After Hospital Discharge

Coming home from hospital is an important step in recovery, but it is not uncommon to find that you are weaker, less mobile and more tired than you were before your admission. This can be particularly noticeable after a prolonged hospital stay, but even a relatively short period of reduced activity can have an impact on strength and physical function.

One of the main reasons for this is deconditioning. Deconditioning is the physical decline that occurs when the body is less active than usual. It can happen during illness and hospitalisation and can affect muscle strength, cardiovascular fitness, balance, mobility and confidence.

Physiotherapy at home can play an important role in helping you regain your strength, mobility and independence following hospital discharge.

What is deconditioning?

Our bodies are designed to move. When we are active, our muscles, heart, lungs, bones and nervous system are continually being challenged and maintained.

During a hospital admission, however, activity levels can reduce significantly. You may spend much of the day in bed or sitting in a chair. You may walk only short distances, receive help with activities that you would normally do yourself, and spend less time standing and moving around.

If this continues for several days or weeks, the body begins to adapt to the reduced demands placed upon it.

• Muscles become weaker
• Walking becomes harder
• Balance and confidence can reduce
• Everyday activities require more effort

This is deconditioning.

Why does hospitalisation cause deconditioning?

Deconditioning is often not caused by the original illness alone. It is frequently the combination of being unwell and being less physically active while recovering. Contributing factors can include:

• Spending prolonged periods lying in bed or sitting in a chair
• Reduced walking
• Pain
• Fatigue
• Poor appetite or reduced nutritional intake
• Surgery
• Delirium
• Infection
• Changes in medication
• Fear of falling
• Needing assistance with everyday activities
• Existing health conditions
• Loss of confidence following illness

For older adults or people who were already physically vulnerable before their admission, the effects can be particularly significant. Someone who was independently walking before going into hospital may return home needing a walking frame, assistance with stairs or help with everyday activities. This can be alarming, but it doesn’t necessarily mean that these changes are permanent.

What about fatigue after hospital?

Fatigue is extremely common following illness and hospitalisation. It is important to understand that feeling tired doesn’t necessarily mean you should avoid all activity. In fact, too little activity can contribute to further deconditioning.

Instead, rehabilitation often involves finding an appropriate balance between activity and recovery. Your physiotherapist may help you with pacing strategies, such as breaking activities into manageable sections, scheduling rest periods and gradually increasing your activity over time. The aim is to improve your tolerance so that everyday activities become less exhausting.

How long does recovery from deconditioning take?

This can vary greatly depending on the individual. Recovery depends on factors such as:

• How long you were in hospital
• How unwell you were
• Your physical condition before admission
• Your age and general health
• How much strength you lost
• Nutrition and appetite
• Other medical conditions
• Your activity levels following discharge

Some people notice improvements relatively quickly, while others require a longer period of rehabilitation.

Why home physiotherapy can make a difference

One of the advantages of receiving physiotherapy at home is that rehabilitation can take place in the environment where you actually need to function. Home rehabilitation allows physiotherapy to be personalised to your actual life. Your physiotherapist can see the environment you are navigating every day, identify practical challenges and help you develop strategies that are relevant to you.

You and your physiotherapist can agree specific goals. An example of these might look like:

• Being less reliant on a walking frame or stand aid
• Being able to walk more independently
• Getting dressed without help
• Being able to safely use the stairs
• Making yourself a cup of tea
• Going into the garden
• Walking to the local shop
• Getting back to your normal routine
• Walking the dog
• Getting back to specific hobbies

These functional goals provide direction for rehabilitation. Being weaker after hospital is common, but it doesn’t necessarily need to become your new baseline. The longer physical inactivity continues, the harder it can become to regain lost function. Recognising deconditioning early and beginning an appropriate rehabilitation programme can therefore be an important part of recovery.