Active Recovery in Rehabilitation Environments: A descriptive study of patient activity in inpatient rehabilitation units.

Observational study using behavioural mapping (for cognitive, social and physical activity) and accelerometry monitoring (for additional collection of physical activity data in those able to walk). Data collection (behavioural mapping and accelerometry) will commence 10 +/- 3 days after admission to the rehabilitation unit. Behavioural Mapping - The patient activity will be collected using a behaviour mapping technique, where observations of participants in the health care setting are recorded in a standardised manner by a trained researcher. The protocol and checklist for collecting these observations was developed specifically for this study, modified based on AREiSSA protocol (Janssen et al., 2012, 2014a, 2014b), validated for use in rehabilitation settings in those studies. - Observations of activity will occur every ten minutes. The observation of physical, cognitive, and social activity or no activity will be recorded through use of a mark against relevant categories. The location of the participant, their position (lying, sitting or upright), and any other people present will also be noted. - A physical activity is defined as any purposeful physical movement – eg all aspects of mobility including transfers or ambulation, and/or participation in activities of daily living such as eating and drinking or getting dressed. - A cognitive activity is defined as the participant actively engaging in a cognitive task – eg reading/writing/games such as crosswords/participating in a verbal activity such as reading aloud or speech therapy games/listening. - Social activity is defined as any interaction involving engagement with the participant and other person/s (present or not) – eg talking/non-verbal communication such a laughter - The category of people present will include: medical, nursing, allied health; other patients; visitors; other hospital staff (eg food services); and alone. - The location of the participant will be recorded at each observation. Locations will be defined as: bedroom, bathroom, hallway, lounge/dining, outdoor courtyard, therapy, and other off-ward locations (café, library, garden). - Duration of observation is for each participant is three non-consecutive days of observation from 6am - 8pm. - Observation days will be a mix of weekday and weekend, as well as aim to observe at different times of the day (early morning and evenings). Accelerometry monitoring - Participants that are able to walk (either independent or with assistance) will also be asked to wear an activity monitor (Stepwatch brand) to provide an additional measure of their physical activity. This will record their number of steps/day, and the pattern of activity over their waking hours. - Duration of accelerometry - Stepwatch monitor worn for all waking hours (taken off for bathing and sleeping) for seven consecutive days during their inpatient stay, with at least one of those days coinciding with behavioural mapping observation.