Just get out of bed – for the benefit of patients

Take more responsibility for movement

Early mobilisation is crucial for both short-term postoperative recovery and sustained maintenance of mobility. In the ERAS concept too, the factor of early mobilisation through intensive physiotherapy is given great importance. Prof. Dr Susanne Klotz, professor of the Physiotherapy course at the Hochschule 21 University of Applied Sciences, would like to show how this knowledge can be put into practice and what structural changes are necessary.

"We want to get patients into a long-term active lifestyle. To do this, it is important to increase the health literacy of everyone who works with the patient."

Klotz encourages healthcare professionals to rethink the importance of movement: "Motion is everyone’s responsibility. As a caregiver, do I think that patients are best cared for in bed? As a business person, do I see the need to furnish lounges and purchase the necessary equipment?"

Advanced Physiotherapy Practitioner – more skills & responsibility

When it comes to working with patients, she advocates the academisation and thus greater responsibility for her profession. Physiotherapists spend more time directly with the patient than doctors and need to be able to decide for themselves how a patient would benefit most from which therapy, says Klotz. Similar to the Advanced Practice Nurse, she can well imagine an Advanced Physiotherapy Practitioner. This person would decide on the best possible therapy during a type of physio appointment. "For example, through study, a therapist can acquire the skills to screen for serious pathologies. This means that they can make initial contact with the patient instead of only acting on the doctor's prescription," Klotz argues. The physiotherapist, who has a PhD in the subject, considers her role to be more participatory than paternalistic. She wants to motivate patients.

Patients are only active for 6 minutes a day

The bed serves as a place of retreat for many patients – they spend most of the day here, and movement usually only takes place during physiotherapy. Various examinations range from between five or six minutes to up to a few hours, during which time patients are out of bed. Regular and early mobilisation is considered one of the most important factors for successful rehabilitation.

As part of the Bewegtes Krankenhaus (Mobile Hospital) project study at the University Medical Center Hamburg-Eppendorf, Prof. Klotz, together with the doctors and nursing staff, shone a light on the actual situation. In focus groups, the participants looked for opportunities for improvement. In addition to redesigning hospital rooms and lounges, Prof. Dr Klotz particularly sees great potential in improved physiotherapist training.

Preoperative preparation lays the foundation for rapid recovery

As part of the INCREASE research project, Professor Klotz works with patients even before surgery – and can thus prepare them for the post-surgery period. She can practise with them before a planned surgery so that they can remember it when they start feeling poorly.

"Together, we should encourage patients to get out of bed, get dressed and take responsibility for their lives. Promoting an active life in turn makes care easier."

She works with them to develop long-term, very individual goals, such as a five-kilometre run. This results in milestones that are broken down into daily targets. Patients receive a diary of exercises, but these are not mandatory. "We want to find something that brings joy and contributes to an active lifestyle in the long term. At INCREASE, we have trained physiotherapists on how to have motivating conversations."

When it comes to care, she recommends the movement from England based on the guiding principle of Prof. Brian Dolan. This is: Get up. Get dressed. Get moving.

This is a tool that you can learn, like massage. This would make the patient recognise their°own responsibility. Klotz makes an impression with her positive attitude: "I don't assume that patients are unwilling, but rather ambivalent. There are always reasons to stay in bed. Then I have to tickle the patient out and give them a reason to get up."

Academisation of physiotherapy training

Klotz is, as she says, a champion of academisation. According to Klotz, skills in discussion techniques, motivation and behavioural change are not emphasised enough in the current training. They are taught in subjects such as psychology, pedagogy and sociology in just 60 hours. In Europe, Germany is the only country that still offers training in physiotherapy. To date, only a few German universities offer a Bachelor of Science or Arts degree in physiotherapy. Other countries, such as the Netherlands or the UK, are already further ahead in terms of academic physiotherapy training. “Better education would benefit patient care in terms of incorporating research results.”