The Editorial Board of Journal of Physiotherapy is pleased to announce the 2019 Paper of the Year Award: ‘Physiotherapist advice to older inpatients about the importance of staying physically active during hospitalisation reduces sedentary time, increases daily steps and preserves mobility: a randomised trial.’ The authors are Nayara Alexia Moreno from Universidade Cidade de São Paulo and her colleagues in Brazil.

This paper addresses the problem of sedentary behaviour during hospitalisation, with many patients spending long periods resting in bed, regardless of the primary reason for their admission. Low physical activity during hospitalisation can lead to impairment of independence, with losses in muscle strength and functional performance. Older adults have less capacity to fully recover from such losses, which are associated with important outcomes after hospital discharge, including disability and mortality.

The new research published in Journal of Physiotherapy examined whether physiotherapists could increase older patients’ activity during a hospital admission by providing them with written and verbal advice about the deleterious effects of hospitalisation and the importance of staying active during hospitalisation. Sixty- eight older people were randomised at admission to receive the physiotherapist’s advice or to receive usual care only. In addition to the amount of physical activity, other outcomes measured included mobility, strength, length of stay, and complications.

Accelerometry showed a mean between- group difference of 974 steps/day (95% CI 28 to 1919) in favour of the experimental group. The intervention also increased moderate-intensity physical activity and reduced sedentary time. Experimental group participants were about one-fifth as likely to lose mobility during their hospital admission (two of 33) than control group participants (10 of 35), relative risk 0.21 (95% CI 0.05 to 0.90). Effects of the intervention were unclear regarding muscle strength, length of stay and incidence of complications. Patients reported that the main barriers to remaining active during hospitalisation were dyspnoea, lack of space, and fear of contracting infection.

The winning paper is judged by a panel of members of the International Advisory Board who do not have a conflict of interest with any of the papers under consideration. They vote for the paper published in the 2019 calendar year that, in their opinion, has the best combination of scientific merit and application to the clinical practice of physiotherapy.

References

Moreno NA, de Aquino BG, Garcia IF, Tavares LS, Costa LF, Giacomassi IWS, Lunardi AC (2019) Physiotherapist advice to older inpatients about the importance of staying physically active during hospitalisation reduces sedentary time, increases daily steps and preserves mobility: a randomised trial. Journal of Physiotherapy.

Go to journal.physio to read the research.