van Delft Lotte M M, Bor Petra, Valkenet Karin, Slooter Arjen J C, Veenhof Cindy
Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Centre Utrecht, Utrecht University; and UMC Utrecht Brain Center, Utrecht University.
Phys Ther. 2020 Dec 7;100(12):2090-2098. doi: 10.1093/ptj/pzaa160.
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.
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.
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.
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.
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.
“动态医院”是一个多维度实施项目，旨在改善住院期间的活动行为。本研究的目的是调查“动态医院”对活动行为的有效性。
这项前瞻性研究采用实施前和实施后设计。“动态医院”项目在荷兰一家学术医院的4个病房开展。在每个病房，多学科团队采用了为期10个月的逐步推进方法，包括制定和实施针对病房的行动计划，其中包含多项改善活动行为的干预措施。在项目开始前和1年后，采用行为映射法评估住院患者的活动行为，观察时间为上午9点至下午4点。主要结局是卧床时间的百分比。此外，还调查了坐立和活动时间、与不动相关的并发症、住院时间、出院回家的目的地、出院后康复机构的目的地、死亡率和30天再入院情况。对于二分变量，使用卡方检验分析实施前和实施后情况之间的差异；对于非正态分布数据，使用曼-惠特尼检验；对于正态分布数据，使用独立样本t检验。
患者观察结果显示，主要结局卧床时间从60.1%降至52.2%。对于次要结局，坐立时间从31.6%增加到38.3%，出院后转至康复机构的比例从6例（4.4%）降至1例（0.7%）。在其他次要结局指标中未发现统计学差异。
多维度项目“动态医院”的实施与住院患者卧床时间减少以及出院后转至康复机构的人数减少有关。
住院患者的活动行为可受到多维度干预的影响。建议实施专门侧重于增加活动时间并减少卧床时间的干预措施的项目。
