Muscle deconditioning due to hospitalisation is problematic, causing delayed discharges, more nursing, carer, or social service support following discharge, and possible discharge to a care home rather than the patient’s own home. Muscle deconditioning is associated with increased mortality, infections, depression, and reductions in patient mobility and ability to engage in their activities of daily living. Preserving muscle strength and function should form part of patients’ rehabilitation plans. Progressive resistance training (PRE) offers the most cost-effective way of preserving muscle strength and function; however, it is not routinely carried out in hospitals. A leg strengthening device (the S-Press) has been developed with the aim of improving access to effective PRE for adults. Using a qualitative approach, thematic analysis of interviews with physiotherapists, patients, and relative carers about their experience of using the S-Press provided insight into integrating PRE into patients’ rehabilitation, what promoted or prevented its use, and the outcomes associated with its use. Four overall themes emerged from the data. “ExperienceofUsers” described that the S-Press was accessible, convenient, time efficient, portable, and manoeuvrable, and it provided an objective measure of progress. “Facilitators” included findings around how the S-Press was easy to use, motivational, and comfortable when in use. “Barriers” comprised the inability of some patients to use the S-Press independently and the identification of obstacles that prevented consistent use. “ImpactandBenefits” represented the perceptions of increased leg strength and psychological benefits. The S-Press is beneficial for patients’ rehabilitation by offering PRE that is simple and easy to use, acceptable to both patients and professionals, and can be integrated as part of patients’ rehabilitation plans.
References
[1]
NHS England (2024) Urgent and Emergency Care Daily Situation Reports 2023-24. https://www.england.nhs.uk/statistics/statistical-work-areas/uec-sitrep/urgent-and-emergency-care-daily-situation-reports-2023-24/
[2]
Hendy, P., Patel, J., Kordbacheh, T., Laskar, N. and Harbord, M. (2012) In-Depth Analysis of Delays to Patient Discharge: A Metropolitan Teaching Hospital Experience. Clinical Medicine, 12, 320-323. https://doi.org/10.7861/clinmedicine.12-4-320
[3]
Smith, T.O., Sreekanta, A., Walkeden, S., Penhale, B. and Hanson, S. (2020) Interventions for Reducing Hospital-Associated Deconditioning: A Systematic Review and Meta-Analysis. Archives of Gerontology and Geriatrics, 90, Article ID: 104176. https://doi.org/10.1016/j.archger.2020.104176
[4]
Kings Fund (2023) The Hidden Problem behind Discharges and Their Costs. https://www.kingsfund.org.uk/insight-and-analysis/blogs/hidden-problems-delayed-discharges
[5]
Rojas‐García, A., Turner, S., Pizzo, E., Hudson, E., Thomas, J. and Raine, R. (2017) Impact and Experiences of Delayed Discharge: A Mixed‐Studies Systematic Review. Health Expectations, 21, 41-56. https://doi.org/10.1111/hex.12619
[6]
Guilcher, S.J.T., Everall, A.C., Cadel, L., Li, J. and Kuluski, K. (2021) A Qualitative Study Exploring the Lived Experiences of Deconditioning in Hospital in Ontario, Canada. BMC Geriatrics, 21, Article No. 169. https://doi.org/10.1186/s12877-021-02111-2
[7]
British Geriatrics Society (2023) Protecting the Rights of Older People to Health and Social Care. https://www.bgs.org.uk/policy-and-media/protecting-the-rights-of-older-people-to-health-and-social-care
[8]
Kortebein, P., Symons, T.B., Ferrando, A., Paddon-Jones, D., Ronsen, O., Protas, E., et al. (2008) Functional Impact of 10 Days of Bed Rest in Healthy Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63, 1076-1081. https://doi.org/10.1093/gerona/63.10.1076
