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Impact of distance on stroke inpatients’ mobility in rehabilitation clinics: a shadowing study

December 2022
The Center For Health Design

Why does this study matter?
Stroke patients spend a substantial amount of time in rehabilitation environments. Differing rehabilitation stages, mobility aid utilization, sizes and spatial configuration of rehabilitation clinics can both impact interactions and create wayfinding challenges for patients who are expected to find and attend daily therapies independently. And the stakes are high; failure to rehabilitate typically results in nursing home placement. Research is needed to understand how size and spatial configuration of rehabilitation settings can support wayfinding and overcome mobility barriers for patients. This study was undertaken to evaluate the how distances between spaces in rehabilitation clinics impact patients’ mobility.                            


How was the study done?
The researchers conducted a behavioral mapping study in Germany between 2014-2020 designed to examine the relationship between distance and patients’ independent mobility in rehabilitation clinics. Seven (predominantly neurological rehabilitation) clinics with capacity ranging from 188-250 beds were selected for the study. Sites were selected to include a variety of configurations, characteristics and ways of allocating locations accessible to patients, including patient wards, therapy rooms, diagnostic facilities, the main cafeteria and various communal areas. Participants were identified by clinical staff within the 7 sites. The final sample consisted of 70 patients who had suffered a stroke and were able to move independently with or without the use of a mobility aid. Patients with severe communication, cognitive and mobility impairments, pre-existing comorbidities and/or orthopedic, neurological, dementia or other conditions of consequence were excluded. All patients included in the analysis were over 60 years of age. In this study, an ‘observe only’ shadowing data collection method was used. Three complimentary types of notes were taken on pre-prepared building floorplans during a 12 hour observation period: 1) paths taken; 2) time log of all activities; and 3) notable encounters with the built environment. A supplemental questionnaire asked patients one open-ended question about the barriers they experienced within the built environment, and staff members one open-ended question about the barriers they witnessed patients encountering.  


What do we learn from the study?
Data from floor plans and time log sheets were digitalized and analyzed for:
1) daily distances covered,
2) relationship between distance and encountering mobility barriers or requiring assistance from staff,
3) comparison of path distances with and without mobility barriers or assistance,
4) patients’ observed paths and interactions with space.

The paths were categorized according to : 1) no mobility barriers, 2) mobility barriers the could be overcome without assistance, and 3) mobility barriers that required assistance to overcome.

Thematic analysis revealed 5 key mobility barrier categories: 1) wayfinding, 2) long distances, 3) corridor clearance, 4) physical obstacles, and 5) flooring. Increased distance increased the number of encountered mobility barriers in all 5 categories for all patients, with no significant difference between patients’ mobility levels. Clinics with more complex configurations had considerably longer distances. Patients encountered mobility barriers and needed help more often on distances that were around 360’ in comparison with maintaining independence on distances of 196’ or less. The two most functional types of building configurations (in terms of distance) related to multi-story buildings where patient and therapy rooms were stacked vertically (like a hotel) and buildings where patient and therapy rooms were mixed on the same floor, with the main therapy area separated vertically.

A thematic analysis of the open-ended responses to mobility challenges revealed agreement between patients and staff who mentioned clinic long distances and inadequate visual communication (signage) most frequently."             


Can we say the results are definitive?
Even though the representative sample within each of the 7 settings is small, the total sample size of 70 patients and 840 hours of shadowing observations was sufficient to study the phenomenon under question. Future research would benefit from using mixed methods to replicate the study with a larger and more diverse sample, especially during free time when movement is voluntarily undertaken.


What’s the takeaway?
We know that built features within healthcare environments can positively influence infection control, recovery, activity levels, well-being and overall satisfaction. This study demonstrates that the spatial needs and independent mobility of stroke patients can also be improved through building layouts with short distances and carefully planned routes between destinations.        

Summary of:
Kevdzija, M., & Marquardt, G. (2021). Impact of distance on stroke inpatients’ mobility in rehabilitation clinics: A shadowing study. Building Research & Information, 50(2-Jan); 74–88.  



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