Barriers and Enablers to Physical Activity in Patients During Hospital Stay: a Scoping Review

Overview

Journal Syst Rev

Publisher Biomed Central

Date 2021 Nov 5

PMID 34736531

Citations 20

Authors

Sven Jacobus Gertruda Geelen

Hanneke Corine van Dijk-Huisman

Robert Adriaan de Bie

Cindy Veenhof

Raoul Engelbert

Marike van der Schaaf

Antoine Francois Lenssen

Affiliations

Soon will be listed here.

Abstract

Background: Low levels of physical activity are common during the hospital stay and have been associated with negative health outcomes. Understanding barriers and enablers to physical activity during a hospital stay can improve the development and implementation of tailored interventions aimed at improving physical activity. Previous studies have identified many barriers and enablers, but a comprehensive overview is lacking. This study aimed to identify and categorize all published patient- and healthcare professional-reported barriers and enablers to physical activity during a hospital stay for acute care, using the Theoretical Domains Framework (TDF).

Methods: We conducted a scoping review of Dutch and English articles using MEDLINE, CINAHL Plus, EMBASE, PsycINFO, and Cochrane Library (inception to September 2020), which included quantitative, qualitative, and mixed-methods studies reporting barriers and enablers to physical activity during a hospital stay for acute care, as perceived by patients or healthcare professionals. Two reviewers systematically extracted, coded, and categorized all barriers and enablers into TDF domains.

Results: Fifty-six articles were included in this review (32 qualitative, 7 quantitative, and 17 mixed-methods). In total, 264 barriers and 228 enablers were reported by patients, and 415 barriers and 409 enablers by healthcare professionals. Patient-reported barriers were most frequently assigned to the TDF domains Environmental Context & Resources (ECR, n = 148), Social Influences (n = 32), and Beliefs about Consequences (n = 25), while most enablers were assigned to ECR (n = 67), Social Influences (n = 54), and Goals (n = 32). Barriers reported by healthcare professionals were most frequently assigned to ECR (n = 210), Memory, Attention and Decision Process (n = 45), and Social/Professional Role & Identity (n = 31), while most healthcare professional-reported enablers were assigned to the TDF domains ECR (n = 143), Social Influences (n = 76), and Behavioural Regulation (n = 54).

Conclusions: Our scoping review presents a comprehensive overview of all barriers and enablers to physical activity during a hospital stay and highlights the prominent role of the TDF domains ECR and Social Influences in hospitalized patients' physical activity behavior. This TDF-based overview provides a theoretical foundation to guide clinicians and researchers in future intervention development and implementation.

Scoping Review Registration: No protocol was registered for this review.

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References

Prior M, Guerin M, Grimmer-Somers K . The effectiveness of clinical guideline implementation strategies--a synthesis of systematic review findings. J Eval Clin Pract. 2008; 14(5):888-97. DOI: 10.1111/j.1365-2753.2008.01014.x. View

Fazio S, Stocking J, Kuhn B, Doroy A, Blackmon E, Young H . How much do hospitalized adults move? A systematic review and meta-analysis. Appl Nurs Res. 2019; 51:151189. PMC: 7051878. DOI: 10.1016/j.apnr.2019.151189. View

Stolbrink M, McGowan L, Saman H, Nguyen T, Knightly R, Sharpe J . The Early Mobility Bundle: a simple enhancement of therapy which may reduce incidence of hospital-acquired pneumonia and length of hospital stay. J Hosp Infect. 2014; 88(1):34-9. DOI: 10.1016/j.jhin.2014.05.006. View

Moore J, Mascarenhas A, Marquez C, Almaawiy U, Chan W, DSouza J . Mapping barriers and intervention activities to behaviour change theory for Mobilization of Vulnerable Elders in Ontario (MOVE ON), a multi-site implementation intervention in acute care hospitals. Implement Sci. 2015; 9:160. PMC: 4225038. DOI: 10.1186/s13012-014-0160-6. View

Koenders N, van Oorsouw R, Seeger J, Nijhuis-van Der Sanden M, van de Glind I, Hoogeboom T . "I'm not going to walk, just for the sake of walking…": a qualitative, phenomenological study on physical activity during hospital stay. Disabil Rehabil. 2018; 42(1):78-85. DOI: 10.1080/09638288.2018.1492636. View

