Inpatient physical activity across a large university city hospital: a behavioral mapping study

Figures & data

Table 1. Participant characteristics.

Demographic	Value	N
Age (years), mean (SD)	61 (16)	345
Male, N (%)	197 (57)	345
Surgery, N (%)	166 (48)	306
Elective admission, N (%)	127 (37)	300
Barriers for physical activity, N (%) None Pain Fatigue Weakness Fear, nausea, other	92 (30) 98 (32) 53 (17) 43 (14) 20 (7)	306
Assistance with walking, N (%) Independent Walking aid Totally dependent	206 (65) 93 (29) 18 (6)	317
Intravenous therapy, N (%)	116 (37)	317
Urinary catheter, N (%)	27 (8)	252^a
AM-PAC Basic Mobility score, mean (SD)	21 (5)	257^b
Length of stay (days), median (IQR)	10 (14)	301

SD: Standard Deviation, N: number of participants, AM-PAC: Activity Measure for Post-Acute Care, IQR: Interquartile Range; ^a) This variable was not included during the first observation round. ^b) In ±50% of the missing cases no AM-PAC data were available, in the other ±50% of the missing cases data were incompletely collected making the calculation of a (mean) total score not possible.

Table 2. Average percentage of the time observed per behavioral map item.

Location (n = 12,411 observations)*	% (SD)	Body position (n = 11,789 observations)*	% (SD)
Patient room	86 (15)	Lying in bed (HOB <30 degrees)	26 (27)
Outside the ward	7 (13)	Lying in bed (HOB >30 degrees)	29 (28)
Toilet/bathroom	3 (4)	Sitting edge of the bed	10 (12)
Corridor	3 (5)	Sitting in chair	25 (28)
Therapy room	0.1 (1)	Transfer bed-chair	1 (2)
Day care/living room	0.6 (3)	Standing	4 (6)
Medical examination room	0.5 (4)	Walking	5 (8)
		Ergometer cycling	0.1 (1)
Total	100%	Total	100%
Daily activity(n = 11,802 observations)*	% (SD)	In contact with(n = 11,785 observations)*	% (SD)
Reading/television/tablet	26 (21)	Nobody	56 (27)
Talking/phoning	23 (15)	Visit/family	13 (16)
Sleeping	13 (15)	Nurse	11 (10)
No activity	12 (12)	Other patient(s)	6 (10)
Eating/drinking	7 (6)	Physician	3 (7)
Medical examination	5 (9)	Therapist	1 (4)
Nursing/washing/clothing	5 (6)	Other staff	2 (4)
Physical exercise	2 (5)	Volunteer	0.3 (2)
Other	7 (11)	Other	8 (20)
Total	100%	Total	100%

* Observations took place every 10 minutes between 9 AM and 4 PM. Observers were allowed three 10 minute breaks leading to a possible maximum of 13,455 observations. HOB: head of bed; SD: Standard Deviation.

Figure 1. Patterns of key observed items throughout the day. 1a. Pattern throughout the day of the proportion of patients observed in their room. 1b. Patterns throughout the day of the proportion of patients spending their time lying, sitting or moving. 1c. Patterns throughout the day of the proportion of patients observed in direct contact with a nurse, therapist or family/visitors. 1d. Patterns throughout the day of the proportion of patients observed relaxing, talking, sleeping or performing exercise.

Table 3. Associations between proportion of time spent lying in bed and factors of interest*.

	Univariable linear regression			Multivariable linear regression adjusted R^2 = 0.114
	B	p-value	95% CI	B	p-value	95% CI
Age >65	−6.2	0.079	−13.1–0.7	−3.4	0.432	−12-5.2
Female gender	6.7	0.057	−0.2–13.6	9.4	0.034	0.7–18.2
Intravenous therapy	11.6	0.002	4.5–18.8	9.3	0.039	0.5–18.2
Urine catheter	25.4	<0.001	13.0–37.8	16.5	0.031	1.6–31.5
Any help with walking	16.5	<0.001	8.8–24.2	13.8	0.016	2.6–24.9
Surgery	10.3	0.005	3.2–17.5	0.1	0.977	−9.1–9.3
Encouraged by nurse	5.7	0.138	−1.9–13.3	−0.4	0.994	−10.1–10.0
Encouraged by physician	5.5	0.161	−2.2–13.2	6.7	0.167	−2.9–16.7
Any physical complaint during mobility	12.9	0.001	5.2–20.5	0.1	0.993	−10.2–10.3
Pain during mobility	9.2	0.017	1.7–16.8	1.7	0.772	−9.6–12.9

*The percentage lying in bed was used as dependent variable. R²: R-squared; B: Beta; CI: Confidence Interval.

Table

Location	Body position	Daily Activity	In contact with
Patient room Toilet or bath room Corridor Therapy room Daycare or living room Examination room Outside the ward	Lying in bed (<30 degrees) Sitting in bed (>30 degrees) Moving (bed-chair) Sitting edge of the bed Sitting (toilet)chair Standing Walking Cycle ergometer Other	Talking or phoning Reading, television, tablet, or telephone Eating or drinking Sleeping Nursing, washing, or clothing Physical exercise (self-therapy) Medical examination No activity Other	Nobody Other patient(s) Nurse Doctor Physio, occupational, or speech therapy Other staff Volunteer Visit or family Other/unknown person(s)

Table

	Lying % (SD)	Sitting % (SD)	Moving % (SD)	Physical Functioning mean (SD)a
Cardiology and pulmonology General cardiology (n = 28) Cardiothoracic surgery (n = 25) Pulmonary medicine (n = 19)	46 (30) 59 (35) 43 (48)	39 (26) 35 (20) 48 (31)	14 (17) 7 (8) 8 (10)	22 (3) 22 (4) 21 (4)
General medicine Internal medicine (n = 23) Gerontology (n = 18) Nephrology/ Gastroenterology (n = 15) Rheumatology (n = 16) Dermatology (n = 15)	47 (35) 42 (34) 40 (39) 63 (28) 42 (30)	45 (32) 49 (30) 45 (33) 24 (21) 47 (31)	8 (9) 9 (9) 16 (21) 13 (13) 11 (12)	18 (7) 22 (2) 21 (3) 21 (5) 22 (3)
Orthopedics Orthopedic surgery (n = 13) Traumatology (n = 13)	68 (32) 77 (21)	24 (25) 18 (20)	8 (10) 5 (6)	17 (7) 17 (5)
Oncology GI oncological surgery (n = 27) Medical oncology (n = 20) Hematology (n = 20)	67 (29) 52 (36) 60 (30)	25 (24) 38 (31) 31 (29)	7 (8) 10 (9) 8 (9)	22 (4) 23 (3) 22 (6)
Neurology Neurology (n = 24) Neurosurgery (n = 6)	52 (30) 68 (19)	40 (29) 26 (20)	8 (10) 6 (7)	22 (3) 19 (5)
Surgery Head neck surgery (n = 8) Vascular surgery (n = 22) Ear nose throat/Plastic surgery (n = 12)	33 (29) 64 (33) 73 (27)	45 (35) 31 (30) 8 (7)	22 (22) 5 (7) 19 (23)	24 (0) 18 (6) 24 (1)
Other Gynecology (n = 10) Ward unknown (n = 11)	76 (24) 57 (37)	19 (21) 36 (35)	6 (6) 6 (5)	21 (4) 23 (3)

^aMeasured with the AM-PAC Basic Mobility short form (Activity Measure for Post-Acute Care: range from 6 to 24 with higher scores indicating better function) GI: gastrointestinal.