- Kristin McNealus, DPT, MBA
Step Up So Patients Get Up (Part 2)
One of the ways to lower the risk of falls is to keep patients in bed. Cynthia Brown, MD has been studying the amount of physical activity that people get while they are hospitalized, and while her findings may not be surprising to health care providers, they should alarm us. After studying a group of 45 men who were admitted for a medical diagnosis and did not have any cognitive or physical limitation were found to have spent 83% of their hospital stay in bed. That is nearly 20 hours per day! And of the 17% of each day spent out of bed, only 43 minutes were spent on their feet! These are the individuals without physical or cognitive impairments, so it is likely that the presence of any deficit further decreases that time. There was a study of older individuals in 2004 that found only 5.5 minutes of walking per day in the hospital (Callen et al.) Healthy, mobile individuals who enter the hospital for a medical issue could leave deconditioned even after the actual problem is resolved.
As health care providers, we know that decreased mobility is associated with adverse outcomes, including functional impairments. Limited mobility in acute care settings has shown to increase the rate of discharge to skilled nursing, even after controlling for illness severity and comorbidity. Young adults demonstrate low plasma volume, orthostatic intolerance, and a loss of muscle mass within 24 hours of bedrest, and, the effects are obviously greater and more detrimental in older adults. If there is sufficient evidence (like it was needed) to show that limiting mobility during hospitalization can result in functional decline, pressure ulcers, and increased falls after hospitalization, etc. than why are patients not being encouraged to move more?
A study was conducted to look at the perceived barriers to increasing mobility while in the hospital, and both patients and staff reported that the patient’s symptoms were the top concern, followed by the patient’s pain, perceived weakness, and fatigue. As physical therapists, we know that movement can improve all of these, and we have the expertise to monitor any symptoms to know when to proceed and when to stop.
Both patients and staff also reported that restraining medical devices limited mobility, such as catheters and IVs. As both of these are portable, physical therapists can provide education to both staff and patients regarding how to walk and manage the device.
The concern for falls was also listed by patients and staff, which leads into the answer “lack of staff” as a reason for limiting mobility. Yet another opportunity for physical therapy to step in and be the solution!
It seems like a simple resolution. But then again, we are the experts in movement! By helping people move more during their hospital stay, we can decrease their risk for falls. We can increase the possibility of a safer discharge to home. And we can provide education to decrease the risk of readmission. We are an important part of the health care team, and should be involved in all patients’ care. Continue making this apparent to payer sources and administrators.