Exploring perspectives of geriatric rehabilitants and their informal caregivers on physical activity during the non-weight-bearing period, a qualitative study

Exploring perspectives of geriatric rehabilitants and their informal caregivers on physical activity during the non-weight-bearing period, a qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring perspectives of geriatric rehabilitants and their informal caregivers on physical activity during the non-weight-bearing period, a qualitative study Elma van Garderen, Mandy Visser, Wilco P. Achterberg This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7417603/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Older adults in inpatient rehabilitation often struggle to remain physically active, especially when they are restricted from bearing weight on a lower extremity. Given the negative consequences of inactivity, it is important to provide and encourage physical activities, as well as include the input and views of rehabilitants’ and their informal caregivers’ in this process. This qualitative study explores the perspectives of non-weight-bearing rehabilitants and their informal caregivers regarding the content and frequency of physical activities, and the motivational factors for performing such physical activities. Methods Semi-structured interviews were conducted with geriatric rehabilitants restricted from bearing weight on a lower extremity and their informal caregivers. The interviews were thematically analyzed using the framework method. Results Eleven ICF-related themes emerged from the interviews. The participants reported what they consider to be physical activity during the non-weight-bearing period, their preferences regarding the frequency and content of physical therapy sessions and patient-regulated exercises, and the importance of incorporating multiple elements into physical activity, which makes being physical active more enjoyable. They also mentioned the limited involvement of informal caregivers and disciplines other than physiotherapist, and they shared their coping strategies and goals to stay physically active. Conclusion Physical activity during the non-weight-bearing (NWB) period should be tailored to the rehabilitant and their informal caregivers. It is important to inform and discuss the possibilities for being physically active with the rehabilitant. The most important goals for engaging in physical activity were regaining the ability to walk and returning home. Non weight bearing Geriatric rehabilitant Informal caregiver Physical activity Figures Figure 1 Key summary points Aim: We conducted semi-structured interviews with non-weight-bearing rehabilitants and their informal caregivers regarding the content and frequency of physical activities, and motivational factors for performing such physical activities. Findings: Eleven themes emerged from the interviews, which can be categorized into the different domains of the ICF model. Physical activity during the non-weight-bearing (NWB) period should be tailored to the rehabilitant and their informal caregivers. Message: We recommend integrating the perspectives of NWB rehabilitants and their informal caregivers into their rehabilitation plans and addressing any differences between their perspectives and those of healthcare providers. Introduction An 8.4 year increase since 1995 brought global life expectancy at birth to 73.3 years in 2024 ( 1 ). This increase also leads to a rise in the number of older adults admitted to the emergency room (ER). In the US in 2022, 76 per 100 adults aged 75 and older visited the ER ( 2 ). In the Netherlands, ER visits related to serious injuries for adults aged 65 and older increased by 29% between 2013 and 2022 ( 3 ). Of those hospital admissions, 24% involved a fracture of the lower extremity ( 3 ). Depending on the location and type of fracture, as well as the surgical intervention performed, patients may be restricted from bearing weight on a lower extremity for a certain period of time, known as the non-weight-bearing-period (NWB) period. Older adults often spend this period in temporary inpatient care ( 4 ). While this period may be important for recovery, not being allowed to stand on one or both legs makes it challenging to remain physically active. In general, it is challenging for older adults to remain physically active during inpatient care ( 5 – 7 ). Older rehabilitants spend most of the day sitting or lying down (23.1 hours a day), and observations reveal that they spend only 16% of daytime performing physical activities, including self-care, therapy and transferring ( 7 , 8 ). Being restricted from bearing weight on a lower extremity makes it even more challenging to remain physically active. Inactivity has many negative consequences. Five to ten days of bed rest can result in a significant decrease in muscle strength, muscle mass, physical condition and motivation to resume physical activity ( 9 , 10 ). Prolonged periods of sedentary behavior and weight-bearing restrictions have even been associated with increased mortality ( 11 , 12 ). Therefore, it is important for geriatric non-weight-bearing rehabilitants (NWB rehabilitants) to remain physically active, 98% of all healthcare professionals agreed in a consensus study ( 13 ). The importance of including the perspectives of both rehabilitants and informal caregivers is widely recognized ( 14 ). Involvement in decision-making is of great importance to rehabilitants ( 15 ). Shared decision-making can improve communication between healthcare providers and rehabilitants, increase the accuracy of rehabilitants’ expectations and enhance satisfaction with care ( 16 ). Moreover, being involved in setting and planning rehabilitation goals improves function and goal attainment for rehabilitants ( 17 ). The involvement of informal caregivers leads to better physical functioning, a higher level of independence and a greater likelihood of rehabilitants returning home ( 18 – 21 ). Furthermore, their involvement reduces anxiety and depression and improves the quality of life for both geriatric rehabilitants and informal caregivers ( 18 – 21 ). In order to prevent physical inactivity, it is important to understand which activities both NWB rehabilitants and their informal caregivers consider to be physical activities, what physical activities they find important, and what motivates or demotivates them to stay physically active. However, information on how to help NWB rehabilitants to stay physical active is scarce, and there is a lack of input from the rehabilitants and informal caregivers on their views of physical activity during the NWB period ( 11 , 22 ). This qualitative study therefore investigates their perspectives regarding the content and frequency of physical activities, as well as the motivational factors that promote or obstruct performing these activities. This knowledge might facilitate the implementation and promotion of physical activity interventions for NWB rehabilitants and help prevent inactivity. Method Design This qualitative study was conducted using an inductive grounded theory approach ( 23 , 24 ). This method was chosen as knowledge on this topic is limited, and to ensure an open perspective in identifying what is important to the participants. Apart from physical activity and motivation, no pre-determined themes were established. The codes, categories, and themes were developed directly from the interviews. We have adhered to the standards for reporting qualitative research ( 25 ). The Medical Ethics Committee of the Leiden University Medical Centre has declared that this study is not subject to the Medical Research Involving Human Subjects Act (WMO) (Protocol number 23-3125). Participant population and recruitment This study used a convenience sampling method. We reached out to geriatric inpatient rehabilitation centers (GR centers) that provide temporary care, including for NWB rehabilitants, through the University Network of the Care sector South Holland (UNC-ZH network) and LinkedIn. Participating centers informed potential candidates, extended invitations, and facilitated contact between the candidates and the researcher (EvG). Eligible for inclusion were rehabilitants aged 65+, who were temporarily admitted to a GR center, and temporarily restricted from bearing weight on at least one lower extremity. Exclusion criteria for potential candidates were: an inadequate comprehension or production of the Dutch language, delirium, end-of-life care pathway, communication disability, psychiatric disorder or cognitive impairment that would hinder conducting an interview. Informal caregivers were eligible for inclusion if their relative, the NWB rehabilitant, met the aforementioned inclusion criteria. They also needed to have an adequate comprehension and production of the Dutch language and no communication disability, or psychiatric