How inpatients spend their day: A behavioural mapping study of physical, cognitive and social participation across acute and rehabilitation wards

Objective To describe and compare patterns of physical, cognitive and social activity across inpatient wards in a regional hospital. Design Prospective observational study using behavioural mapping. Setting Five inpatient wards (three acute, two rehabilitation) in a regional public hospital in Australia. Participants A total of 151 inpatients were observed over five weekdays between March and April 2025. Main measures Behavioural mapping was conducted from 08:00 to 16:00 using a standardised protocol. At each observation, four domains were recorded: location, body position, activity and social context (presence of others). Proportions within each category were summarised descriptively for each ward. Results Across 6804 data points recorded, patients spent most of their observed time in their bedrooms (85–100% across wards). In acute wards, patients were predominantly on or in bed (65%–100%); rehabilitation wards demonstrated lower but still substantial time on or in bed (37%–45%). Walking or standing accounted for ≤13% of body-position observations, and structured exercise was infrequent (0%–14% of activity observations). Patients were alone for 50%–67% of observations. Differences between acute and rehabilitation wards were modest, with rehabilitation wards demonstrating greater sitting out of bed but similarly low upright mobility. Conclusions Across acute and rehabilitation settings, patients spent most of the daytime hours in bed and alone, with limited physical activity. The consistency of these behaviours across wards suggests inactivity and isolation reflect routine hospital environments rather than individual patient motivation. System-level strategies that reshape hospital routines and environments may be required to meaningfully increase participation during admission.