Background: Physical inactivity is common during hospitalization. Physical activity has been described in different inpatient populations but never across a hospital. Purpose: To describe inpatient movement behavior and associated factors throughout a single university hospital. Methods: A prospective observational study was performed. Patients admitted to clinical wards were included. Behavioral mapping was undertaken for each participant between 9AM and 4PM. The location, physical activity, daily activity, and company of participants were described. Barriers to physical activity were examined using linear regression analyses. Results: In total, 345 participants from 19 different wards were included. The mean (SD) age was 61 (16) years and 57% of participants were male. In total, 65% of participants were able to walk independently. On average participants spent 86% of observed time in their room and 10% of their time moving. A physiotherapist or occupational therapist was present during 1% of the time, nursing staff and family were present 11% and 13%, respectively. Multivariate regression analysis showed the presence of an intravenous line (p = .039), urinary catheter (p = .031), being female (p = .034), or being dependent on others for walking (p = .016) to be positively associated with the time spent in bed. Age > 65, undergoing surgery, receiving encouragement by a nurse or physician, reporting a physical complaint or pain were not associated with the time spent in bed (P > .05). Conclusion: As family members and nursing staff spend more time with patients than physiotherapists or occupational therapists, increasing their involvement might be an important next step in the promotion of physical activity.
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BACKGROUND: Although enhancing physical activity (PA) is important to improve physical and/or cognitive recovery, little is known about PA of patients admitted to an inpatient rehabilitation setting. Therefore, this study assessed the quantity, nature and context of inpatients PA admitted to a rehabilitation center. METHODOLOGY/PRINICIPAL FINDINGS: Prospective observational study using accelerometry & behavioral mapping. PA of patients admitted to inpatient rehabilitation was measured during one day between 7.00-22.00 by means of 3d-accelerometery (Activ8; percentage of sedentary/active time, number of sedentary/active bouts (continuous period of ≥1 minute), and active/sedentary bout lengths and behavioral mapping. Behavioral mapping consisted of observations (every 20 minutes) to assess: type of activity, body position, social context and physical location. Descriptive statistics were used to describe PA on group and individual level. At median the 15 patients spent 81% (IQR 74%-85%) being sedentary. Patients were most sedentary in the evening (maximum sedentary bout length minutes of 69 (IQR 54-95)). During 54% (IQR 50%-61%) of the observations patients were alone) and in their room (median 50% (IQR 45%-59%)), but individual patterns varied widely. CONCLUSION/SIGNIFICANCE: The results of this study enable a deeper understanding of the daily PA patterns of patients admitted for inpatient rehabilitation treatment. PA patterns of patients differ in both quantity, day structure, social and environmental contexts. This supports the need for individualized strategies to support PA behavior during inpatient rehabilitation treatment.
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Objective: Self-management is a core theme within chronic care and several evidence-based interventions (EBIs) exist to promote self-management ability. However, these interventions cannot be adapted in a mere copy-paste manner. The current study describes and demonstrates a planned approach in adapting EBI’s in order to promote self-management in community-dwelling people with chronic conditions. Methods: We used Intervention Mapping (IM) to increase the intervention’s fit with a new context. IM helps researchers to take decisions about whether and what to adapt, while maintaining the working ingredients of existing EBI’s. Results: We present a case study in which we used IM to adapt EBI’s to the Flemish primary care context to promote self-management in people with one or more chronic disease. We present the reader with a contextual analysis, intervention aims, and content, sequence and scope of the resulting intervention. Conclusion: IM provides an excellent framework in providing detailed guidance on intervention adaption to a new context, while preserving the essential working ingredients of EBI’s. Practice Implications: The case study is exemplary for public health researchers and practitioners as a planned approach to seek and find EBI’s, and to make adaptations.
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Depression is a highly prevalent and seriously impairing disorder. Evidence suggests that music therapy can decrease depression, though the music therapy that is offered is often not clearly described in studies. The purpose of this study was to develop an improvisational music therapy intervention based on insights from theory, evidence and clinical practice for young adults with depressive symptoms. The Intervention Mapping method was used and resulted in (1) a model to explain how emotion dysregulation may affect depressive symptoms using the Component Process Model (CPM) as a theoretical framework; (2) a model to clarify as to how improvisational music therapy may change depressive symptoms using synchronisation and emotional resonance; (3) a prototype Emotion-regulating Improvisational Music Therapy for Preventing Depressive symptoms (EIMT-PD); (4) a ten-session improvisational music therapy manual aimed at improving emotion regulation and reducing depressive symptoms; (5) a program implementation plan; and (6) a summary of a multiple baseline study protocol to evaluate the effectiveness and principles of EIMT-PD. EIMT-PD, using synchronisation and emotional resonance may be a promising music therapy to improve emotion regulation and, in line with our expectations, reduce depressive symptoms. More research is needed to assess its effectiveness and principles.
