Hospital in Motion: motivating movement with a digital assistant
Knowledge database Human Workload & well-being Patient-centred approach B.2: Hospital in Motion - Preventing complications through activity monitoring in hospitalLack of exercise among patients in hospitals is a common problem - and this is precisely where an innovative solution comes in: A wearable-based activity monitoring system that records patients' movement and visualises it for both the HCP and the patients themselves.
Problem description, research question and relevance
Almost one million people are hospitalised once a year in Switzerland, half of whom are over 65 years old (Federal Statistical Office, 2021). 50% of patients with 21 or more days of hospitalisation are hospitalised up to four times within two years (Federal Statistical Office, 2021), with an average length of stay of 5.3 days.
Patients who exercise early and sufficiently recover more quickly and maintain their independence better. In addition, mobility reduces the risk of post-inpatient problems such as physical weakness or readmission to hospital. Early mobilisation and sufficient physical activity can also improve mental well-being (Matsuoka et al., 2023) (Zhang et al, 2019). Motivation and activity can be increased with targeted exercise programmes (van Grootel et al, 2023).
Studies show that mobile apps can have a significant impact on patients' exercise behaviour. They help to increase the physical activity of users. A key advantage of apps is the ability to provide personalised goals and feedback. By providing detailed feedback on progress and daily activities, patients can develop a better understanding of their own progress and have their goals more clearly in mind (Dijk-Huisman et al,2023).
In addition, reminder functions in the apps allow patients to be regularly reminded of their exercise goals. These reminders promote continuity and discipline in the performance of exercise sessions, which leads to higher and more stable physical activity. Progress reports are another important feature that motivates patients to actively participate in increasing physical activity. By regularly reviewing their progress, patients can see how their physical fitness is improving, which boosts self-confidence and increases the incentive to remain active (Silvia et al, 2020).
Methods and procedures in the project
A pilot study and the subsequent validation study have already been conducted to investigate the wearable-based system for activity monitoring in hospitalised patients. The system focused on setting and achieving personalised physical activity goals. Healthcare professionals define specific goals for patients via a dashboard. Patients can view these goals and track their activities accordingly.
The pilot and validation studies have created the basis for testing the new system in hospital. An intervention study is planned for the coming year to test the hypothesis of whether the system leads to an increase in physical activity among patients. The results of this study will help to evaluate the effectiveness of the system under real-life conditions.
The design and content of the application for patients are already planned in detail. The development will be realised next year by our partner Leitwert. The application will then be tested in a study with patients.
Results and findings
- Studies show that patients who use an app to support their recovery see significant improvements in their physical activity. An app can not only provide structured guidance, but also personalised reminders that encourage users to exercise regularly. This combination of targeted motivation and ongoing guidance helps patients achieve their daily exercise goals more easily.
- Faster recovery after their treatment: With the support of the app, patients feel more involved in the healing process and experience a higher level of self-efficacy. An app helps them to better track their progress, which leads to increased satisfaction during hospitalisation. Overall, an app not only helps to improve physical activity, but also has a positive effect on general well-being and recovery.
- Clear goals encourage long-term use and user engagement. Personalised goals, supplemented by targeted reminders and progress tracking, boost motivation and increase the effectiveness of the app, as users can directly track their progress and reach milestones tailored to their individual needs.
Recommendations for practice
1. training of specialised staff: ensuring that specialised staff are fully trained in the use of the app so that they can optimally support users.
2. interactive feedback mechanisms and social support: integrating real-time feedback and social interactions to continuously motivate users and foster a sense of community
3. social elements: Creating forums or group features that enable sharing and mutual support to boost motivation through community engagement.
4. user-friendliness: minimising technical barriers to ensure the app is easy and intuitive to use.
Literature and other sources
Mani, H., Möri, C., Mattmann, M., Liechti, F., Inauen, J., Aujesky, D., Donzé, J., Aubert, CE. (2020). Barriers and facilitators to mobility of patients hospitalised on an acute medical ward: a systematic review, 1;51(7):afac159. doi: 10.1093/ageing/afac159
Matsuoka, A., Yoshihiro, S., Shida, H., Aikawa, G., Fujinami, Y., Kawamura, Y., Nakanishi, N., Shimizu, M., Watanabe, S., Sugimoto, K., Taito, S., Inoue, S. (2023). Effects of Mobilization within 72 h of ICU Admission in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 12(18):5888. doi: 10.3390/jcm12185888
Dijk-Huisman, H.C.v., Senden, R., Smeets, M.H.H., Marcellis, R.G.J., Magdelijns, F.J.H., Lenssen, A.F. (2023). The Effect of a Smartphone App with an Accelerometer on the Physical Activity Behavior of Hospitalised Patients: A Randomized Controlled Trial. Sensors 2023, 23, 8704. https://doi.org/10.3390/s23218704
Park, L.G., Elnaggar, A., Lee, S.J., Merek, S., Hoffmann, T.J., Von Oppenfeld, J., Ignacio, N., Whooley, M.A. (2021). Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomised Controlled Trial, 16;5(4):e20468. doi: 10.2196/20468. PMID: 3
Silva, A.G.; Simões, P.; Queirós, A.; P Rocha, N.; Rodrigues, M. Effectiveness of Mobile Applications Running on Smartphones to Promote Physical Activity: A Systematic Review with Meta-Analysis, Int. J. Environ. Res. Public Health 2020, 17, 2251. https://doi.org/10.3390/ijerph17072251
van Grootel J, Bor P, Netjes JA, Veenhof C, Valkenet K. Improving physical activity in hospitalised patients: The preliminary effectiveness of a goal-directed movement intervention. Clin Rehabil. 2023 Nov;37(11):1501-1509. doi: 10.1177/02692155231189607
Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, Yu K, Chen X, Zhu L, Ma J, Qin Y. Early mobilisation of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One. 2019 Oct 3;14(10):e0223185. doi: 10.1371/journal.pone.0223185