Covinsky K, Palmer R, Fortinsky R, Counsell S, Stewart A, Kresevic D . 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(4):451-8. DOI: 10.1046/j.1532-5415.2003.51152.x. View

Lyon A, Solomon M, Harrison J . A qualitative study assessing the barriers to implementation of enhanced recovery after surgery. World J Surg. 2014; 38(6):1374-80. DOI: 10.1007/s00268-013-2441-7. View

Boyd C, Landefeld C, Counsell S, Palmer R, Fortinsky R, Kresevic D . Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008; 56(12):2171-9. PMC: 2717728. DOI: 10.1111/j.1532-5415.2008.02023.x. View

van Delft L, Bor P, Valkenet K, Slooter A, Veenhof C . The Effectiveness of Hospital in Motion, a Multidimensional Implementation Project to Improve Patients' Movement Behavior During Hospitalization. Phys Ther. 2020; 100(12):2090-2098. PMC: 7720640. DOI: 10.1093/ptj/pzaa160. View

10.

De Klein K, Valkenet K, Veenhof C . Perspectives of patients and health-care professionals on physical activity of hospitalized patients. Physiother Theory Pract. 2019; 37(2):307-314. DOI: 10.1080/09593985.2019.1626517. View

11.

Probasco J, Lavezza A, Cassell A, Shakes T, Feurer A, Russell H . Choosing Wisely Together: Physical and Occupational Therapy Consultation for Acute Neurology Inpatients. Neurohospitalist. 2018; 8(2):53-59. PMC: 5882008. DOI: 10.1177/1941874417729981. View

12.

Weatherson K, Gainforth H, Jung M . A theoretical analysis of the barriers and facilitators to the implementation of school-based physical activity policies in Canada: a mixed methods scoping review. Implement Sci. 2017; 12(1):41. PMC: 5369225. DOI: 10.1186/s13012-017-0570-3. View

13.

Istanboulian L, Rose L, Gorospe F, Yunusova Y, Dale C . Barriers to and facilitators for the use of augmentative and alternative communication and voice restorative strategies for adults with an advanced airway in the intensive care unit: A scoping review. J Crit Care. 2020; 57:168-176. DOI: 10.1016/j.jcrc.2020.02.015. View

14.

Garne-Dalgaard A, Mann S, Bredahl T, Stochkendahl M . Implementation strategies, and barriers and facilitators for implementation of physical activity at work: a scoping review. Chiropr Man Therap. 2019; 27:48. PMC: 6784342. DOI: 10.1186/s12998-019-0268-5. View

15.

Gordge L, De Young J, Wiechula R . Reducing functional decline of older people in an acute-care setting: are we providing adequate care to maintain/optimise the functional status of our elder patients?. Int J Evid Based Healthc. 2011; 7(3):181-6. DOI: 10.1111/j.1744-1609.2009.00139.x. View

16.

Gourlan M, Bernard P, Bortolon C, Romain A, Lareyre O, Carayol M . Efficacy of theory-based interventions to promote physical activity. A meta-analysis of randomised controlled trials. Health Psychol Rev. 2014; 10(1):50-66. DOI: 10.1080/17437199.2014.981777. View

17.

Rasmussen R, Holst M, Nielsen L, Villumsen M, Andreasen J . The perspectives of health professionals in Denmark on physical exercise and nutritional interventions for acutely admitted frail older people during and after hospitalisation. Health Soc Care Community. 2020; 28(6):2140-2149. DOI: 10.1111/hsc.13025. View

18.

Nilsen P . Making sense of implementation theories, models and frameworks. Implement Sci. 2015; 10:53. PMC: 4406164. DOI: 10.1186/s13012-015-0242-0. View

19.

Granger C, Parry S, Denehy L, Remedios L . Evidence, education and multi-disciplinary integration are needed to embed exercise into lung cancer clinical care: A qualitative study involving physiotherapists. Physiother Theory Pract. 2018; 34(11):852-860. DOI: 10.1080/09593985.2018.1425939. View

20.

Brown C, Williams B, Woodby L, Davis L, Allman R . Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians. J Hosp Med. 2007; 2(5):305-13. DOI: 10.1002/jhm.209. View