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The ageing of people with intellectual disabilities, with associated morbidity like dementia, calls for new types of care. Person-centered methods may support care staff in providing this, an example being Dementia Care Mapping (DCM). DCM has been shown to be feasible in ID-care. We examined the experiences of ID-professionals in using DCM. We performed a mixed-methods study, using quantitative data from care staff (N = 136) and qualitative data (focus-groups, individual interviews) from care staff, group home managers and DCM-in-intellectual disabilities mappers (N = 53). ageing, dementia, Dementia Care Mapping, intellectual disability, mixed-methods, personcentred care
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Deze rapportage maakt deel uit van zes rapportages die zijn opgeleverd in het WHeelchair ExercisE and Lifestyle Study (WHEELS) project. In deze rapportages worden de resultaten gepresenteerd van de Intervention Mapping (IM) stappen 1 t/m 6 in het ontwikkelen van een leefstijlapp voor rolstoelgebruikers met een dwarslaesie of beenamputatie. Deze rapportage betreft de uitwerking van IM-stap 3 waarin gedragsveranderingsmethodieken en praktische strategieën zijn geselecteerd om de veranderdoelen (beoogde veranderingen in het beweeg-, voedings- en ontspangedrag) te behalen.
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Patients with cardiovascular risk factors can reduce their risk of cardiovascular disease by increasing their physical activity and their physical fitness. According to the guidelines for cardiovascular risk management, health professionals should encourage their patients to engage in physical activity. In this paper, we provide insight regarding the systematic development of a Web-based intervention for both health professionals and patients with cardiovascular risk factors using the development method Intervention Mapping. The different steps of Intervention Mapping are described to open up the “black box” of Web-based intervention development and to support future Web-based intervention development.
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PurposeTo determine which factors are associated with physical inactivity in hospitalized adults of all ages.MethodsA cross-sectional sample of 114 adults admitted to a gastrointestinal surgery, internal medicine or cardiology hospital ward (median age 60, length of stay 13 days) were observed during one random day from 8 am to 8 pm using wireless accelerometers and behavioral mapping protocols. Factors (e.g., comorbidities, self-efficacy, independence in mobility, functional restraints) were collected from medical records, surveys, and observations.ResultsPatients were physically active for median(IQR) 26 (13–52.3) min and were observed to lie in bed for 67.3%, sit for 25.2%, stand for 2.5%, and walk for 5.0% of the time. Multivariable regression analysis revealed that physical inactivity was 159.87% (CI = 89.84; 255.73) higher in patients dependent in basic mobility, and 58.88% (CI = 10.08; 129.33) higher in patients with a urinary catheter (adjusted R2 = 0.52). The fit of our multivariable regression analysis did not improve after adding hospital ward to the analysis (p > 0.05).ConclusionsIndependence in mobility and urine catheter presence are two important factors associated with physical inactivity in hospitalized adults of all ages, and these associations do not differ between hospital wards. Routine assessments of both factors may therefore help to identify physically inactive patients throughout the hospital.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be aware that physical inactivity during hospital stay may result into functional decline.Regardless of which hospital ward patients are admitted to, once patients require assistance in basic mobility or have a urinary catheter they are at risk of physical inactivity during hospital stay.Implementing routine assessments on the independence of basic mobility and urine catheter presence may therefore assist healthcare professionals in identifying physically inactive patients before they experience functional decline.
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Background: Remote coaching might be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR).Objective: The goal of the research was to explore and summarize information and support needs of patients with CAD and develop an early remote coaching program providing tailored information and support.Methods: We used the intervention mapping approach to develop a remote coaching program. Three steps were completed in this study: (1) identification of information and support needs in patients with CAD, using an exploratory literature study and semistructured interviews, (2) definition of program objectives, and (3) selection of theory-based methods and practical intervention strategies.Results: Our exploratory literature study (n=38) and semistructured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: (1) patients gain knowledge on how CAD and revascularization affect their bodies and health, (2) patients gain knowledge about medication and side effects and adhere to their treatment plan, (3) patients know which daily physical activities they can and can’t do safely after hospital discharge and are physically active, and (4) patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as a theoretical framework with behavioral counseling and video modeling as practical strategies for the program.Conclusions: This study shows that after (acute) cardiac hospitalization, patients are in need of information and support about CAD and revascularization, medication and side effects, physical activity, and psychological distress. In this study, we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR.
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Social needs are important basic human needs; when not satisfied, loneliness and social isolation can occur and subsequently sickness or even premature death. For older people social needs can be more difficult to satisfy because of the loss of resources such as health and mobility. Interventions for older people to satisfy social needs are often not evaluated and when evaluated are not proven successful. Technological interventions can be successful, but the relationship between technology and social wellbeing is complex and more research in this area is needed. The aim of this research is to uncover design opportunities for technological interventions to fulfil social needs of older people. Context-mapping sessions are a way to gain more insight into the social needs of older people and to involve them in the design of interventions to fulfil social needs. Participants of the context-mapping sessions were older people and social workers working with older people. Four sessions with a total of 20 participants were held to generate ideas for interventions to satisfy social needs. The results are transcripts from the discussion parts of the context-mapping sessions and collages the participants created. The transcripts were independently analysed and inductive codes were attached to quotations in the transcripts that are relevant to the research question and subsequently thematic analysis took place. Collages made by the participants were independently analysed by the researchers and after discussion consensus was reached about important themes. The following three main themes emerged: ‘connectedness’, ‘independence’ and ‘meaningfulness’. Technology was not identified as a separate theme, but was addressed in relation to the above mentioned themes. Staying active in a meaningful way, for example by engaging in volunteer work, may fulfil the three needs of being connected, independent and meaningful. In addition, interventions can also focus on the need to be and remain independent and to deal with becoming more dependent. The older people in our study have an ambivalent attitude towards technology, which needs to be taken into account when designing an intervention. We conclude this paper by making recommendations for possible technological interventions to fulfil social needs.
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