Although early physical activity is a cornerstone for effective stroke recovery, stroke patients spend a large amount of time immobile. Medical co-morbidities, system restrictions, and recent results from a randomized trial of very early mobilization within the first 24 hours after stroke have contributed to variations in practice about how and when we liberate patients from bedrest. Previous international reports suggest that patients spend large amounts of time alone. This study sought to determine activity levels of stroke patients and the environment of recovery in a U.S. comprehensive stroke center.

Hourly observations about environmental and patient activities were recorded over 12 hour days for a two week period in our comprehensive stroke center. Our transdisciplinary team of stroke recovery experts defined environmental stimuli deemed to have potential positive or negative benefits to hospitalized stroke patients. Environmental and patient level activity was recorded using pre-defined definitions for the following: patient in bed or out of bed, lights on, shades up, alarm sounding, television on, radio on, door open, staff/visitor presence, patient positioning, and patient activity. Patients, visitors, and staff were aware that we were conducting an observational project, but were unaware of the study’s hypotheses. Data were analyzed using Chi-squared tests and 2-sample t-tests were applied.

During this period, 1001 hourly unit observations were recorded. Patients were in bed 73% (732/1001) of hourly observations and alone 33% (326/1001) of the day. Presence of others in the room also correlated with patient activity levels, with those alone showing lower average activity ratings (2.1 vs 3.0, p<0.01). Of those observed, 3% required sitter for agitated behaviors.

This observational study, suggests that hospitalized stroke patients spend significant time in bed, but less time alone as compared to previously published international studies. Both negative and positive environmental stimuli were associated with increased out of bed activities. Additional study of the environmental influences on individual patient outcomes are needed.