From treatment to prevention in health and social care: Hospital acquired deconditioning to reconditioning
On this page
Dr Anita Mottram, Principal Occupational Therapist for Kirklees Council, examines evidence on how a shift to reconditioning practices can keep people’s minds and bodies healthy during a hospital stay, with benefits for both health and social care.
As far back as 400BC, the ancient Greek physician, Hippocrates promoted the value of bed rest to help manage pain and support recuperation, but he also cautioned that too much rest would lead to a loss of muscle tone and strength.
Fast forward to the 21st century and we still haven’t managed yet to get this balance right in the health care system. People are being admitted to hospital for one problem, but extended bed rest means they’re developing new and additional health issues, which is known as ‘hospital acquired deconditioning’. Research shows half of people experience functional decline between admission and discharge from hospital and only 39% of those people regain it after one year.
Aside from any health condition, a lack of purposeful activity whilst on a hospital ward, alone, can transform a frail person, previously living independently, into one dependent on services. Hospital acquired deconditioning is thought of as a loss of mobility, but it has far more wide-ranging impact. It can result in physiological, psychological, cognitive, and functional performance decline that impacts on a range of body systems.
Not only is this a tragedy for the individual, but we also need to be increasingly aware of the financial costs of deconditioning. This is felt at a local authority level through additional adult social care (ASC) support required for people. The Association of Directors of Adult Social Services’ Spring Survey 2024 results revealed that 99% of Directors in Adult Social Care said increased NHS pressures will result in additional pressures for ASC in 2023/24. It’s also felt at an NHS level too as people return to hospital due to falls and other injuries.
So, what can acute trusts do to mitigate the risks of this preventable harm given that for 60% of people on bed rest, there is no medical reason documented?
In a recent project for Mid Yorkshire NHS Trust, Occupational Therapy and Physiotherapy students and staff proactively worked with individuals on an acute ward to undertake daily living and cognitive activities to prevent the risk of deconditioning. The project ran from April to May 2024. Individuals were reviewed daily by the therapy team, who each held a caseload with impressive results achieved compared to the previous month’s pre-project outcomes.
The number of therapy hours provided more than tripled. Three quarters of individuals maintained or improved their level of function in May 2024 compared to 50% the previous month, while the number of individuals whose function deteriorated during the length of their stay fell from 48% to 3%.
Whilst, importantly, the outcomes highlight an increased level of independence for individuals, for social care there was a reduction in the number of daily living equipment devices requested and a reduction in packages of care required post discharge.
Due to a lack of a deconditioning evaluation tool, the students created one that would enable each person to be screened on admission, their level of functional ability and the potential risk of deconditioning identified. Those people who were identified as high risk were referred to daily therapy to prevent deconditioning, and the low-risk group were provided with a self-management booklet. The next phase of the project is to validate the deconditioning tool and evaluate its effectiveness.
More support to keep patients minds and bodies active in hospital will enables them to get home from hospital as fast as possible, where most of us want to be. It also will help free up space in our overcrowded hospitals which prevents people from needing complex social care support and reduces financial costs.
So as our Secretary of State for Health and Social Care, Wes Streeting seeks to shift our health and social care system from treatment to prevention, we can see how the benefits of occupational therapy can support the move from hospital acquired deconditioning to reconditioning which has benefits for both health and social care.
Dr Anita Mottram is also the Chair of the Yorkshire and Humber Principal Occupational Therapy Network and Co-Vice Chair of the National Principal Occupational Therapy Task Force.
Occupational Therapy Week 2024 takes place from 4-11 November 2024.