The Better By Moving study: A multifaceted intervention to improve physical activity in adults during hospital stay.
Sven Jg Geelen, Boukje M Giele, Cindy Veenhof and 3 others
PMID 35702004WHAT IT FOUND
A multifaceted hospital ward programme did not significantly increase patients' measured physical activity, reduce time lying in bed, shorten stay or increase discharge home.
Patients and staff reported more encouragement and exercise, but no measured activity improvement was shown.
Key findings
01Measured physical activity between 8 am and 8 pm did not change significantly after implementation: median 23 minutes before and 27 minutes after, with interquartile ranges 12 to 51 and 17 to 55 minutes, P = 0.107.
02Time lying in bed, length of stay and discharge home did not change significantly: lying in bed was 72.6% before and 67.4% after, P = 0.115, and length of stay and discharge home showed no significant trend or level changes.
03The intervention reached 26% to 78% of patients and was adopted by 19% to 57% of those reached; patients reported significantly more encouragement from the environment and more frequent exercise, but measured activity did not change.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was uncontrolled before-after, so it cannot show that the intervention caused the observed outcomes. The before-after comparison of physical activity and time lying in bed had limited power and could miss a real effect. No a priori sample size calculation was performed. It was a single-site university hospital study, so results may not apply elsewhere. The cardiology ward implementation was stopped because of COVID-19 and was not included. Patients who could not transfer independently before admission, had delirium, were on obligatory bed rest or were receiving end-of-life care were excluded, so it does not address those groups. Physical activity was measured on only one random day between 8 am and 8 pm. The before and after groups differed in independence in basic mobility, 61.4% before and 77.6% after, which may affect interpretation.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by Amsterdam UMC through an unrestricted internal innovation fund.
The easy way to misread this
Do not conclude that in-hospital physical activity programmes are ineffective. This was one uncontrolled before-after evaluation of a package of 8 patient and 15 healthcare professional components, with moderate reach and low adoption, and it did not test any single component separately.