disorder or cognitive impairment that would impede participation in an interview. Potential participants received an information letter and were asked to sign the informed consent form after having ample time to consider participation. Rehabilitants and informal caregivers were included until saturation was reached. Data collection Semi-structured interviews were conducted by EvG between April and October 2024. EvG is a female physiotherapist and PhD student with formal training in qualitative research and seven years of experience in geriatric rehabilitation. An interview guide was used to gather demographic data of the participants and to collect information about physical activity and motivation across five topics: demographics, knowledge, behavior, motivation and preferences. The topic list was piloted with members of the elderly board, caregivers, as well as through pilot interviews with one NWB rehabilitant and one informal caregiver. The interviewer asked open-ended questions about each topic and in-depth follow-up questions to gain a better understanding. After each topic, at the end of the interview and at appropriate moments, the interviewer provided a verbal summary of the findings and gave interviewees the opportunity to offer additional comments or corrections. One-on-one interviews with NWB rehabilitants were conducted at one of the participating GR centers. One-on-one interviews with informal caregivers were held at one of the participating GR centers, by telephone, or at a location convenient for the informal caregiver. The interviews took place in the last week of the pre-determined predicted last week of the NWB period. This ensured that both the rehabilitant and their informal caregiver had experience with the non-weight-bearing period while still in that situation. The interviews lasted approximately 45 minutes. Data Analysis The interviews were recorded, transcribed verbatim, and thematically analyzed using the framework method ( 26 ). This framework consists of the following seven stages: 1) Transcription; 2) Familiarization with the interview; 3) Coding; 4) Developing a working analytical framework; 5) Applying the analytical framework; 6) Charting data into the framework matrix; 7) Interpreting the data ( 26 ). Two researchers, EvG and MV, openly coded the first few transcripts. MV is a female experienced qualitative researcher. EvG and MV compared their codes, and grouped them into themes to form the working analytical framework. EvG then used this framework to analyze the remaining transcripts. Any new codes or themes that emerged were added to the analytical framework. The Atlas.ti program was used for coding and developing the analytical framework. After the final stage, interpreting the data, the results were reported, and relevant quotes were identified and translated into English. To provide a clear description of the participants, characteristics of the NWB rehabilitants and informal caregivers, such as age, gender, duration, and reason for the NWB period, were gathered and are presented in Table 1 . Results Characteristics Ten rehabilitants and seven informal caregivers from four different GR centers consented to be interviewed. The data of one informal caregiver was excluded due to a malfunctioning recording device during their interview. While all rehabilitants who were asked to participate consented, most did not want us to contact their informal caregiver due to time constraints or limited involvement of the informal caregiver. Therefore, we were only able to interview two informal caregivers who were related to participating rehabilitants. We continued recruiting informal caregivers after reaching data saturation with rehabilitants. The rehabilitants (R1-R10) were between 61 and 87 years old and the informal caregivers (IC1-IC6) between 58 and 86 years old. Most rehabilitants were restricted in bearing weight on a lower extremity due to one or more fractures of the lower extremity. Characteristics of the participants are shown in Table 1. Table 1 Demographic characteristics of the participating non-weight-bearing rehabilitants and informal caregivers. Rehabilitants n = 10 Informal caregivers n = 6 GENDER, n (%) Female 8 (80%) 3 (50%) Age. Range (Median) 61–87 (71) 58–86 (76) Weeks since advised NWB Median (IQR) 7 (5.00-9.75) 5.5 (5.00-7.25) Reason for admission to GR Unplanned surgery: (7) One ore more fractures in a lower extremity (7) Planned surgery: (3) Amputation (1) Infection in hip prosthesis (1) Ankle osteoarthritis (1) * Unplanned surgery: (6) One ore more fractures in a lower extremity (6) N: number. NWB: Non Weight Bearing. IQR: Interquartile range. GR: geriatric rehabilitation. *Reason for admission to GR of the NWB rehabilitant for whom they are the informal caregiver. The level of pre-hospitalization physical activity varied from still participating in sports activities to being inactive due to a history of falls or pain. However, both the pre-hospitalization active and inactive rehabilitants experienced loss of strength, condition, and independence during their hospitalization. ICF model The International Classification of Functioning, Disability and Health (ICF) model provides a comprehensive framework for understanding health and health-related domains (27). While analyzing the interviews, we identified themes that aligned well with the different domains of the ICF model (Fig. 1). Body function: body functions or structures motivating or obstructing physical activity Activity & participation: (preferred) execution of physical activity by an individual and participation in social life Environmental factors: external factors influencing physical activity Personal factors: internal factors influencing physical activity In the context of this study the ICF model's domain of health refers to physical activity during a period of restricted weight-bearing on a lower extremity for older adults. Given the importance of understanding what qualifies as physical activity during this non-weight-bearing period, we will start with the participants' definition of physical activity. Physical activity during a period of restricted weight-bearing Definition of physical activity during the non-weight-bearing period The participants had different views on what qualifies as being physically active during the NWB period. Some participants considered physical activity impossible during the NWB period. Most participants, however, considered strength training and other exercises given by the physiotherapist to be physical activities, followed by performing activities of daily living (ADL) and self-propelling the wheelchair. However, according to one participant, self-propelling the wheelchair only counts as physical activity if it is challenging for the arms. Most participants experienced limited possibilities in performing physical activities during the NWB period. Exercise. That means stretching your leg. So making sure your leg muscles stay strong, your back, things like that. I move my arms a lot because I use a self-propelled wheelchair. And then sometimes I also use my foot, sometimes I don't. Because then I throw them both in the air, and then I think: right, and a leg exercise as well. (Rehabilitant 10) Body function Activity limitations The participants experienced limited ability to perform physical activities due to the weight-bearing restrictions, (pre-)existing comorbidities, multiple fractures, and low energy due to poor sleep. Pain, fear of falling, and concern about the wound not healing properly were reasons to be cautious when performing physical activities. So I say, we're not going to work on that, because it will go, it will get worse again. And it's my body, not yours, so when I say, I'm not doing that, then I'm not doing it. Plain and simple. (Rehabilitant 7) Activity & participation Frequency and duration of physical therapy Most of the participating rehabilitants received some form of physical therapy between two and four times a week for 30 minutes per session. Many rehabilitants found this sufficient, while others preferred more frequent therapy moments or simply the possibility to use the fitness room more often and for longer periods of time throughout the day, and to engage in more patient-regulated exercises, either self-directed or prescribed by their therapist. Informal caregivers mentioned that 30 minutes is sufficient, but suggested increasing the time based on the rehabilitant's fitness level. However, they did find the number of sessions insufficient. Yes, yes, yes, and we were also, well not surprised, but gosh, she only has physiotherapy two or three times a week, is that enough, you know, so you think, well, can' they do half an hour of exercise every day. (Informal caregiver 1) Content of physical therapy Physical therapy during the non-weight-bearing period should, according to most participants, include