Advertisement

Systems Approach Is Needed for In-Hospital Mobility: A Qualitative Metasynthesis of Patient and Clinician Perspectives

Published:September 19, 2020DOI:https://doi.org/10.1016/j.apmr.2020.09.370

      Abstract

      Objective

      To describe how different key stakeholders (ie, interprofessional clinical care team and patients) perceive their role in promoting in-hospital mobility by systematically synthesizing qualitative literature.

      Data Sources

      PubMed, Ovid MEDLINE, Ovid PsychInfo, and Cumulative Index to Nursing and Allied Health were searched using terms relevant to mobility, hospitalization, and qualitative research. A total of 510 unique articles were retrieved and screened for eligibility.

      Study Selection

      Eligible qualitative studies included stakeholder perspectives on in-hospital mobility, including patients, nursing staff, rehabilitation staff, and physicians. Eleven articles remained after inclusion/exclusion criteria were applied.

      Data Extraction

      At least 2 authors independently read, coded, and derived themes from each study. We used a team-based inductive approach to thematic synthesis informed by critical realism and the socioecological model. Reciprocal translation unified convergent and divergent constructs across primary studies. Investigator triangulation enhanced interpretation.

      Data Synthesis

      Three primary themes emerged: (1) patient, family, and clinician expectations shape roles in in-hospital mobility; (2) stakeholders’ role in mobility depends on hospital environment, infrastructure, culture, and resources; and (3) teamwork creates successful in-hospital mobility, but lack of coordination and cooperation leads to delay in mobilizing. Studies suggested that while mobility is an essential construct in the professional role of clinicians and in the personal identity of patients, the ability of stakeholders to realize their role in mobility is highly dependent on the hospital physical and cultural environment, administrative support, clarity in professional roles, and teamwork.

      Conclusions

      Interventions designed to address the problem of low hospital mobility should take a systems approach and consider allocation of resources, clarity around professional responsibilities, and elevation of patient and clinician expectations surrounding mobility.

      Graphical abstract

      Keywords

      List of abbreviations:

