Totally Excited about Moving Mobility and Exercise (TEAM Me): A Successful Multidisciplinary Exercise Quality Improvement Initiative for Pediatric and Young Adult Oncology and Stem Cell Transplant Inpatients

Abstract

Background: Pediatric, adolescent and young adult (PAYA) patients are less active than their healthy counterparts, particularly during inpatient stays. Methods: We conducted a quality improvement initiative to increase activity levels in patients admitted to our pediatric oncology and cellular therapy unit using a Plan-Do-Study-Act (PDSA) model. An interdisciplinary team was assembled to develop an incentive-based inpatient exercise and activity program titled Totally Excited About Moving Mobility and Exercise (TEAM Me). As part of the program, patients were encouraged by their care team to remain active during their inpatient stay. As an additional incentive, patients earned stickers to display on TEAM Me door boards along with tickets that could be exchanged for prizes. Activity was assessed by documentation of physical therapy participation, tests of physical function, and surveys of staff perceptions of patient activity levels, motivations, and barriers. Results: Compared to baseline, patient refusals to participate in physical therapy decreased significantly (24% vs. 2%) (p < 0.02), and staff perceptions of patient motivation to stay active increased from 40% to 70% in the post implementation period. There were no changes in physical function tests. Conclusions: An incentive-based exercise program for young oncology inpatients greatly improved patient activity levels, participation in physical therapy and influenced professional caregivers’ beliefs.

The Use of Quality Improvement in the Physical Therapy Literature: A Scoping Review

“…The acute care setting accounted for the largest number of included studies ( n = 41, 59%), 27,28,33,34,37,39-42,45,46,48,50,52,53,55,58,59,62,66,68,70-74,76-78,88,89,95-98,100-105 followed by the outpatient setting ( n = 19, 27%). 29-32,36,38,47,49,54,56,60,61,64,67,69,79,80,93,99 Other practice settings included inpatient rehabilitation ( n = 6, 8.6%), 36,43,57,65,75,76 home health ( n = 2, 2.9%), 44,63 other ( n = 2, 2.9%), 19,81 and academia ( n = 2, 2.9%).…”

“…There were six unique study designs applied to QI publications, of which 34 studies (49%) 28,32-34,36,37,39,41,42,45-48,50-53,55,58,59,67,68,70,72,74,77,95-102 used a pre-post design. The second most commonly used design was an adaptive-iterative design ( n = 17, 24%) 29,30,35,38,54,56,57,61,63-66,73,75,78,80,93 in which studies reported using multiple cycles of improvement that were informed and adapted based on initial successes or failures.…”

“…Twentytwo studies (31%) 27,29,30,32,[39][40][41]48,50,60,70,74,79,81,88,89,96,98,99,101,102,105 used none of these to guide their QI effort. The most commonly cited model/tool was Plan-Do-Study-Act cycles (n 5 19, 27%) 35,38,46,52,54,55,57,58,[63][64][65][66]73,75,78,80,93,100,103 followed by the Model for Improvement (N 5 8, 11%). 38,53,55,57,73,78,80,93 Other organization change models and data demonstration methods common to QI were rarely reported.…”

“…Of the 70 total included studies in this review, 18 (26%) 28,37,39,40,[43][44][45]48,52,60,68,70,73,74,77,79,96,102 were approved by local ethics boards, 19 (27%) [32][33][34]36,41,46,47,49,50,53,55,56,58,63,64,67,81,97,100 sought approval but were considered exempt, 15 (21%) 19,35,38,42,57,59,61,62,65,71,72,75,78,80,…”

Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study

“…Exercise has been shown to be effective in ameliorating mental health–related issues such as depression [ 5 , 6 ] and dementia [ 7 , 8 ]. Despite the significant effectiveness of exercise as a complementary method to improve the symptoms of mental health issues, it is challenging for people to remain engaged in and motivated to continue exercising [ 9 , 10 ]. Therefore, it is vital to provide users with physical activity–based immersive and fun interventions to optimize retention.…”