Increasing Physical Activity among Medical Inpatients by Digital Nudging of Patients and Staff (the IPAMINA trial): A Stepped Wedge Cluster Randomised Multicentre Study Protocol
The IPAMINA trial is a stepped-wedge cluster randomised multicentre study in Denmark designed to evaluate whether a digital nudging intervention using real-time wearable accelerometer feedback to both patients and staff increases daily physical activity and reduces sedentary behaviour among adult medical inpatients compared to usual care.
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When a person is admitted to a hospital for a serious illness, the body often begins to weaken faster than the disease itself. This happens because the routine of hospital life is built around rest. Patients spend most of their time in bed or sitting in chairs, and the culture of medical wards often accepts long periods of stillness as necessary for recovery. However, science has long shown that this inactivity is dangerous. It leads to a rapid loss of muscle strength and independence, making it harder for patients to return to their normal lives. The goal of modern care is to keep patients moving as much as their condition allows, but in a busy hospital, getting patients to stand up and walk is difficult. It requires constant effort from staff who are already stretched thin, and patients often lack the motivation or the clear feedback needed to keep going.
To solve this, researchers are turning to digital tools that can gently encourage movement without adding to the workload of the medical team. This approach, known as "digital nudging," uses technology to provide real-time information about a person's activity. Instead of relying on memory or guesswork, these systems show exactly how much time a patient has spent standing or walking. The idea is that when people can see their progress, they are more likely to keep moving. This concept is being tested on a large scale in a new study called the IPAMINA trial, which aims to see if giving both patients and hospital staff a live view of activity levels can change the way hospitals handle recovery.
The IPAMINA trial is a massive experiment taking place across four different hospital sites in Denmark, Greenland, and the Faroe Islands. The researchers are studying adult patients admitted for medical conditions, such as infections or respiratory issues. The study involves a total of 400 patients, a number chosen to ensure the results are reliable enough to detect a meaningful change in daily activity. The researchers are not just watching what happens; they are actively testing a specific system designed to break the cycle of inactivity.
The system relies on a small, waterproof sensor that looks like a medical bandage. A member of the research team places this sensor on the patient's thigh, about ten centimeters above the knee. This device does not interfere with treatment or daily care. It works quietly, measuring every movement the patient makes, from lying in bed to walking down the hall. The sensor sends this data wirelessly to a secure server, where a computer program sorts the movements into categories: lying down, sitting, standing, or walking.
For the patients, the system provides a simple, visual way to see their own progress. In the intervention part of the study, a tablet is placed at the patient's bedside. The screen shows a game-like display that tracks how much time they have spent standing or walking. As the patient moves more, a visual indicator on the screen moves closer to a goal. This is designed to be encouraging, turning the act of getting out of bed into a small, achievable challenge. The patient, their family, and the staff can all see this progress.
For the hospital staff, the system offers a different kind of view. A digital monitor in the nurses' station displays the activity levels of all the patients on the ward at once. The screen uses a traffic-light system to highlight who needs help. If a patient has been active in the last three hours, their name appears in green. If they have not moved for three to twelve hours, the name turns yellow. If a patient has been inactive for more than twelve hours, the name turns red. This immediate visual cue helps the staff quickly identify who needs encouragement to get up and move, turning a vague feeling of concern into a clear, actionable signal.
The study is designed to be fair and thorough. It uses a method called a stepped-wedge design, which means that all the hospital wards start by providing their usual care. Then, one by one, the wards switch to using the new digital system. This happens in stages over several weeks. By the end of the study, every ward will have used the system. This approach allows the researchers to compare the same wards when they are using the system against when they are not, while also ensuring that every site eventually gets the benefit of the new technology. The researchers are measuring the primary outcome by looking at the average number of minutes per day that patients spend standing or walking. They are also tracking how long patients stay in the hospital, whether they are readmitted within 90 days, and if they fall while in the hospital.
The researchers are also conducting a separate, smaller study to understand how the staff feels about the new system. They will hold group discussions with nurses and doctors to learn if the digital tools are easy to use, if they actually change how the staff works, and what barriers might exist. This part of the study is crucial because even the best technology will fail if the people using it do not find it helpful or if it gets in the way of their other duties.
The results of this trial are expected to provide a clear answer on whether digital nudging can successfully increase physical activity in a real-world hospital setting. If the system works, it could change the standard of care for medical inpatients, making movement a central part of the recovery process rather than an afterthought. The study is currently ongoing, with recruitment expected to finish in early 2026. The researchers are confident that the data they collect will help them understand not just if the system works, but how it fits into the complex, busy reality of a modern hospital ward. By combining simple technology with human motivation, the IPAMINA trial seeks to prove that keeping patients active is possible, even in the most challenging environments.
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