Barriers to and solutions for improving physical activity in adults during hospital stay: a mixed-methods study among healthcare professionals

To identify healthcare professionals’ perspectives on key barriers to improving physical activity in hospitalized adult patients, and to identify solutions to overcome these barriers. We used an explanatory sequential mixed-methods study design in a Dutch university hospital. A survey exploring 39 potential barriers was completed by 15 physicians/physician assistants, 106 nurses, four nursing assistants, and four physical therapists working on surgery, internal medicine, and cardiology wards. Next, three in-depth semi-structured focus groups – comprising 30 healthcare professionals – discussed the survey findings to identify key barriers and solutions. Focus group discussions were analyzed using thematic analysis. Five themes were identified that described both the key barriers and the solutions to overcome these barriers. Healthcare professionals proposed several solutions, including clarifying the definition of physical activity, empowering patients to take responsibility for physical activity, giving physical therapists or physicians a prominent role in encouraging physical activity, and changing the hospital ward to entice patients to become physically active. Healthcare professionals need clear guidelines, roles, and responsibilities when it comes to physical activity. They also need personalized interventions that empower patients in physical activity. Finally, hospital wards should be designed and furnished so that patients are encouraged to be active.IMPLICATIONS FOR REHABILITATIONMany healthcare professionals want to sustainably improve physical activity in hospitalized adults.For this they need clear guidelines that not only define physical activity, but also describe the roles and responsibilities of all members of the medical team.Healthcare professionals need interventions that help to empower patients to take an active role in physical activity during hospital stay.Hospital wards should be designed and furnished so that patients are encouraged to be physically active. Many healthcare professionals want to sustainably improve physical activity in hospitalized adults. For this they need clear guidelines that not only define physical activity, but also describe the roles and responsibilities of all members of the medical team. Healthcare professionals need interventions that help to empower patients to take an active role in physical activity during hospital stay. Hospital wards should be designed and furnished so that patients are encouraged to be physically active.

本研究旨在明确医疗专业人员对改善住院成年患者身体活动的核心障碍的认知，并探寻克服此类障碍的解决方案。研究于荷兰某大学医院开展，采用解释性序列混合方法研究设计。
第一阶段，针对外科、内科及心内科病房的15名医师/医师助理、106名护士、4名护理助理与4名物理治疗师开展问卷调研，调研涵盖39项潜在障碍，上述人员均完成了问卷填写。
第二阶段，围绕调研结果开展3场半结构化深度焦点小组讨论，共计30名医疗专业人员参与研讨，共同梳理核心障碍与解决方案；研究采用主题分析法对小组讨论内容进行编码分析，最终提炼出5个同时涵盖核心障碍与对应解决方案的主题。
医疗专业人员提出的解决方案包括：明确身体活动的定义、赋能患者主动承担身体活动的相关职责、赋予物理治疗师或医师在患者身体活动引导工作中的核心主导角色，以及优化病房空间与设施以激励患者提升身体活动水平。医疗专业人员在推进患者身体活动相关工作时，亟需清晰明确的指南、清晰的角色与职责界定，同时需要能够赋能患者主动参与身体活动的个性化干预方案。
最后，病房的设计与陈设应进行适配优化，以切实激励患者提升身体活动水平。

【康复实践启示】
众多医疗专业人员期望可持续地改善住院成年患者的身体活动水平，为此他们需要兼具明确身体活动定义与医疗团队各成员角色、职责说明的清晰指南；需要能够赋能患者在住院期间主动参与身体活动的干预方案；同时病房的设计与陈设应适配优化，以激励患者提升身体活动水平。