Physical Activity During Hospitalization and Hospital-Associated Disability

Hospital-associated disability

Hospital-associated disability (HAD) is defined as a new decline in functional independence in at least one activity compared with the participant's pre-admission level. Functional independence is assessed using three components: six basic activities of daily living from the Katz Index (bathing, dressing, toileting, transferring, continence, and feeding); five instrumental activities of daily living inspired by the Lawton IADL Index (shopping, housekeeping, laundry, food preparation, and medication management); and four mobility-related activities (walking 400 meters without rest, climbing or descending one flight of stairs without rest, carrying 5 kg, and driving a car). Each activity is scored as unable to perform (0), able to perform with assistance (1), or able to perform independently (2). Participants with a decline in independence in at least one activity compared with their retrospectively assessed pre-admission level are classified as having HAD.

Imagined ability to perform physical activity during hospitalization

Participants' imagined ability to perform physical activity during hospitalization will be assessed by asking whether they can imagine performing the activity daily during hospitalization. Imagined ability will be assessed for hallway walking (200 steps) and resistance exercise (three sets of 8-12 sit-to-stand repetitions) and group-based functionel training.

Actual ability to perform physical activity during hospitalization

Participants' actual ability to perform physical activity during hospitalization will be assessed by asking them to perform hallway walking (200 steps) and resistance exercise (three sets of 8-12 sit-to-stand repetitions). For each activity, actual ability will be categorized as able to complete the activity as defined, 0) unable to complete the activity, 1) able to complete the activity with assistance and 2) able to complete the activity independently. Reasons for inability to complete an activity will be recorded.

Preferred type of physical activity during hospitalization

Participants will be asked which type of physical activity they prefer: hallway walking, resistance training and group-based functional training. (Group-based functional training will be assessed as a preference only and will not be physically performed as part of the assessment).

Mean Daily steps

Number of daily steps assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

Mean daily uptime

Daily time spent in uptime assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

Mean daily walking

Daily time spent walking assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

Mean daily standing

Daily time spent standing assessed by a SENS motion® accelerometer worn continuously from inclusion and throughout hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. A measurement day is considered valid if more than 20 hours of 24-hour mobility data are available. For each participant, mean daily step count is calculated across all available valid days within each measurement period.

Self-reported mobility

Self-reported mobility by the Acute Care Mobility Assessment. A score of 0-12 can be obtained, with 0 reflecting poor mobility and 12 reflecting a high level of mobility.

Life space mobility

By the Life Space Assessment-DK, which measure mobility and level of dependence in mobility. A score of 0-120 can be obtained, with 0 reflecting poor mobility and 120 reflecting high mobility

Self-reported pre-admission (2 weeks prior to admission) and post discharge mobility

By the New Mobility Score, which assesses the ability to walk indoors and outdoors and the ability to go shopping. A score from 0-9 can be obtained, with 0 reflecting low mobility and 9 reflecting high mobility.

Frailty pre-admission (2 weeks prior to admission)

By the Clinical Frailty Scale, which is a clinical evaluation of the degree of frailty of a person. It is scored by health care professionals on a scale from 1 (very fit) to 9 (terminally ill)