Proof of Concept trial to achieve an increase of inpatient activity levels through the use of rewards

Year Submitted: 2024
Published Date: 31 December 2024

Tags: Training ＆ Education, Care Process ＆ Redesign, Physical Learning Platform, Lean Methodology, Design Thinking

About this Content

Aims

This program aims to achieve the following: a) An increase in patients’ overall activity levels during their inpatient stay through performing of self-exercises (self-initiated, caregiver-guided or prescribed). b) To achieve patients’ compliance rate of 80% of carrying out self-exercises with prescribed exercises, participation monitoring, positive reinforcements and rewards. c) To provide preliminary experience in application of such a rewards program that will allow further refinement for a more comprehensive rewards program in the TTSH-ICH.

Background

Currently patients are given self-exercises to do in their own time out of formal therapy time as decided by their primary therapists. However, this is an inconsistent practice. There is no structure of monitoring if patients are doing these self-exercises except for verbal self-reporting and no rewards system in place. Hence, this program serves to initiate a formalised approach to empower and encourage patients to perform prescribed and self-initiated exercises outside of formal therapy time through a monitoring and rewards system, with the intention to increase overall inpatient activity levels.

Methods

A maximum of 35 patients from ICH-TR & IR/SA settings would be recruited to voluntarily participate in the program. Patients with estimated Length of Stay less than 1 week from enrolment would be excluded. Suitable patients would be identified to enrolled into this program after assessment by the therapist. As the patient progresses in his/her rehab journey, activities would be added to increase the activity time for the patient. Patients with the following conditions would be excluded: a) Medically unstable b) patients not referred or discharged from therapy c) Require higher level of assistance beyond moderate assistance d) Presence of cognitive issues that preclude participation e) Unable to understand the concept of earning points for rewards. Prior to start of the program, baseline activity level of the patient would be measured for 3 consecutive days. During the period of participation, each patient would be issued an activity diary to do daily self-logging of the activities or exercises. Changes or addition of activities or exercises to the activity diary may be initiated by the care team or by the patient and/or caregiver accordingly to their rehabilitation progress. Baseline mean of the physical activity would be collected for 7 consecutive days.

Results

26 out of 35 patients completed the study. 9 could not complete their exercises for a variety of reasons. 4 were limited by pain, 2 due to lack of physical support to set patient up for their exercises, 1 could not express his reason due to expressive aphasia, 1 felt too tired and the last patient claim there were no activities over a long public holiday thus didn’t want to do his exercises. 29 out of a possible 35 vouchers were given to patients who completed their 7 days of exercise which include 3 patients who were not able to complete exercises consistently due to pain and lack of physical support. 80% of patients made the effort to log the completion of their exercises.

Conclusion

The study met the aims which was for 80% of patients to be compliant to in completing their exercise log. It can be concluded having a visual reminder/log helped to prompt patients to complete their exercise. However, quantitative data was not sought on whether giving a voucher increased patient’s compliance or increased their motivation. The main limitation of this study is that compliance is self-reported and may not be accurate in reflecting patient’s exercises and activities.

Lessons Learnt

The main challenge was ensuring that patients were reporting accurately. Although patients may have ticked completion, it is unknown whether the patients were able to progress their exercises in increasing the number of repetitions/range of movement/doing their exercises accurately. The gold standard method would be to use activity trackers and self-reported activity diaries to correlate the activity. A visual activity tracker showing how much the patient has moved throughout the day, may prompt the patient to increase their activity levels.

Additional Information

There are no further plans to expand this study. There are other projects to explore the use of the iPads by bedside for patients to engage in exercise videos to increase their out of therapy time participation.

Keywords

Rehabilitation, Patient Participation, Rewards

Innovators' Details

Connect with this contributor!

Ms Lynn Chua - Ying_Lynn_CHUA@ttsh.com.sg

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