some form of strength training. Others mentioned that physical therapy already includes, or should include, standing and ‘hopping’ exercises with a walking frame or between bars, wheelchair mobilization, seated general whole-body exercises, and cycling with the arms or one leg. Particularly popular among participants was cycling, combined with a virtual reality video screen. Some of the participants reported that making the physical exercises enjoyable stimulates their participation. Activities or components that make physical exercises enjoyable included: cycling (arms or one leg) with a virtual reality video screen, variation in exercises, playful or competitive elements within the exercises, and performing exercises while watching TV or while outside. And with a video clip to watch. Then you're on holiday for 15 minutes, you know? It's true, isn’t it? (Rehabilitant 8) Patient-regulated exercise Patient-regulated exercises may include wheelchair mobilization, standing (on one leg), performing strength training exercises for the legs or arms, stretching and mobilizing exercises for different parts of the body, and performing daily living activities (ADL) such as watering the flowers. And sometimes then I also look for it like, well, there aren't that many flowers now, but I used to have a house full of flowers, and then I'd have to water them and clean up, and I'd be back and forth five times with a small cup - haha like that. (Rehabilitant 5) Some rehabilitants already had their own repertoire of exercises while others were given or asked for exercises from a physiotherapist or occupational therapist. Most rehabilitants performed their exercises daily. The duration and frequency varied between rehabilitants, ranging from the whole day, regularly per day 5 minutes, to once a day for 15 minutes. Only two rehabilitants mentioned that whether they performed the patient-regulated exercises on a specific day depended on other factors such as how they felt, pain levels, and other activities they had planned for that day, including physical therapy. Group vs. individual therapy preferences The rehabilitants preferred group therapy, sometimes combined with individual therapy. The informal caregivers, however, believed that the rehabilitants mostly preferred individual therapy. Participants expressed that individual therapy should focus on solutions, i.e. performing ADL independently, and that the focus of group therapy should be on general training. According to participants, merits of group therapy are: the therapists don’t hover around you, you can chat with others, it makes the therapy more enjoyable, it distracts you, and it makes you humble. Well, sometimes a group lesson is also fun because you are with others who are in the same boat, and you also challenge each other a bit or look at what others are doing. Like, oh can you do that as well, I didn't know that, can I do that too? You know, like you're kind of learning by copying. (Rehabilitant 5) Environmental factors Therapists’ role in facilitating and encouraging physical activity Physiotherapists play an important role in facilitating physical activity for non-weight-bearing rehabilitants. Their role includes: providing therapy sessions; instructing rehabilitants on how to perform exercises, and on frequency and duration of patient-regulated exercises; installing the exercise equipment; educating rehabilitants about physical activity and its consequences; providing solutions for performing ADL independently; ensuring safety and taking responsibility for the exercises performed by the rehabilitants. But the other thing is, when it comes to movement, I still think you have to limit that to the, to where the person, or, to what the physiotherapists can monitor. (Rehabilitant 9) Occupational therapists are responsible for providing or repairing wheelchairs and assisting with the transition home by offering guidance on assistive devices and training in ADL, such as cooking. However, this assistance usually begins later in the rehabilitation process, typically when rehabilitants are permitted to bear weight on both legs. Nurses primarily assist with ADL, and their involvement depends on the rehabilitant’s level of independence and energy. More help is often required at the start of the rehabilitation and for rehabilitants with low energy levels. As the rehabilitants become more independent, the nurses’ involvement can decrease. I hardly see the nurses, actually. In the evening they come to bring the bedpan and then it's "oh, you're in bed already, well bye! Haha see you tomorrow! (Rehabilitant 4) The level of encouragement required from various therapists depends on the individual rehabilitant. For some rehabilitants, a stricter approach may be beneficial in achieving their goals. Methods to encouraging physical activity include providing group therapy, promoting independence in ADL and patient-regulated exercises, monitoring the execution of these exercises, educating rehabilitants, and emphasizing the consequences of physical inactivity. No. I, I think it's different for each person. Some people need a kick up the backside and others you need to leave alone. (Rehabilitant 10) Informal caregivers' role in facilitating and encouraging physical activity All participants stated that informal caregivers were not involved in physical activities during the NWB period. Additionally, all informal caregivers reported that they did not encourage the NWB rehabilitant to be physically active. Reasons given for not encouraging physical activity include the NWB rehabilitants' existing motivation and unwillingness to listen, the informal caregivers’ perception that encouraging physical activity is not their responsibility, and their belief that they are not sufficiently involved to encourage physical activity. Informal caregivers were not involved in physical activities because the NWB rehabilitant did not want or need help, others took over the care, or they themselves were not around enough to assist. Some informal caregivers chose not to be involved due to their own health issues, feelings of incompetence, believing that it is not their job, and because they already have to assist when the rehabilitant returns home. When asked if there are aspects of physical activity that a rehabilitation center could involve informal caregivers in, one rehabilitant responded as follows: No, because it is a profession. You are trained for physiotherapy. And then you start doing other things anyway. (Informal caregivers 5) Informal caregivers emphasized the importance of being informed by the doctor or therapist when their involvement is required. Without this communication, the rehabilitant might not accept help or may feel uncomfortable asking their informal caregivers for assistance. All informal caregivers agreed that it was their role to provide support once the rehabilitant returns home. Well, actually, actually from, from someone with more authority. Because she would say, 'no, there's no need, I can do that.' But if it comes from..., from a bit higher up, I think she would accept it more easily. (Informal caregivers 4) Some rehabilitants reported that their informal caregivers did motivate them by complimenting their performance and offering encouragement. However, rehabilitants were often reluctant to ask their informal caregivers for help. The reasons given were: they did not want to burden their informal caregiver too much, they believed that assisting with physical activities is not their responsibility, and they viewed their role as providing companionship and taking them outside and to places like restaurants. Well, she is in a wheelchair. She doesn't move that much then. It's mainly the social aspect, being outside. (Informal caregivers 2) Informing the rehabilitants and informal caregivers Some rehabilitants emphasized the importance of being adequately informed about the challenges of maintaining independence while adhering to weight-bearing restrictions. They received information about not being allowed to bear weight on the affected leg, along with general and specific instructions regarding physical activities during the NWB period. Instructions for patient-regulated exercises should be provided verbally or in written form and should include pictures. Some rehabilitants preferred both options. Only one rehabilitant received information through e-health. Although she found it convenient, she did not prefer it over written instructions. You can watch it again and again, although the picture that was hanging there was also very handy. That showed everything at a glance, now I have to start it up. Because everything else I do on my own laptop. (Rehabilitant 10) Most informal caregivers did not receive information about physical activity from the GR center. They did not feel the need to be informed because they trusted the