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.

Angela M Shaw,Ian Cion,Raymund Valderrama,Rhonda Robert,Betsy Lewis,Brittni Maetzold,Kimberly Kresta,Clark R Andersen,Priti Tewari

doi:10.3390/children9020186

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.

Highlights

Introduction published maps and institutional affilPhysical activity has been well-established as having short and long-term health benefits for almost all populations, while literature exists in adult oncology investigating the benefits of exercise, including decreased cancer-related fatigue, improved motor performance [1,2], and improved overall health-related quality of life [3] among both survivors of cancer and those receiving active therapy
We soughtfor to improve mobilitytoand activity levels a challenging popUnfortunately, opportunities and motivation exercise are ofteninoverlooked during ulation to motivate pediatric and patients admitted to our oncology and stem cell inpatient stays
We sought to improve mobility and activity levels in a challenging poputransplant unit through the development of a self-reporting, semi-independent, incentivelation to motivate pediatric and AYA patients admitted to our oncology and stem cell based exercise program

Summary

Materials and Methods

An interdisciplinary team comprised of physicians, nurses, child life specialists, volunteer service staff members, a physical therapist, an occupational therapist, an artist in residence, and a clinical psychologist was assembled to elicit input on the problem of reduced physical activity in our pediatric inpatients and to develop an intervention. Our inpatient pediatric unit is designed for the treatment of a wide age range of patients with cancer This team aimed to motivate patients to be more physically active. A 16-item survey, entitled ‘TEAM Me QI’ was created by the principal investigator and clinical psychologist, and used to assess staff perceptions of patients’ physical activity levels and physical activity barriers and motivators This was a Pre/Post survey with which results prior to and following program implementation were compared. Survey results were viewable by the principal investigator and psychologist only

Statistical Analysis

Patient Physical Activity Measures and Participation in Physical Therapy

Modifiedmeans

Discussion