4.2. Clinical Implications and Recommendations for Future Research
COMPLICATIONS
The present study has a number of implications for clinical practice and future research. First, it provides valuable insight that the effect of Hospital Fit increases with the number of days patients use Hospital Fit and suggests that a clinically relevant contribution to the prevention of the negative effects of inactivity can be seen when Hospital Fit is used for at least four days. The increase in PA behavior has a positive influence on the prevention of functional decline and complications, a reduction in LOS, an improved quality of life, and reduced risk of institutionalization. Moreover, the positive trend in the increase in PA with Hospital Fit also supports personalized care and empowers patients in their recovery process. Second, the results demonstrate a strong association between functional independence and PA, with independent patients spending significantly more time standing and walking per day and performing more transitions per day than patients that are dependent on others. Patients that were dependent on others and did not use Hospital Fit spent on average 4.3 min walking on day five and 5.2 min on day six, compared to 41.4 and 39.2 min in independent patients that did not use Hospital Fit. In independent patients using Hospital Fit, time spent walking on day five and six increased to 58.4 and 54.8 min, respectively. In order to prevent the negative effects of inactivity, patients that are dependent on others should therefore first receive intensive treatment to regain functional independence. Once independence is regained, patients may benefit from PA-promoting interventions such as Hospital Fit. Lastly, the data created by Hospital Fit have tremendous potential. Monitoring PA as usual care enables physiotherapists to make more efficient choices regarding which patients need treatment, but it also enables creating population norms for PA. But before implementing Hospital Fit in standard care, we would first propose to study the effect of Hospital Fit in patients that are functionally independent and are able to use Hospital Fit for at least four days, in a study that is adequately powered on all consecutive measurement days. Additionally, 45% of the patients that were screened for eligibility in the present study were excluded due to their age exceeding 75 years. As we see an increase in smartphone use amongst elderly patients, we propose to remove this exclusion criterion in future studies. Moreover, the primary focus of the current study was to investigate the effectiveness of using Hospital Fit on increasing patients’ PA behavior. In future studies, we propose to perform a process evaluation as well, to investigate how often Hospital Fit and the different functionalities were used and to allow a correct interpretation of the effectiveness. 