professionals' capabilities, received information from the rehabilitant, or simply asked for information when needed. The informal caregivers expressed a preference for receiving information about the rehabilitation plan when the rehabilitant is allowed to bear weight again. They also wanted details about the process of the rehabilitant returning home, including which assistive devices to purchase. Rehabilitation location It is important that the rehabilitation location and its immediate surroundings are wheelchair accessible. This includes having no thresholds or sloping floors, wheelchair-accessible elevators and (exit) doors, easy exit access, as well as smooth, even sidewalks outside. And what I think is really important: remove the thresholds in the buildings. Because if they don't place the wheelchair ramp for me, I can't get to the terrace here. (Rehabilitant 10) Personal factors Intrinsic motivation Coping strategies for staying motivated despite experiencing fear, pain, exhaustion, or reluctance to perform physical activity include thinking ahead to when weight bearing will be allowed again, doing what one is capable of, and maintaining a positive outlook (e.g., things could be worse). Rehabilitants also hope that therapy can help them manage their fear. Yes, basically giving her back her confidence. That, to me, is the most important thing you can have. The people who treat her, restore that confidence. (Informal caregivers 3) Several rehabilitants mentioned experiencing dependency at some point or throughout the entire NWB period. However, most participants emphasized the importance of being independent and trying to do as much as possible on their own. Yes of course. You have to arrange everything yourself, you know. You shouldn't press that button every time like, come and help me, you shouldn't do that of course. You have to try it yourself first, and if you really can't do it, well, then you should call someone, but you have to try everything yourself. That's motivation if you want to, like, progress. (Rehabilitant 7) The social aspect, distraction, and a sense of accomplishment motivated the rehabilitants to remain physically active. Participants emphasized the importance of staying active to maintain or improve physical function during the NWB period, including strength, overall progression (e.g., being able to sit up for longer periods of time and to cover longer distances hopping with the walking frame) and physical condition. Other incentives included avoiding prolonged sitting, changing body positions to reduce stiffness and pain, improving balance, and achieving weight loss. The most important goals of performing physical activity were: regaining the ability to walk, returning home, and resuming life as they knew it, including family activities, sports, and traveling without limitations (e.g., driving a car). I only have one motive, as you know. And that is that I want to walk out the door using both my legs. (Rehabilitant 8) Discussion In this article, we describe the perspectives of NWB rehabilitants and their informal caregivers regarding the content and frequency of physical activities, as well as the motivational factors that promote or obstruct performing these activities. Eleven themes emerged from the interviews, which can be categorized into the different domains of the ICF model. The first theme defines what constitutes being physically active during the NWB period. Themes related to the domains of body function and activity and participation include: activity limitations; frequency, duration, and content of physical therapy; patient-regulated exercise; and preferences for group versus individual therapy. Themes within the domains of environmental and personal factors include the therapists’ and informal caregivers’ role in facilitating and encouraging physical activity, the dissemination of information, the rehabilitation location, and intrinsic motivation. Definition of physical activity The most widely accepted definition of physical activity is “any bodily movement produced by skeletal muscles that results in energy expenditure”, first published by Caspersen et al. (1985) and adopted by many health policies worldwide ( 28 – 30 ). This definition emphasizes muscle activity and energy expenditure, with higher levels of physical activity leading to greater energy expenditure. This aligns with the participants’ responses, as most considered strength training and other exercises prescribed by physiotherapists to be physical activities. Some also viewed performing ADL activities and self-propelling a wheelchair as being physically active. However, one participant mentioned that propelling the wheelchair only counts as a physical activity if it remains challenging for the arms. Other participants felt that it was impossible to be physically active during the NWB period because they were unable to do their usual body movements, such as walking or carrying out ADL independently. A broader definition by Piggin (2020) states that “Physical activity involves people moving, acting and performing within culturally specific spaces and contexts, and influenced by a unique array of interests, emotions, ideas, instructions, and relationships.” ( 30 ). This broader definition increases awareness of the importance of any body movement and highlight that physical activity is still possible despite weight-bearing restrictions. Frequency of physical activity Older adults find it challenging to remain physically active during inpatient care, spending only 16% of the day engaged in physical activities ( 5 – 8 ). However, this may be sufficient to meet the activity guidelines. Most rehabilitants received physical therapy 2–4 times a week for 30 minutes, combined with patient-regulated exercises. If these activities were of moderate or vigorous intensity, they may have met the physical activity guidelines ( 31 ). Nevertheless, it is important to avoid long periods of sedentary behavior between exercise sessions. For some rehabilitants, this might include low-intensity activities such as wheelchair mobilization. Motivational factors Understanding the motivational factors that promote or obstruct physical activity can help to find ways to encourage it. Physical activity behavior is influenced by knowledge, awareness, and attitude. Barriers to physical activity include unwillingness to move, physical health status, symptoms, and fear ( 32 ). These barriers are consistent with those identified during the NWB period. Motivating physical activity involves removing or addressing these barriers. This study highlights the important role of healthcare providers, particularly physiotherapists, in promoting and facilitating physical activity. Methods they can use, as mentioned in this study, include educating rehabilitants, encouraging independence in ADL, providing group therapy, making therapy enjoyable (e.g., using e-health), and offering patient-regulated exercises. However, therapists' responsibility to promote physical activity may decrease as rehabilitants become more independent ( 33 ). Another important motivator is found in the rehabilitants’ own coping strategies and short- and long-term goals. Involving participants in goal setting is found important in GR, because it leads to patient-centered care, even if it does not necessarily improve physical function ( 34 , 35 ). While supporting and involving informal caregivers are seen as important promotors of physical activity ( 32 ), our study found that their involvement was almost nonexistent. This indicates a gap between the expectations of the caregivers’ role and reality, as well as potential bias in the study results due to the selected group of informal caregivers willing to participate ( 36 , 37 ). Strengths and Limitations To the best of our knowledge, this is the first study to explore the perspectives of geriatric rehabilitants and their informal caregivers regarding physical activity during the non-weight-bearing period. A strength of this study is the timing of the interviews, which were conducted during the final week of the predetermined non-weight-bearing period. This ensured that both the rehabilitants and their informal caregivers had experience with the non-weight-bearing period while still being in that situation. Another strength is that we interviewed rehabilitants from four different rehabilitation centers, making sure that the outcomes are not location-specific. We had difficulty finding informal caregivers willing to participate. While all of the NWB rehabilitants we contacted agreed to participate, not all of them had an informal caregiver available for an interview, or they did not want to burden their informal caregiver with an interview. As a result, we were only able to interview two informal caregivers who were related to participating rehabilitants. We recruited the other four informal caregivers of