Measuring Patient Mobilization for Better Outcomes

By Guy Fragala, PhD, PE, CSP, CSPHP

March 12, 2019

Human bodies need rest to recover, but a balance between bed rest and ambulation/mobilization is important in a patient’s recovery. Bed rest reduces the hydrostatic pressure gradient within the cardiovascular system, reduces muscle force production, virtually eliminates compression on the bones and lowers total energy expenditure.1 It is important for clinicians to recognize the negative consequences of insufficient ambulation and develop care plans to promote getting patients moving early and often.

As an example, each year, more than one million patients who require mechanical ventilation are admitted to intensive care units (ICUs) in the United States.2 Patients who require mechanical ventilation have many barriers to mobility as they are surrounded by catheters, tubes and life support and monitoring equipment. Mobilization is perceived as a complex task, and therefore, these patients are often treated with bed rest. According to a study in the American Journal of Critical Care, “After one week of bed rest, muscle strength may decrease as much as 20 percent, with an additional 20 percent loss of remaining strength each subsequent week”. 3 It was also found that, weakened muscles generate an increased oxygen demand. Based on these negative consequences, patients in ICUs likely would benefit from episodes of supported mobility.

Patient ambulation, or the act of walking independently with or without assistance, is vitally important to mobilization programs and the healing process. A 2016 study published in the Journal of Hospital Medicine provides additional evidence that lack of movement during the recovery process can cause health complications that further prolong the patient’s hospital stay, incurring unnecessary hospital costs.4

It is in the best interest of both the patient and the hospital to promote and track ambulation during recovery. Yet how do caregivers effectively measure and manage patient ambulation? In a study published in The Archives of Physical Medicine and Rehabilitation, Johns Hopkins researchers reveal that patient ambulation can be accurately and automatically measured by Midmark RTLS.5 Selected patients in the neuroscience inpatient unit wore RTLS badges during a two-minute walk test. Adhering to stringent study protocols, researchers found that RTLS accurately captured two key mobility metrics with high accuracy: the distance traveled by the patient and the ambulation speed of the patient.

While promoting ambulation during acute care hospitalization is critical to successful patient recovery and reducing readmission rates, traditional mobility measurements often rely on physical observations and manual recording. By leveraging the existing Midmark RTLS infrastructure at Johns Hopkins, researchers established that clinicians can effectively and accurately support patient ambulation. Ultimately, this supports better care planning where ambulation and mobilization are key elements in patient recovery.


  1. Stuempfle, K., and D. Drury. The Physiological Consequences of Bed Rest. Journal of Exercise Physiology online (June 2007), 10(3):32-41.
  2. Cox, C., Carson, S., Govert, J., Chelluri, L. and Sanders, G. (2007). An economic evaluation of prolonged mechanical ventilation*. Critical Care Medicine, 35(8), pp.1918-1927.    
  3. Perme, C. and Chandrashekar, R. (2009). Early Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of Care. American Journal of Critical Care, 18(3), pp.212-221.
  4. Hoyer, E., Friedman, M., Lavezza, A., Wagner-Kosmakos, K., Lewis-Cherry, R., Skolnik, J., Byers, S., Atanelov, L., Colantuoni, E., Brotman, D. and Needham, D. (2016). Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project. Journal of Hospital Medicine, 11(5), pp.341-347.
  5. Jeong, I., Bychkov, D., Hiser, S., Kreif, J., Klein, L., Hoyer, E. and Searson, P. (2017). Using a Real-Time Location System for Assessment of Patient Ambulation in a Hospital Setting. Archives of Physical Medicine and Rehabilitation, 98(7), pp.1366-1373.e1.