SERVICE DEVELOPMENT FEATURE
whole team saw that activity was everyone’s business and that
purposeful activity continued across all seven days.
The baseline results shocked the team – occupational therapists,
nursing staff and researchers alike. It was identified that the average
number of steps per week, per person was only 668. This became
a driving force for the improvement activity.
Challenges
Patients and staff were interviewed by HIS and the information
gathered was used to inform the #ThinkActivity improvement
programme.
Demands on time were recognised by both patients and
staff alike. Staff described the differences in patients’ ability as
a challenge and one patient recognised a change in his level of
activity when admitted to the hospital.
Patients described their boredom, a view
echoed by Clarke, Stack and Martin
(2018). Consequently, by focusing
on activity and improving the
physical resources in the hospital,
relationships were developed with
the local schools, churches and local
musicians and choirs.
An activity board provides information and advertises
upcoming events, such as concerts, for patients and their
families.
The improvement programme was multi-facetted. Nursing
staff led the #EndPJParalysis challenge, resulting in patients
being up and dressed by 10.30 am, releasing an additional 90
minutes for rehabilitation.
Therapy staff led the mobility challenge. The activePAL™
measured steps taken for all participants. This was visualised in a
graph describing the virtual climb up Tinto Hill, a local hill (15,320
steps).
Activity champions
It was the role of activity champions to promote activity and seek
opportunities to reduce sedentary behaviour. Infographics posted
on the walls informed the staff, patients and visitors of the project
and the need to get up and move.
There are low levels of activity in the majority of older people
in Britain (CMO 2011). Where mobility is termed as poor, physical
activity should be undertaken three or more days a week to
enhance balance and prevent falls (WHO 2010). The longer-term
benefits of activity include a reduction in bone and muscle loss
associated with ageing, a reduction in falls, and more immediate
benefits, with improved cognitive function.
Development of the My Activity Passport
The My Activity Passport (Care Opinion 2018) began with the need
to demonstrate an improvement in a patient’s level of activity. The
occupational therapist developed this person-centred tool with the
patients.
Permission was granted from Dr Harvey for materials from her
research to be used to set individualised personal goals to address
their sedentary behaviour (Harvey, Chastin and Skelton 2018).
Patients had clearly stated that they wanted to be more
involved in activities that mattered to them and have more control
over the decisions that were made about their physical and mental
outcomes.
When the passport was introduced, most participants
described their activities at home as reading books or watching
television. As a means to aid the conversation with the participants
and broaden perceptions of activities they could participate in,
a chart of physical, social, mental and recreational activities was
designed by the occupational therapist.
The conversation generates important information for personcentred
planning and goal setting. More importantly, it allows an
individual to set realistic person-centred goals that can be graded
with their rehabilitation and they can articulate what they want to be
involved in.
This concept of co-production is a tool used by allied health
professionals to modify a person’s focus towards wellbeing and
contribute to a person’s enablement with their long-term goals
or reducing their dependency on health and social care services
(Knowledge Network 2017).
Change in behaviour
For some people, the measurements from the activePAL™ were
motivational, relating mobility to increased activity. However the
technology was only available during the project period and it was
important that the message being given to patients and staff was
that activity is more than walking.
For the purpose of #ThinkActivity, patients and staff still needed
to be motivated to change their behaviour.
Patients, when assessed by the physiotherapist as safe to
do so, are encouraged to mobilise more as part of their activity
passport. It became apparent that in attempting to reduce patient
falls, the team had become risk averse and had inadvertently
created barriers to prevent patients from moving around freely.
Through implementing the improvement programme a
significant reduction in the falls rate was noted.
The most recent CMO report (2019) acknowledges that an
inactive lifestyle can create a barrier to achieving the previously
recommended activity levels. However, health benefits can still be
accomplished with moderate levels of activity.
A change in attitude towards physical activity is required in
order to mitigate the negative impacts of sedentary time. Data
near the end of the trial demonstrated that the average steps per
person had increased significantly to 4,000 steps per person, per
week.
Evaluation
The programme has highlighted the importance of the culture and
environment of care and its impact on motivation to participate in
rehabilitation and activity.
OTnews August 2020 43