NWB-rehabilitants after reaching data saturation with rehabilitants. This may have led to differences in responses regarding encouragement from informal caregivers or preferences for group versus individual therapy between the caregivers and rehabilitants. We conducted interviews at different locations, one of which was the workplace of one of the interviewers. Although we did not include rehabilitants for whom the interviewer was the primary physiotherapist, some of the participants from that location recognized the interviewer as a therapist, which might have influenced their responses. The interviewer’s background as a physiotherapist may have shaped some of the questions she asked. To mitigate interview bias, we used a topic list that was discussed with the research team and piloted. Conclusion Physical activity during the non-weight-bearing (NWB) period should be tailored to the rehabilitant and their informal caregivers. It is important to inform the rehabilitant and discuss with them the physical activities that they can perform during therapy or individually. The most important goals of engaging in physical activity are regaining the ability to walk and returning home. We recommend integrating the perspectives of NWB rehabilitants and their informal caregivers into their rehabilitation plans and addressing any differences between these perspectives and those of healthcare providers. Declarations Acknowledgement: The authors thank the non-weight-bearing participants and informal caregivers for participating in this study and the healthcare providers who facilitated contact between the potential participants and the researcher. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was funded by the Dutch Zorgondersteuningfonds. KPO 72, 2023/05/01, Leiden. Authors' contributions The study sponsor had no role at any stage in preparing the manuscript or any other stage of the work. All authors’ have contributed significantly to the article, approved the submitted version and have agreed to be personally accountable for the author’s own contributions and the resolution documented in the literature. 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Journal of the American Medical Directors Association. 2021;22(12):2432–9.e1. Rojer AGM, Ramsey KA, Trappenburg MC, Meskers CGM, Twisk JWR, Goonan R, et al. Patterns of Objectively Measured Sedentary Behavior and Physical Activity and Their Association with Changes in Physical and Functional Performance in Geriatric Rehabilitation Inpatients. Journal of the American Medical Directors Association. 2023;24(5):629–37.e11. Jolliffe L, Collyer TA, Sun KH, Done L, Barber S, Callisaya ML, et al. Geriatric evaluation and management inpatients spend little time participating in physically, cognitively or socially meaningful activity: a time-motion analysis. Age Ageing. 2025;54(3). Kortebein P, Symons TB, Ferrando A, Paddon-Jones D, Ronsen O, Protas E, et al. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci. 2008;63(10):1076–81. Tanner RE, Brunker LB, Agergaard J, Barrows KM, Briggs RA, Kwon OS, et al. Age-related differences in lean mass, protein synthesis and skeletal muscle markers of proteolysis after bed rest and exercise rehabilitation. J Physiol. 2015;593(18):4259–73. Aloraibi S, Booth V, Robinson K, Lunt EK, Godfrey D, Caswell A, et al. Optimal management of older people with frailty non-weight bearing after lower limb fracture: a scoping review. Age Ageing. 2021;50(4):1129–36. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998–1005. Aloraibi S, Gladman J, Godfrey D, Booth V, Robinson K, Lunt E, et al. Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study. BMC Geriatr. 2021;21(1):332. Grund S, Gordon AL, van Balen R, Bachmann S, Cherubini A, Landi F, et al. European consensus on core principles and future priorities for geriatric rehabilitation: consensus statement. European Geriatric Medicine. 2020;11(2):233–8. Lubbe AL, van Rijn M, Groen WG, Hilhorst S, Burchell GL, Hertogh CMPM, et al. The quality of geriatric rehabilitation from the patients’ perspective: a scoping review. Age and Ageing. 2023;52(3). Hoffmann T, Bakhit M, Michaleff Z. Shared decision making and physical therapy: What, when, how, and why? Braz J Phys Ther. 2022;26(1):100382. Sagen JS, Kjeken I, Habberstad A, Linge AD, Simonsen AE, Lyken AD, et al. Patient Involvement in the Rehabilitation Process Is Associated with Improvement in Function and Goal Attainment: Results from an Explorative Longitudinal Study. J Clin Med. 2024;13(2). Lee MJ, Yoon S, Kang JJ, Kim J, Kim JM, Han JY. Efficacy and Safety of Caregiver-Mediated Exercise in Post-stroke Rehabilitation. Ann Rehabil Med. 2018;42(3):406–15. Tijsen LM, Derksen EW, Achterberg WP, Buijck BI. Challenging rehabilitation environment for older patients. Clin Interv Aging. 2019;14:1451–60. van Dijk M, Vreven J, Deschodt M, Verheyden G, Tournoy J, Flamaing J. Can in-hospital or post discharge caregiver involvement increase functional performance of older patients? A systematic review. BMC Geriatr. 2020;20(1):362. Vloothuis JD, Mulder M, Veerbeek JM, Konijnenbelt M, Visser-Meily JM, Ket JC, et al. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev. 2016;12(12):Cd011058. van Garderen E, Visser M, Achterberg WP. Physical activity interventions to improve physical function in temporarily non-ambulant older persons: A scoping review. . European Review of Aging and Physical Activity. (in press). Clarke V, Braun V. Successful Qualitative Research: A Practical Guide for Beginners2013. Teherani A, Martimianakis T, Stenfors-Hayes T, Wadhwa A, Varpio L. Choosing a Qualitative Research Approach. J Grad Med Educ. 2015;7(4):669–70. O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–51. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. World Health Organization (WHO). International classification of Functioning, Disability and Health (ICF). Geneva. 2001. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31. Organization WH. More active people for a healthier world: global action plan on physical activity 2018-2030. (No Title). 2018. Piggin J. What Is Physical Activity? A Holistic Definition for Teachers, Researchers and Policy Makers. Front Sports Act Living. 2020;2:72. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62. Dijkstra F, van der Sluis G, Jager-Wittenaar H, Hempenius L, Hobbelen JSM, Finnema E. Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review. Int J Behav Nutr Phys Act. 2022;19(1):99. Scheerman K, Mesters JW, Borger JN, Meskers CGM, Maier AB. Tasks and responsibilities in physical activity promotion of older patients during hospitalization: A nurse perspective. Nurs Open. 2020;7(6):1966–77. Smit EB, Bouwstra H, Hertogh CM, Wattel EM, van der Wouden JC. Goal-setting in geriatric rehabilitation: a systematic review and meta-analysis. Clin Rehabil. 2019;33(3):395–407. Wattel EM, de Groot AJ, Deetman-van der Breggen S, Bonthuis R, Jongejan N, Tol-Schilder MMR, et al. Development of a practical guideline for person centred goal setting in geriatric rehabilitation: a participatory action research. Eur Geriatr Med. 2023;14(5):1011–9. Everink IHJ, van Haastregt JCM, Tan FES, Schols JMGA, Kempen GIJM. The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study. BMC Geriatrics. 2018;18(1):285. Welsh A, Hanson S, Pfeiffer K, Khoury R, Clark A, Ashford PA, et al. Perspectives of informal caregivers who support people following hip fracture surgery: a qualitative study embedded within the HIP HELPER feasibility trial. BMJ Open. 2023;13(11):e074095. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7417603","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509240241,"identity":"9ea78390-70ac-4f64-a3c3-199f391b5af0","order_by":0,"name":"Elma van Garderen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYHCDBBBhIwPhFBCvJY0HwjEgXsthwlr4GXgMPxcw1Mqbtycf+/Bxx3keg2uHHzAX4NEi2cBjLD2D4bjhnDPPkmfOPHObx+B2mgHzDDxaDA6wJUjzMBxjnCGRY8zM2wbSksPAzINHi/0BtuTfQC32MyTyPzP/bTtHWIsBA/MxoC01iUBbmJkZ2w4Q1iJxmPmYNQ/DgeQZPM+MGXvbknkkgX45jE8Lf3tj820ehjrbGezJjxl+ttnJ8d1OfviYpwK3FgZmIGb8dxhV8AAeDTBQR4SaUTAKRsEoGLEAADV1RfW4yCseAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0004-7047-7709","institution":"Leiden University Medical Center: Leids Universitair Medisch Centrum","correspondingAuthor":true,"prefix":"","firstName":"Elma","middleName":"van","lastName":"Garderen","suffix":""},{"id":509240242,"identity":"cbc51fd4-c273-4566-9879-37cdfa69f9d6","order_by":1,"name":"Mandy Visser","email":"","orcid":"https://orcid.org/0000-0001-6796-6246","institution":"Topaz","correspondingAuthor":false,"prefix":"","firstName":"Mandy","middleName":"","lastName":"Visser","suffix":""},{"id":509240243,"identity":"6d1fb806-ba94-43a2-b531-c7e964c770bc","order_by":2,"name":"Wilco P. Achterberg","email":"","orcid":"https://orcid.org/0000-0001-9227-7135","institution":"LUMC: Leids Universitair Medisch Centrum","correspondingAuthor":false,"prefix":"","firstName":"Wilco","middleName":"P.","lastName":"Achterberg","suffix":""}],"badges":[],"createdAt":"2025-08-20 12:47:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7417603/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7417603/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90904955,"identity":"19b6503b-64f4-4b87-b659-a3ec0f437702","added_by":"auto","created_at":"2025-09-09 12:56:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":328096,"visible":true,"origin":"","legend":"\u003cp\u003eICF-model Physical activity during a period of restricted weight-bearing of a lower extremity\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7417603/v1/987108b3291b1a9faec3b1a2.png"},{"id":90907222,"identity":"bea9d349-4084-4a9f-ad25-2e640c464836","added_by":"auto","created_at":"2025-09-09 13:20:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1184896,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7417603/v1/c3f0b7cc-a861-43fb-bb86-e67c5e417cd4.pdf"},{"id":90904959,"identity":"6ff83851-e8b4-4eab-925c-10405638e976","added_by":"auto","created_at":"2025-09-09 12:56:38","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":433316,"visible":true,"origin":"","legend":"","description":"","filename":"COREQChecklist1308.