Staying put: a systematic review of accelerometer use and physical activity levels in acutely ill adults during hospitalisation

Aim: To review how objective activity monitoring has been used across studies of acutely ill inpatients. What active and sedentary behaviours have been measured; how active or sedentary are inpatients with medical or surgical admissions?
Design: Prospectively registered systematic review.
Methods: Four databases were searched. Procedures included completion of tasks in duplicate with cross-checking, and contact with corresponding authors. Risk of bias was assessed with the PEDro and Newcastle Ottawa Scales as appropriate to study design. Results: 42 studies were identified. Twenty-four percent of studies were of older general/mixed medical admissions; at least half of studies recruited people with a cardiorespiratory condition. Positional monitors were most commonly used. Physical activities were reported more frequently than sedentary behaviours as time spent in a particular posture, step count, number of postural transitions, and bouts. Inpatients spent 93-98.8% of their hospital stay inactive, and in most studies completed <1000 steps/day despite up to 50 postural transitions/day. Missing data was a concern from risk of bias assessment.
Conclusion/Key Practice Points:
• This is the first review to summarise the use of wearable technology for physical activity monitoring in the acute setting; issues of missing data can be classified according to patient factors, application errors, device issues, changes in medical status, or patient flow.
• Despite heterogeneity in outcome reporting, inactivity was a common finding across groups.
• Characteristics of sedentary behaviour were less frequently described and may warrant further detailed reporting in research considering that changes in response to treatment may first be seen in sedentary patterns.