1. Introduction
PA behavior
REGRESSION
Inactive behavior is common in hospitalized patients. This study investigated the effectiveness of using a smartphone app with an accelerometer (Hospital Fit) in addition to usual care physiotherapy on increasing patients’ physical activity (PA) behavior. A randomized controlled trial was performed at Maastricht University Medical Centre. Patients receiving physiotherapy while hospitalized at the department of Pulmonology or Internal Medicine were randomized to usual care physiotherapy or using Hospital Fit additionally. Daily time spent walking, standing, and upright (standing/walking) (min) and daily number of postural transitions were measured with an accelerometer between the first and last treatment. Multiple linear regression analysis was performed to determine the association between PA behavior and Hospital Fit use, corrected for functional independence (mILAS). Seventy-eight patients were included with a median (IQR) age of 63 (56–68) years. Although no significant effects were found, a trend was seen in favor of Hospital Fit. Effects increased with length of use. Corrected for functional independence, Hospital Fit use resulted in an average increase of 27.4 min (95% CI: −2.4–57.3) standing/walking on day five and 29.2 min (95% CI: −6.4–64.7) on day six compared to usual care. Hospital Fit appears valuable in increasing PA in functionally independent patients.Physical inactivity is common during hospital stay with patients spending between 87% and 100% of their time lying in bed or seated in a chair [Physiotherapy during hospital stay is primarily aimed at enhancing patients’ PA behavior and improving functional recovery of activities of daily living [In several studies, accelerometers are linked to a smartphone in order to gain insight into patients’ PA behavior. Van Grootel et al. investigated the preliminary effectiveness of a goal-directed PA-promoting intervention using an activity tracker in a pre–post study in patients admitted to the Department of Pulmonology or Department of Nephrology/Gastro-enterology. Data regarding patients’ PA behavior were made visible to patients and healthcare professionals via a smartphone app, a public screen on the ward, and via the electronic patient record. Before implementation, patients spent a mean total of 38 (standard deviation (SD) 21) minutes active per day. Providing insight into patients’ PA behavior and setting daily movement goals resulted in a 32% increase to 50 (SD 31) minutes active per day (Furthermore, a recent non-randomized quasi-experimental study investigated the potential of using a wearable activity tracker during the physiotherapy treatment of hospitalized patients following orthopedic surgery to increase the amount of time spent standing and walking per day and the extent of functional recovery [Furthermore, patients and physiotherapists proposed to improve Hospital Fit through adding a goal setting feature, an educational feature, and sending automatically generated reminder messages. Moreover, they suggested to improve the clinical applicability of the accelerometer through being able to differentiate standing from walking as well as being able to count the number of postural transitions per day from a sedentary (lying/sitting) to an active (standing/walking) position. As a result, the accelerometer algorithm was optimized and validated in comparison to video analysis in 50 hospitalized patients under free-living conditions [