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7417603/v1/367ccfde19d4b9f998157135.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eExploring perspectives of geriatric rehabilitants and their informal caregivers on physical activity during the non-weight-bearing period, a qualitative study\u003c/p\u003e","fulltext":[{"header":"Key summary points","content":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWe conducted semi-structured interviews with non-weight-bearing rehabilitants and their informal caregivers regarding the content and frequency of physical activities, and motivational factors for performing such physical activities.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFindings:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEleven themes emerged from the interviews, which can be categorized into the different domains of the ICF model.\u003c/li\u003e\n \u003cli\u003ePhysical activity during the non-weight-bearing (NWB) period should be tailored to the rehabilitant and their informal caregivers.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eMessage:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWe recommend integrating the perspectives of NWB rehabilitants and their informal caregivers into their rehabilitation plans and addressing any differences between their perspectives and those of healthcare providers.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eAn 8.4 year increase since 1995 brought global life expectancy at birth to 73.3 years in 2024 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This increase also leads to a rise in the number of older adults admitted to the emergency room (ER). In the US in 2022, 76 per 100 adults aged 75 and older visited the ER (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In the Netherlands, ER visits related to serious injuries for adults aged 65 and older increased by 29% between 2013 and 2022 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Of those hospital admissions, 24% involved a fracture of the lower extremity (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Depending on the location and type of fracture, as well as the surgical intervention performed, patients may be restricted from bearing weight on a lower extremity for a certain period of time, known as the non-weight-bearing-period (NWB) period. Older adults often spend this period in temporary inpatient care (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). While this period may be important for recovery, not being allowed to stand on one or both legs makes it challenging to remain physically active.\u003c/p\u003e\u003cp\u003eIn general, it is challenging for older adults to remain physically active during inpatient care (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Older rehabilitants spend most of the day sitting or lying down (23.1 hours a day), and observations reveal that they spend only 16% of daytime performing physical activities, including self-care, therapy and transferring (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Being restricted from bearing weight on a lower extremity makes it even more challenging to remain physically active. Inactivity has many negative consequences. Five to ten days of bed rest can result in a significant decrease in muscle strength, muscle mass, physical condition and motivation to resume physical activity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Prolonged periods of sedentary behavior and weight-bearing restrictions have even been associated with increased mortality (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Therefore, it is important for geriatric non-weight-bearing rehabilitants (NWB rehabilitants) to remain physically active, 98% of all healthcare professionals agreed in a consensus study (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe importance of including the perspectives of both rehabilitants and informal caregivers is widely recognized (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Involvement in decision-making is of great importance to rehabilitants (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Shared decision-making can improve communication between healthcare providers and rehabilitants, increase the accuracy of rehabilitants\u0026rsquo; expectations and enhance satisfaction with care (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Moreover, being involved in setting and planning rehabilitation goals improves function and goal attainment for rehabilitants (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The involvement of informal caregivers leads to better physical functioning, a higher level of independence and a greater likelihood of rehabilitants returning home (\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Furthermore, their involvement reduces anxiety and depression and improves the quality of life for both geriatric rehabilitants and informal caregivers (\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In order to prevent physical inactivity, it is important to understand which activities both NWB rehabilitants and their informal caregivers consider to be physical activities, what physical activities they find important, and what motivates or demotivates them to stay physically active.\u003c/p\u003e\u003cp\u003eHowever, information on how to help NWB rehabilitants to stay physical active is scarce, and there is a lack of input from the rehabilitants and informal caregivers on their views of physical activity during the NWB period (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This qualitative study therefore investigates their perspectives regarding the content and frequency of physical activities, as well as the motivational factors that promote or obstruct performing these activities. This knowledge might facilitate the implementation and promotion of physical activity interventions for NWB rehabilitants and help prevent inactivity.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eThis qualitative study was conducted using an inductive grounded theory approach (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This method was chosen as knowledge on this topic is limited, and to ensure an open perspective in identifying what is important to the participants. Apart from physical activity and motivation, no pre-determined themes were established. The codes, categories, and themes were developed directly from the interviews. We have adhered to the standards for reporting qualitative research (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The Medical Ethics Committee of the Leiden University Medical Centre has declared that this study is not subject to the Medical Research Involving Human Subjects Act (WMO) (Protocol number 23-3125).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipant population and recruitment\u003c/h3\u003e\n\u003cp\u003eThis study used a convenience sampling method. We reached out to geriatric inpatient rehabilitation centers (GR centers) that provide temporary care, including for NWB rehabilitants, through the University Network of the Care sector South Holland (UNC-ZH network) and LinkedIn. Participating centers informed potential candidates, extended invitations, and facilitated contact between the candidates and the researcher (EvG).