Recovery from stroke aims at regaining mobility through performing activities. However, research studies on time use in rehabilitation environments consistently show low activity levels of stroke p...

To examine stroke inpatients’ real-life wayfinding behaviour and how the built environment of rehabilitation clinics might influence their behaviour and experiences.Stroke inpatients in seven rehab...

Objectives: To investigate which spaces stroke patients visit in their free time while undergoing inpatient recovery in rehabilitation centers, what activities they engage in, and what kind of spaces they want. Background: Research studies consistently show that stroke patients are highly inactive during rehabilitation. Much remains unknown about what patients do in their free time and how the built environment might affect their behavior and activities. Methods: Patients’ free-time activities were recorded via patient shadowing ( n = 70, 840 hr), and their spatial preferences were collected using a survey ( n = 60) in seven rehabilitation centers. Each participant was observed over one typical day (12 consecutive hours). Their activities, durations, and locations were recorded using floor plans and time log sheets. Results: Six main themes emerged from the analysis of shadowing data and patient surveys: (1) spending most free time in their room, (2) corridor as the overlooked activity hub, (3) food and beverage stations as triggers of activity, (4) wanting to socialize, (5) variety of common spaces for different activities is desired, and (6) common room’s atmosphere, comfort, style, and view are important. Even though socializing with other patients was mentioned as a primary reason for visiting common spaces in the survey, patients spent most of their free time alone. Conclusions: Corridor emerged as a space with great potential to motivate and support various activities of patients. Patients’ free-time activities could contribute to their recovery, and the built environment may play a role in facilitating and supporting these activities.

Background: Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units. Objective: The aim of this systematic review was to compile the concept of an EE in stroke units. Methods: The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included. Results: This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements. Conclusions: To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.

Stroke inpatients in rehabilitation clinics are highly inactive in their free time and often depend on staff members to transport them to scheduled therapies. This study examines how distances between spaces in rehabilitation clinics impact patients’ mobility. Seventy patients were shadowed over the course of one ordinary day in rehabilitation. Shadowing was accompanied by patient and staff questionnaires. Both patients and staff members described the labyrinthine built environment with long corridors that all look similar. Patients covered substantial daily distances in the clinics, and longer distances were significantly related to encountering more mobility barriers and dependence on staff. Compact layouts with vertically separate wards and main therapy areas resulted in reduced travel distances compared to more complex building layouts. Patients’ mobility abilities were occasionally observed to change on different distances and even throughout the day. As distances result from the building's layout, greater attention needs to be paid to this aspect of the built environment in the early design stages. This is especially the case since other built-environment barriers were found to be intertwined with long distances. All patients may be independently mobile if distances between their most important areas (wards, therapy areas and dining spaces) are carefully planned.

Nutrition and mobility risks include complex and interrelated physiological, medical, and social factors. A growing body of evidence demonstrates that the built environment can affect patients’ well-being and recovery. Nevertheless, the relationship between the built environment, nutrition, and mobility in general hospitals is largely unexplored. This study examines the implications of the nutritionDay study’s results for the architectural design of hospital wards and nutrition environments. This one-day annual cross-sectional study uses online questionnaires in 31 different languages to collect ward-specific and patient-specific variables. The main findings relevant to the design of hospital wards were: (1) 61.5% of patients (n = 48,700) could walk before hospitalization and (2) this number dropped to 56.8% on nutritionDay (p < 0.0001), while the number of bedridden patients increased from 6.5% to 11.5% (p < 0.0001), (3) patients who needed more assistance had a much longer mean LOS than mobile patients, (4) mobility was associated with changes in eating, and (5) 72% of units (n = 2793) offered additional meals or snacks, but only 30% promoted a positive eating environment. The built environment may indirectly affect hospitalized patients’ mobility, independence, and nutritional intake. Possible future study directions are suggested to further investigate this relationship.