Lim, S., Doshi, V., Castasus, B., Lim, J. and Mamun, K. (2006) Factors Causing Delay in Discharge of Elderly Patients in an Acute Care Hospital. Annals of the Academy of Medicine, Singapore, 35, 27-32. https://doi.org/10.47102/annals-acadmedsg.v35n1p27
[11]
Sáez de Asteasu, M.L., Martínez‐Velilla, N., Zambom‐Ferraresi, F., Ramírez‐Vélez, R., García‐Hermoso, A., Cadore, E.L., et al. (2020) Changes in Muscle Power after Usual Care or Early Structured Exercise Intervention in Acutely Hospitalized Older Adults. Journal of Cachexia, Sarcopenia and Muscle, 11, 997-1006. https://doi.org/10.1002/jcsm.12564
[12]
Brown, C.J., Friedkin, R.J. and Inouye, S.K. (2004) Prevalence and Outcomes of Low Mobility in Hospitalized Older Patients. Journal of the American Geriatrics Society, 52, 1263-1270. https://doi.org/10.1111/j.1532-5415.2004.52354.x
[13]
Suetta, C., Magnusson, S.P., Beyer, N. and Kjaer, M. (2007) Effect of Strength Training on Muscle Function in Elderly Hospitalized Patients. Scandinavian Journal of Medicine & Science in Sports, 17, 464-472. https://doi.org/10.1111/j.1600-0838.2007.00712.x
[14]
Brennan, M.M. (2024) Movement Is Muscle in Hospitalized Adults. Geriatric Nursing, 55, 373-375. https://doi.org/10.1016/j.gerinurse.2023.11.015
[15]
Wald, H.L., Ramaswamy, R., Perskin, M.H., Roberts, L., Bogaisky, M., Suen, W., et al. (2018) The Case for Mobility Assessment in Hospitalized Older Adults: American Geriatrics Society White Paper Executive Summary. Journal of the American Geriatrics Society, 67, 11-16. https://doi.org/10.1111/jgs.15595
[16]
Hughes, V.A., Frontera, W.R., Wood, M., Evans, W.J., Dallal, G.E., Roubenoff, R., et al. (2001) Longitudinal Muscle Strength Changes in Older Adults: Influence of Muscle Mass, Physical Activity, and Health. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56, B209-B217. https://doi.org/10.1093/gerona/56.5.b209
[17]
Parry, S.M. and Puthucheary, Z.A. (2015) The Impact of Extended Bed Rest on the Musculoskeletal System in the Critical Care Environment. Extreme Physiology & Medicine, 4, Article No. 16. https://doi.org/10.1186/s13728-015-0036-7
[18]
Martínez-Velilla, N., Casas-Herrero, A., Zambom-Ferraresi, F., Sáez de Asteasu, M.L., Lucia, A., Galbete, A., et al. (2019) Effect of Exercise Intervention on Functional Decline in Very Elderly Patients during Acute Hospitalization. JAMA Internal Medicine, 179, 28-36. https://doi.org/10.1001/jamainternmed.2018.4869
[19]
Cadore, E.L. and Izquierdo, M. (2018) Muscle Power Training: A Hallmark for Muscle Function Retaining in Frail Clinical Setting. Journal of the American Medical Directors Association, 19, 190-192. https://doi.org/10.1016/j.jamda.2017.12.010
[20]
Chan, A., Hoens, A., Singh, C., Elashi, M., Gerevas, K., Idle, M., Lundie, J., Urbina, M., Pace, A. and Ma, J. (2022) Current Practices in and Barriers to Physiotherapists’ Use of Resistance Exercise with Older Adults in Acute Care. Physiotherapy Canada, 74, 363-369. https://10.3138/ptc-2020-0123
[21]
Liu, C. and Latham, N.K. (2009) Progressive Resistance Strength Training for Improving Physical Function in Older Adults. Cochrane Database of Systematic Reviews, 2009, CD002759. https://doi.org/10.1002/14651858.cd002759.pub2
[22]
Daly, R.M. (2017) Exercise and Nutritional Approaches to Prevent Frail Bones, Falls and Fractures: An Update. Climacteric, 20, 119-124. https://doi.org/10.1080/13697137.2017.1286890
[23]
Coleman, S.A., Cunningham, C.J., Murphy, N., Feaheny, J., Robinson, D., Lannon, R., et al. (2021) Progressive Resistance Training in a Post-Acute, Older, Inpatient Setting: A Randomised Controlled Feasibility Study. Journal of Frailty, Sarcopenia and Falls, 6, 14-24. https://doi.org/10.22540/jfsf-06-014
[24]
So, C. and Pierluissi, E. (2012) Attitudes and Expectations Regarding Exercise in the Hospital of Hospitalized Older Adults: A Qualitative Study. Journal of the American Geriatrics Society, 60, 713-718. https://doi.org/10.1111/j.1532-5415.2012.03900.x