\u003c/p\u003e\u003cp\u003eEligible for inclusion were rehabilitants aged 65+, who were temporarily admitted to a GR center, and temporarily restricted from bearing weight on at least one lower extremity. Exclusion criteria for potential candidates were: an inadequate comprehension or production of the Dutch language, delirium, end-of-life care pathway, communication disability, psychiatric disorder or cognitive impairment that would hinder conducting an interview. Informal caregivers were eligible for inclusion if their relative, the NWB rehabilitant, met the aforementioned inclusion criteria. They also needed to have an adequate comprehension and production of the Dutch language and no communication disability, or psychiatric disorder or cognitive impairment that would impede participation in an interview.\u003c/p\u003e\u003cp\u003ePotential participants received an information letter and were asked to sign the informed consent form after having ample time to consider participation. Rehabilitants and informal caregivers were included until saturation was reached.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eSemi-structured interviews were conducted by EvG between April and October 2024. EvG is a female physiotherapist and PhD student with formal training in qualitative research and seven years of experience in geriatric rehabilitation. An interview guide was used to gather demographic data of the participants and to collect information about physical activity and motivation across five topics: demographics, knowledge, behavior, motivation and preferences. The topic list was piloted with members of the elderly board, caregivers, as well as through pilot interviews with one NWB rehabilitant and one informal caregiver. The interviewer asked open-ended questions about each topic and in-depth follow-up questions to gain a better understanding. After each topic, at the end of the interview and at appropriate moments, the interviewer provided a verbal summary of the findings and gave interviewees the opportunity to offer additional comments or corrections.\u003c/p\u003e\u003cp\u003eOne-on-one interviews with NWB rehabilitants were conducted at one of the participating GR centers. One-on-one interviews with informal caregivers were held at one of the participating GR centers, by telephone, or at a location convenient for the informal caregiver. The interviews took place in the last week of the pre-determined predicted last week of the NWB period. This ensured that both the rehabilitant and their informal caregiver had experience with the non-weight-bearing period while still in that situation. The interviews lasted approximately 45 minutes.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe interviews were recorded, transcribed verbatim, and thematically analyzed using the framework method (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This framework consists of the following seven stages: 1) Transcription; 2) Familiarization with the interview; 3) Coding; 4) Developing a working analytical framework; 5) Applying the analytical framework; 6) Charting data into the framework matrix; 7) Interpreting the data (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Two researchers, EvG and MV, openly coded the first few transcripts. MV is a female experienced qualitative researcher. EvG and MV compared their codes, and grouped them into themes to form the working analytical framework. EvG then used this framework to analyze the remaining transcripts. Any new codes or themes that emerged were added to the analytical framework. The Atlas.ti program was used for coding and developing the analytical framework. After the final stage, interpreting the data, the results were reported, and relevant quotes were identified and translated into English. To provide a clear description of the participants, characteristics of the NWB rehabilitants and informal caregivers, such as age, gender, duration, and reason for the NWB period, were gathered and are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003eCharacteristics\u003c/h2\u003e\n \u003cp\u003eTen rehabilitants and seven informal caregivers from four different GR centers consented to be interviewed. The data of one informal caregiver was excluded due to a malfunctioning recording device during their interview. While all rehabilitants who were asked to participate consented, most did not want us to contact their informal caregiver due to time constraints or limited involvement of the informal caregiver. Therefore, we were only able to interview two informal caregivers who were related to participating rehabilitants. We continued recruiting informal caregivers after reaching data saturation with rehabilitants. The rehabilitants (R1-R10) were between 61 and 87 years old and the informal caregivers (IC1-IC6) between 58 and 86 years old. Most rehabilitants were restricted in bearing weight on a lower extremity due to one or more fractures of the lower extremity. Characteristics of the participants are shown in Table\u0026nbsp;1.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDemographic characteristics of the participating non-weight-bearing rehabilitants and informal caregivers.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRehabilitants n = 10\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInformal caregivers n = 6\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGENDER, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge. Range (Median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61–87 (71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58–86 (76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeeks since advised NWB Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (5.00-9.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.5 (5.00-7.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReason for admission to GR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnplanned surgery: (7)\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026nbsp;One ore more fractures in a lower extremity (7)\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003ePlanned surgery: (3)\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eAmputation (1)\u003c/li\u003e\n \u003cli\u003eInfection in hip prosthesis (1)\u003c/li\u003e\n \u003cli\u003eAnkle osteoarthritis (1)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e* Unplanned surgery: (6)\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eOne ore more fractures in a lower extremity (6)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eN: number. NWB: Non Weight Bearing. IQR: Interquartile range. GR: geriatric rehabilitation. *Reason for admission to GR of the NWB rehabilitant for whom they are the informal caregiver.\u003c/p\u003e\n \u003cp\u003eThe level of pre-hospitalization physical activity varied from still participating in sports activities to being inactive due to a history of falls or pain. However, both the pre-hospitalization active and inactive rehabilitants experienced loss of strength, condition, and independence during their hospitalization.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eICF model\u003c/h3\u003e\n\u003cp\u003eThe International Classification of Functioning, Disability and Health (ICF) model provides a comprehensive framework for understanding health and health-related domains (27). While analyzing the interviews, we identified themes that aligned well with the different domains of the ICF model (Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003cp\u003eBody function: body functions or structures motivating or obstructing physical activity\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003eActivity \u0026amp; participation: (preferred) execution of physical activity by an individual and participation in social life\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eEnvironmental factors: external factors influencing physical activity\u003c/p\u003e\n\u003cp\u003ePersonal factors: internal factors influencing physical activity\u003c/p\u003e\n\u003cp\u003eIn the context of this study the ICF model's domain of health refers to physical activity during a period of restricted weight-bearing on a lower extremity for older adults. Given the importance of understanding what qualifies as physical activity during this non-weight-bearing period, we will start with the participants' definition of physical activity.\u003c/p\u003e\n\u003ch3\u003ePhysical activity during a period of restricted weight-bearing\u003c/h3\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003eDefinition of physical activity during the non-weight-bearing period\u003c/h2\u003e\n \u003cp\u003eThe participants had different views on what qualifies as being physically active during the NWB period. Some participants considered physical activity impossible during the NWB period. Most participants, however, considered strength training and other exercises given by the physiotherapist to be physical activities, followed by performing activities of daily living (ADL) and self-propelling the wheelchair. However, according to one participant, self-propelling the wheelchair only counts as physical activity if it is challenging for the arms. Most participants experienced limited possibilities in performing physical activities during the NWB period.