      OT (occupational therapist), PT (physical therapist), SEM (socioecological model)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lucas J.W.
        • Venson B.
        Tables of summary health statistics for the U.S. population: 2018 National Health Interview Survey.
        (Available at:) (Accessed October 6, 2020)
        • Kortebein P.
        Rehabilitation for hospital-associated deconditioning.
        Am J Phys Med Rehabil. 2009; 88: 66-77
        • Gill T.M.
        • Allore H.G.
        • Holford T.R.
        • Guo Z.
        Hospitalization, restricted activity, and the development of disability among older persons.
        JAMA. 2004; 292: 2115-2124
        • Pavon J.M.
        • Sloane R.J.
        • Pieper C.F.
        • et al.
        Accelerometer-measured hospital physical activity and hospital-acquired disability in older adults.
        J Am Geriatr Soc. 2020; 68: 261-265
        • Fisher S.R.
        • Kuo Y.F.
        • Sharma G.
        • et al.
        Mobility after hospital discharge as a marker for 30-day readmission.
        J Gerontol A Biol Sci Med Sci. 2016; 68: 805-810
        • Ostir G.V.
        • Berges I.M.
        • Kuo Y.F.
        • Goodwin J.S.
        • Fisher S.R.
        • Guralnik J.M.
        Mobility activity and its value as a prognostic indicator of survival in hospitalized older adults.
        J Am Geriatr Soc. 2013; 61: 551-557
        • Fisher S.R.
        • Goodwin J.S.
        • Protas E.J.
        • et al.
        Ambulatory activity of older adults hospitalized with acute medical illness.
        J Am Geriatr Soc. 2011; 59: 91-95
        • Tudor-Locke C.
        • Craig C.L.
        • Aoyagi Y.
        • et al.
        How many steps/day are enough? For older adults and special populations.
        Int J Behav Nutr Phys Act. 2011; 8: 80
        • Chawla H.
        • Bulathsinghala C.
        • Tejada J.P.
        • Wakefield D.
        • ZuWallack R.
        Physical activity as a predictor of thirty-day hospital readmission after a discharge for a clinical exacerbation of chronic obstructive pulmonary disease.
        Ann Am Thorac Soc. 2014; 11: 1203-1209
        • Koenders N.
        • van Oorsouw R.
        • Seeger J.P.
        • Nijhuis-van der Sanden M.W.
        • van de Glind I.
        • Hoogeboom T.J.
        “I’m not going to walk, just for the sake of walking…”: a qualitative, phenomenological study on physical activity during hospital stay.
        Disabil Rehabil. 2020; 42: 78-85
        • Doherty-King B.
        • Bowers B.J.
        Attributing the responsibility for ambulating patients: a qualitative study.
        Int J Nurs Stud. 2013; 50: 1240-1246
        • Brown C.J.
        • Williams B.R.
        • Woodby L.L.
        • Davis L.L.
        • Allman R.M.
        Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians.
        J Hosp Med. 2007; 2: 305-313
        • So C.
        • Pierluissi E.
        Attitudes and expectations regarding exercise in the hospital of hospitalized older adults: a qualitative study.
        J Am Geriatr Soc. 2012; 60: 713-718
        • Bronfenbrenner U.
        Ecological systems theory.
        Jessica Kingsley Publishers, Thousand Oaks, CA1992
        • Richard L.
        • Gauvin L.
        • Raine K.
        Ecological models revisited: their uses and evolution in health promotion over two decades.
        Annu Rev Public Health. 2011; 32: 307-326
        • Fehlberg E.A.
        • Lucero R.J.
        • Weaver M.T.
        • et al.
        Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns.
        Innov Aging. 2017; 1: igx036
        • Walsh D.
        • Downe S.
        Meta-synthesis method for qualitative research: a literature review.
        J Adv Nurs. 2005; 50: 204-211
        • Smith B.
        • Sparkes A.C.
        Routledge handbook of qualitative research in sport and exercise.
        Taylor & Francis, Milton2016
        • McCormick J.
        • Rodney P.
        • Varcoe C.
        Reinterpretations across studies: an approach to meta-analysis.
        Qual Health Res. 2003; 13: 933-944
        • Parry S.M.
        • Knight L.D.
        • Connolly B.
        • et al.
        Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies.
        Intensive Care Med. 2017; 43: 531-542
        • Miller M.J.
        • Jones J.
        • Anderson C.B.
        • Christiansen C.L.
        Factors influencing participation in physical activity after dysvascular amputation: a qualitative meta-synthesis.
        Disabil Rehabil. 2019; 41: 3141-3150
        • Luker J.
        • Lynch E.
        • Bernhardsson S.
        • Bennett L.
        • Bernhardt J.
        Stroke survivors' experiences of physical rehabilitation: a systematic review of qualitative studies.
        Arch Phys Med Rehabil. 2015; 96: 1698-1708.e1610
        • Thomas J.
        • Harden A.
        Methods for the thematic synthesis of qualitative research in systematic reviews.
        BMC Med Res Methodol. 2008; 8: 45
