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A randomized trial of a behavioral intervention to decrease hospital length of stay by decreasing bedrest

Juliana Tolles, Gabriel Waterman, Charles E Coffey, Rebecca Sandoval, Ross J Fleischman, Mailee Hess, Laura Sarff, Roger J Lewis, Brad Spellberg and on behalf of the BRAVE Study Group

PLOS ONE, 2020, vol. 15, issue 1, 1-11

Abstract: Background: Approximately half of hospitalized patients suffer functional decline due to spending the vast majority of their time in bed. Previous studies of early mobilization have demonstrated improvement in outcomes, but the interventions studied have been resource-intensive. We aimed to decrease the time hospital inpatients spend in bed through a pragmatic mobilization protocol. Methods: This prospective, non-blinded, controlled clinical trial assigned inpatients to the study wards per routine clinical care in an urban teaching hospital. All subjects on intervention wards were provided with a behavioral intervention, consisting of educational handouts, by the nursing staff. Half of the intervention wards were supplied with recliner chairs in which subjects could sit. The primary outcome was hospital length of stay. The secondary outcome was the ‘6-Clicks’ functional score. Results: During a 6-month study period, 6082 patient encounters were included. The median length of stay was 84 hours (IQR 44–175 hours) in the control group, 80 hours (IQR 44–155 hours) in the group who received the behavioral intervention alone, and 88 hours (IQR 44–185 hours) in the group that received both the behavioral intervention and the recliner chair. In the multivariate analysis, neither the behavioral intervention nor the provision of a recliner chair was associated with a significant decrease in length of stay or increase in functional status as measured by the ‘6-Clicks’ functional score. Conclusion: The program of educational handouts and provision of recliner chairs to discourage bed rest did not increase functional status or decrease length of stay for inpatients in a major urban academic center. Education and physical resources must be supplemented by other active interventions to reduce time spent in bed, functional decline, and length of stay. Trial registration:, HS-16-00804.

Date: 2020
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DOI: 10.1371/journal.pone.0226332

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