Safety and Feasibility of Bedside Treadmill Training to Improve the Efficiency of Ambulation Interventions With Hospitalized Adults

Objective: Hospitalized adults are at risk for decline in physical function, which is pronounced in patients suffering from critical illness. Barriers to early physical therapy and ambulation have been identified, including inadequate staffing and logistical constraints. Bedside treadmill training is an intervention that potentially mitigates these barriers; however, literature on this intervention is lacking. Methods: In this quality improvement project, adult inpatients were treated by physical therapists using portable treadmill training in intensive, progressive, and general care units. Data regarding safety events, resource requirements, indications, and patient acceptability were collected from April 2019 to April 2020. Results: Seventy-seven adult inpatients performed a total of 158 treadmill training sessions. One adverse event and one episode of treadmill device malfunction occurred. Most sessions were performed in intensive (42.4%) or progressive care (30.4%) units. Leading indications identified by treating therapists included respiratory support and isolation precautions, with 19% of all sessions involving patients actively receiving mechanical ventilation. Seventy-five percent of all encounters required only the single treating physical therapist. Conclusions: Portable treadmill training is a feasible and safe approach to facilitate ambulation-based interventions during physical therapy for hospitalized patients. This includes those who are critically ill, require invasive support or monitoring devices that may impede ambulation, and/or require additional staff members in addition to a physical therapist to implement. Clinical situations in which strict isolation, staffing, and/or logistical barriers are present, such as COVID, may benefit the most from bedside treadmill interventions. Impact Statement: Implementation of portable bedside treadmill training into physical therapist practice may improve the performance of ambulation interventions in hospitalized patients. The utility of this form of training is highlighted in clinical scenarios in which logistical or environmental barriers exist.