'Bedrest is Bad': New #everyBODYmoves Campaign Is Combatting Hospital Immobility
Experts agree that immobility can harm patients in hospital, postacute care, and other settings. According to researchers, bedrest can have many negative effects:
- Muscle mass decreases by ~1.5%¬–2% per day during bed rest.
- Risk for development of thromboembolic disease increases.
- Increased risk for atelectasis may contribute to pneumonia.
- Raising the head of the bed causes greater pressure on the skin in the sacral region.
- One study found 61 of 155 patients who survived a critical illness had contractures.
Movement can ameliorate these effects, but for patients in hospital settings that often takes encouragement. And sometimes health care providers need to be reminded about their role in promoting movement.
Enter the #everyBODYmoves campaign, a 3-day event designed to encourage providers to make movement a priority and encourage the sharing of best practices and ideas, including an Online Global Summit focused on immobility harm, July 10-12, 2019. (Additional information in the Q&A below.)
For details, #PTTRANSFORMS spoke with Michael Friedman, PT, MBA, director of Johns Hopkins Activity and Mobility Promotion (AMP) and director of strategic program development in the Department of Physical Medicine and Rehabilitation at Johns Hopkins Medicine.
#PTTRANSFORMS: What is the #everyBODYmoves campaign?
Michael Friedman: It's a campaign developed by Johns Hopkins Medicine to raise awareness and put focus on the immobility harm in the hospital and postacute care. The campaign has brought together different groups around the country and around the world that we have had the good fortune to interface with while developing and disseminating our Activity and Mobility Promotion solutions. We have been successful in positioning hospital immobility as a harm just like deep vein thrombosis (DVT) or falls, and felt we could assist other organizations in raising awareness across disciplines—because you can’t address immobility if your organization doesn't realize it is a problem.
#PTTRANSFORMS: You presented on this topic at the recent congress of the World Confederation for Physical Therapy. Can you tell us about that?
MF: The presentation focused on the need to systematically address hospital immobility harm. Beyond having presenters from the United States, the Netherlands, the United Kingdom, and Australia, what I really enjoyed was that presenters included physical therapy, administration, nursing, and physician perspectives. Each perspective included an element focused on barrier assessment, measurement, training, and engagement. At Johns Hopkins we believe that it is essential to assess and measure mobility across disciplines—physicians, nurses, therapists—using a common tool and to be able to communicate a patient's progress to both the care team and the patient. My colleagues from around the world and across disciplines reinforced for me the importance of a global community working together to solve a common problem—and there you have it, #everyBODYmoves.
#PTTRANSFORMS: It's about shifting the culture or the organization mindset.
MF: It's an entire shift from a culture of immobility. Evidence demonstrates that bedrest is bad for every outcome there is. The July 10-12 summit hopefully will provide a jumping off point or accelerant for organizations to initiate or expand formal mobility programs.
The focus of this whole campaign is simple. You can participate in 3 ways.
- Establish a Mobility-a-thon: Over 3 days, what can you do to make mobility a priority in a patient's care plan? Can you get them up more? Can you get them up for 3 meals a day? What can you do to just make mobility a priority? That's it.
- Share your best practices on social media, patient success stories. Just use #everyBODYmoves and #EndPJparalysis to join the conversation.
- Attend the free online conference, which includes hours of content from around the world. Visit http://bit.ly/everybodymoves for conference details and free resources to support your campaigns and communicate with your teams.
#PTTRANSFORMS: How does this campaign extend to long-term care facilities or skilled nursing facilities?
MF: This approach works in postacute care, long-term care, and also home health care. Sedentary behavior is bad. We should all exercise more than we do. But if you're confined to the home or have a chronic illness, it becomes that much harder, and the cycle of comorbidity, debility, and disease accelerates. As a patient, you might say, "I'm sick, I just need to sit in bed and rest." Maybe you're on pain medication. We as providers need to think about all those barriers to movement and collectively develop solutions, no matter the setting.
#PTTRANSFORMS: How do you balance the concern about falls with the concern about immobility?
MF: Inherently, safe mobility would mean no falls, but we instead have been focused on core measure. Therefore, the easiest way not to have to record a fall in the hospital is for the patient not to get out of bed, but then they're more likely to get a pressure ulcer or pneumonia. When they leave the hospital, they're weaker and more likely to have a fall at home.
This is an unintended consequence of falls regulation and misaligned incentives.
There is an article on this topic called "The tension between promoting mobility and preventing falls in the hospital" that I encourage people to read.
#PTTRANSFORMS: What can a PT who's not in a decision-making position do to promote this type of initiative?
MF: To get things to stick, you need to push them to leadership and get your organization invested in it. Patient stories are so important. If you can bring patient stories forward and tie them to your other initiatives, feed them up through your managers and decision makers, you can turn a single patient interaction into a campaign.
Another thing you can do specifically as a PT is engage the rest of the care team across disciplines. Most patients in the hospital are not seen by a physical therapist and don’t need to be, but how can you still add value for those patients? You need to be thinking: I’m a consultant, I’m the expert on mobility. What can I recommend to the rest of the health care team to do when I’m not in the room?
For the patients you are seeing, you see them maybe for a half hour to 45 minutes. What's happening the other 23 hours of the day? What's happening on the days you're not going to see them? If individual staff PTs can start thinking, "What is the mobility plan for this patient when I'm not here?"—that's a huge start.
#PTTRANSFORMS: What is the most important takeaway?
MF: The single most important thing about the #everyBODYmoves campaign is that it allows an opportunity for rehab providers to engage other disciplines and communicate how important mobility is. Awareness, awareness, awareness.
These 3 days are just a start. To develop this as a full plan, you do need a systematic quality improvement approach. But the first steps are building awareness, engaging your organization, and understanding what you can do as an individual. Immobility is a harm and needs to be not only a rehab imperative but a quality and safety imperative just like any other. If we accomplish that, the rest will move in the right direction.