        • Noblit G.W.
        • Hare R.D.
        Meta-ethnography: synthesizing qualitative studies. 11. Sage, Newbury Park, CA1988
        • Tong A.
        • Flemming K.
        • McInnes E.
        • Oliver S.
        • Craig J.
        Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ.
        BMC Med Res Methodol. 2012; 12: 181
        • Letts L.
        • Wilkins S.
        • Law M.
        • Stewart D.
        • Bosch J.
        • Westmorland M.
        Guidelines for critical review form: qualitative studies (version 2.0).
        McMaster University Occupational Therapy Evidence-Based Practice Research Group, Ontario2007
        • Barnett-Page E.
        • Thomas J.
        Methods for the synthesis of qualitative research: a critical review.
        BMC Med Res Methodol. 2009; 9: 59
        • Boltz M.
        • Capezuti E.
        • Shabbat N.
        • Hall K.
        Going home better not worse: older adults' views on physical function during hospitalization.
        Int J Nurs Pract. 2010; 16: 381-388
        • Boltz M.
        • Capezuti E.
        • Shabbat N.
        Nursing staff perceptions of physical function in hospitalized older adults.
        Appl Nurs Res. 2011; 24: 215-222
        • Chan D.E.
        • Hong M.L.I.
        • Tan M.Y.G.
        • Chua W.L.
        Older patients' participation in physical activity during hospitalization: a qualitative study of ward nurses' perceptions in an Asian context.
        Geriatr Nurs (New York, NY). 2019; 40: 91-98
        • Higgins I.
        • Der Riet P.V.
        • Slater L.
        • Peek C.
        The negative attitudes of nurses towards older patients in the acute hospital setting: a qualitative descriptive study.
        Contemp Nurse. 2007; 26: 225-237
        • Kirk J.W.
        • Bodilsen A.C.
        • Sivertsen D.M.
        • Husted R.S.
        • Nilsen P.
        • Tjornhoj-Thomsen T.
        Disentangling the complexity of mobility of older medical patients in routine practice: an ethnographic study in Denmark.
        PLoS One. 2019; 14e0214271
        • Masley P.M.
        • Havrilko C.L.
        • Mahnensmith M.R.
        • Aubert M.
        • Jette D.U.
        Physical therapist practice in the acute care setting: a qualitative study.
        Phys Ther. 2011; 91: 906-919
        • Ohlsson-Nevo E.
        • Andersson G.
        • Strid E.N.
        In the hands of nurses: a focus group study of how nurses perceive and promote inpatients' needs for physical activity.
        Nurs Open. 2019; 7: 334-344
        • Covinsky K.E.
        • Palmer R.M.
        • Fortinsky R.H.
        • et al.
        Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age.
        J Am Geriatr Soc. 2003; 51: 451-458
        • Ekdahl A.W.
        • Andersson L.
        • Friedrichsen M.
        “They do what they think is the best for me.” Frail elderly patients’ preferences for participation in their care during hospitalization.
        Patient Educ Couns. 2010; 80: 233-240
        • Bridges J.
        • Flatley M.
        • Meyer J.
        Older people's and relatives’ experiences in acute care settings: systematic review and synthesis of qualitative studies.
        Int J Nurs Stud. 2010; 47: 89-107
        • Adams J.R.
        • Drake R.E.
        Shared decision-making and evidence-based practice.
        Community Ment Health J. 2006; 42: 87-105
        • World Health Organization
        World report on ageing and health.
        World Health Organization, Geneva2015
        • Levy B.R.
        • Slade M.D.
        • Kunkel S.R.
        • Kasl S.V.
        Longevity increased by positive self-perceptions of aging.
        J Pers Soc Psychol. 2002; 83: 261-270
        • Lang T.A.
        • Hodge M.
        • Olson V.
        • Romano P.S.
        • Kravitz R.L.
        Nurse-patient ratios: a systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes.
        J Nurs Adm. 2004; 34: 326-337
        • Rush K.L.
        • Robey-Williams C.
        • Patton L.M.
        • Chamberlain D.
        • Bendyk H.
        • Sparks T.
        Patient falls: acute care nurses’ experiences.
        J Clin Nurs. 2009; 18: 357-365
        • Cozart H.C.
        • Cesario S.K.
        Falls aren't us: state of the science.
        Crit Care Nurs Q. 2009; 32: 116-127
        • Shorr R.I.
        • Chandler A.M.
        • Mion L.C.
        • et al.
        Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: a cluster randomized trial.
        Ann Intern Med. 2012; 157: 692-699
        • Haines T.P.
        • Bell R.A.
        • Varghese P.N.
        Pragmatic, cluster randomized trial of a policy to introduce low-low beds to hospital wards for the prevention of falls and fall injuries.
        J Am Geriatr Soc. 2010; 58: 435-441
        • Brown C.J.
        • Foley K.T.
        • Lowman J.D.
        • et al.
        Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients: a randomized clinical trial.
        JAMA Intern Med. 2016; 176: 921-927