This article was the 2019 Journal of Physiotherapy paper of the year as voted by a panel of members of the International Advisory Board. The panel decided this paper has the best combination of scientific merit and applicability to clinical practice.
Bed rest, prolonged length of stay and reduced physical activity are all well known complications for older people in hospital. They lead to a downward spiral of acute sarcopenia, reduced confidence, increased falls risk and reduced walking speed. Much has been done to try and reduce these risks but often it is cultural barriers which prevent significant inroads into the problem. The problem is great and the solutions can seem overly complicated, but do they have to be?
A team of researchers in Brazil have performed a RCT investigating if older inpaients physical activity can be increased by providing them with written and verbal advice about the risks of hospitalisation and its impact on their physical abilities. The written information was given in the form of a booklet with text and images and education was given in a 20 minute session. The booklet was kept in the drawer to assure blinding to the physiotherapist. They compared this to usual care which is just as you imagine it would be.
Outcome measures included physical activity level via accelerometer, mobility via DEMMI, length of stay in days, HAIs/complications by diagnosis, barriers to participation of activity in hospital by questionnaire and physiotherapy input in number of sessions. All of these are very reasonable outcome measures and are validated where possible. In total 68 participants were randomized and took part in the study.
Clinical Significance
The intervention group were 6% less sedentary, took a mean of 974 more steps per day, had 4% more light intensity activity and 1% more moderate intensity activity. In termsof how this translates to mobility participants in the intervention group were one-fifth as likely to lose mobility resulting in a 0.5 day reduction in length of stay (LoS) and a need for less physiotherapy intervention overall. The reduction in LoS is likely to be unrelated to the intervention as there are too many variables at play. There were no complications in either group – this is more important than it seems as there tends to be a belief that older people in hospital are unsafe participating in their own activity.
From the questionnaire the main barriers to participation in physical activity in hospital were lack of space and equipment, fear and lack of staff to assist.
Overall leaflet and verbal advice appears to be an excellent value-for-money intervention to reduce complications of prolonged immobility and reduced physical activity associated with hospital stays. It is hard to say how consistent the verbal information was between therapists however this is no bad thing as advice should be tailored to the individual at the time of intervention.