[25]
Parker, A.M., Sricharoenchai, T. and Needham, D.M. (2013) Early Rehabilitation in the Intensive Care Unit: Preventing Impairment of Physical and Mental Health. Current Physical Medicine and Rehabilitation Reports, 1, 307-314. https://doi.org/10.1007/s40141-013-0027-9
[26]
Williams, G. and Denehy, L. (2019) Clinical Education Alone Is Sufficient to Increase Resistance Training Exercise Prescription. PLOS ONE, 14, e0212168. https://doi.org/10.1371/journal.pone.0212168
[27]
Jack, K., McLean, S.M., Moffett, J.K. and Gardiner, E. (2010) Barriers to Treatment Adherence in Physiotherapy Outpatient Clinics: A Systematic Review. Manual Therapy, 15, 220-228. https://doi.org/10.1016/j.math.2009.12.004
[28]
ShahAli, S., Shahabi, S., Etemadi, M., Hedayati, M., Barth, C.A., Mojgani, P., et al. (2023) Barriers and Facilitators of Integrating Physiotherapy into Primary Health Care Settings: A Systematic Scoping Review of Qualitative Research. Heliyon, 9, e20736. https://doi.org/10.1016/j.heliyon.2023.e20736
[29]
Maden-Wilkinson, T.M., Griffiths, C., Lakkappa, B., Walker, K., Kennerley, C.L. and Turner, J.J. (2024). Feasibility, Usability, Acceptability and Efficacy of a Novel Leg Strengthening Device (S-Press) for Strengthening Leg Muscles and Improving Physical Impairment during Hospital Admission. https://doi.org/10.1101/2024.01.15.24301211
[30]
Braun, V. and Clarke, V. (2006) Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3, 77-101. https://doi.org/10.1191/1478088706qp063oa
[31]
Braun, V. and Clarke, V. (2021) Thematic Analysis: A Practical Guide. Sage.
[32]
Korstjens, I. and Moser, A. (2017) Series: Practical Guidance to Qualitative Research. Part 4: Trustworthiness and Publishing. European Journal of General Practice, 24, 120-124. https://doi.org/10.1080/13814788.2017.1375092
[33]
Shenton, A.K. (2004) Strategies for Ensuring Trustworthiness in Qualitative Research Projects. Education for Information, 22, 63-75. https://doi.org/10.3233/efi-2004-22201
[34]
Buckinx, F. and Aubertin-Leheudre, M. (2019) Relevance to Assess and Preserve Muscle Strength in Aging Field. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 94, Article ID: 109663. https://doi.org/10.1016/j.pnpbp.2019.109663
[35]
NICE (2023) Stroke Rehabilitation in Adults NICE Guideline [NG236]. https://www.nice.org.uk/guidance/ng236/chapter/Recommendations#intensity-of-stroke-rehabilitation
[36]
Hartveld, A. and Hegarty, J.R. (1996) Augmented Feedback and Physiotherapy Practice. Physiotherapy, 82, 480-490. https://doi.org/10.1016/s0031-9406(05)66414-0
[37]
Gleadhill, C., Bolsewicz, K., Davidson, S.R.E., Kamper, S.J., Tutty, A., Robson, E., et al. (2022) Physiotherapists’ Opinions, Barriers, and Enablers to Providing Evidence-Based Care: A Mixed-Methods Study. BMC Health Services Research, 22, Article No. 1382. https://doi.org/10.1186/s12913-022-08741-5
[38]
Gayton, J. and Monga, A. (2023) Goal Setting in Physiotherapy‐Led Adult Musculoskeletal Care: A Scoping Review. Musculoskeletal Care, 21, 1315-1340. https://doi.org/10.1002/msc.1803
[39]
Hutting, N., Caneiro, J.P., Ong’wen, O.M., Miciak, M. and Roberts, L. (2022) Patient-centered Care in Musculoskeletal Practice: Key Elements to Support Clinicians to Focus on the Person. Musculoskeletal Science and Practice, 57, Article ID: 102434. https://doi.org/10.1016/j.msksp.2021.102434
[40]
Solbakken, L.M., Nordhaug, M. and Halvorsen, K. (2022) Patients’ Experiences of Involvement, Motivation and Coping with Physiotherapists during Subacute Stroke Rehabilitation—A Qualitative Study. European Journal of Physiotherapy, 25, 154-161. https://doi.org/10.1080/21679169.2022.2032825
[41]
Bastemeijer, C.M., van Ewijk, J.P., Hazelzet, J.A. and Voogt, L.P. (2020) Patient Values in Physiotherapy Practice, a Qualitative Study. Physiotherapy Research International, 26, e1877. https://doi.org/10.1002/pri.1877