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eExercise. That means stretching your leg. So making sure your leg muscles stay strong, your back, things like that. I move my arms a lot because I use a self-propelled wheelchair. And then sometimes I also use my foot, sometimes I don't. Because then I throw them both in the air, and then I think: right, and a leg exercise as well. (Rehabilitant 10)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eBody function\u003c/h2\u003e\n \u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eActivity limitations\u003c/h2\u003e\n \u003cp\u003eThe participants experienced limited ability to perform physical activities due to the weight-bearing restrictions, (pre-)existing comorbidities, multiple fractures, and low energy due to poor sleep. Pain, fear of falling, and concern about the wound not healing properly were reasons to be cautious when performing physical activities.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSo I say, we're not going to work on that, because it will go, it will get worse again. And it's my body, not yours, so when I say, I'm not doing that, then I'm not doing it. Plain and simple. (Rehabilitant 7)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003eActivity \u0026amp; participation\u003c/h2\u003e\n \u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003eFrequency and duration of physical therapy\u003c/h2\u003e\n \u003cp\u003eMost of the participating rehabilitants received some form of physical therapy between two and four times a week for 30 minutes per session. Many rehabilitants found this sufficient, while others preferred more frequent therapy moments or simply the possibility to use the fitness room more often and for longer periods of time throughout the day, and to engage in more patient-regulated exercises, either self-directed or prescribed by their therapist. Informal caregivers mentioned that 30 minutes is sufficient, but suggested increasing the time based on the rehabilitant's fitness level. However, they did find the number of sessions insufficient.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes, yes, yes, and we were also, well not surprised, but gosh, she only has physiotherapy two or three times a week, is that enough, you know, so you think, well, can' they do half an hour of exercise every day. (Informal caregiver 1)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003eContent of physical therapy\u003c/h2\u003e\n \u003cp\u003ePhysical therapy during the non-weight-bearing period should, according to most participants, include some form of strength training. Others mentioned that physical therapy already includes, or should include, standing and ‘hopping’ exercises with a walking frame or between bars, wheelchair mobilization, seated general whole-body exercises, and cycling with the arms or one leg. Particularly popular among participants was cycling, combined with a virtual reality video screen. Some of the participants reported that making the physical exercises enjoyable stimulates their participation. Activities or components that make physical exercises enjoyable included: cycling (arms or one leg) with a virtual reality video screen, variation in exercises, playful or competitive elements within the exercises, and performing exercises while watching TV or while outside.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAnd with a video clip to watch. Then you're on holiday for 15 minutes, you know? It's true, isn’t it? (Rehabilitant 8)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003ePatient-regulated exercise\u003c/h2\u003e\n \u003cp\u003ePatient-regulated exercises may include wheelchair mobilization, standing (on one leg), performing strength training exercises for the legs or arms, stretching and mobilizing exercises for different parts of the body, and performing daily living activities (ADL) such as watering the flowers.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAnd sometimes then I also look for it like, well, there aren't that many flowers now, but I used to have a house full of flowers, and then I'd have to water them and clean up, and I'd be back and forth five times with a small cup - haha like that. (Rehabilitant 5)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eSome rehabilitants already had their own repertoire of exercises while others were given or asked for exercises from a physiotherapist or occupational therapist. Most rehabilitants performed their exercises daily. The duration and frequency varied between rehabilitants, ranging from the whole day, regularly per day 5 minutes, to once a day for 15 minutes. Only two rehabilitants mentioned that whether they performed the patient-regulated exercises on a specific day depended on other factors such as how they felt, pain levels, and other activities they had planned for that day, including physical therapy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\"\u003e\n \u003ch2\u003eGroup vs. individual therapy preferences\u003c/h2\u003e\n \u003cp\u003eThe rehabilitants preferred group therapy, sometimes combined with individual therapy. The informal caregivers, however, believed that the rehabilitants mostly preferred individual therapy. Participants expressed that individual therapy should focus on solutions, i.e. performing ADL independently, and that the focus of group therapy should be on general training. According to participants, merits of group therapy are: the therapists don’t hover around you, you can chat with others, it makes the therapy more enjoyable, it distracts you, and it makes you humble.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWell, sometimes a group lesson is also fun because you are with others who are in the same boat, and you also challenge each other a bit or look at what others are doing. Like, oh can you do that as well, I didn't know that, can I do that too? You know, like you're kind of learning by copying. (Rehabilitant 5)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\"\u003e\n \u003ch2\u003eEnvironmental factors\u003c/h2\u003e\n \u003cdiv id=\"Sec20\"\u003e\n \u003ch2\u003eTherapists’ role in facilitating and encouraging physical activity\u003c/h2\u003e\n \u003cp\u003ePhysiotherapists play an important role in facilitating physical activity for non-weight-bearing rehabilitants. Their role includes: providing therapy sessions; instructing rehabilitants on how to perform exercises, and on frequency and duration of patient-regulated exercises; installing the exercise equipment; educating rehabilitants about physical activity and its consequences; providing solutions for performing ADL independently; ensuring safety and taking responsibility for the exercises performed by the rehabilitants.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBut the other thing is, when it comes to movement, I still think you have to limit that to the, to where the person, or, to what the physiotherapists can monitor. (Rehabilitant 9)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eOccupational therapists are responsible for providing or repairing wheelchairs and assisting with the transition home by offering guidance on assistive devices and training in ADL, such as cooking. However, this assistance usually begins later in the rehabilitation process, typically when rehabilitants are permitted to bear weight on both legs. Nurses primarily assist with ADL, and their involvement depends on the rehabilitant’s level of independence and energy. More help is often required at the start of the rehabilitation and for rehabilitants with low energy levels. As the rehabilitants become more independent, the nurses’ involvement can decrease.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI hardly see the nurses, actually. In the evening they come to bring the bedpan and then it's \"oh, you're in bed already, well bye! Haha see you tomorrow! (Rehabilitant 4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe level of encouragement required from various therapists depends on the individual rehabilitant. For some rehabilitants, a stricter approach may be beneficial in achieving their goals. Methods to encouraging physical activity include providing group therapy, promoting independence in ADL and patient-regulated exercises, monitoring the execution of these exercises, educating rehabilitants, and emphasizing the consequences of physical inactivity.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo. I, I think it's different for each person. Some people need a kick up the backside and others you need to leave alone. (Rehabilitant 10)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\"\u003e\n \u003ch2\u003eInformal caregivers' role in facilitating and encouraging physical activity\u003c/h2\u003e\n \u003cp\u003eAll participants stated that informal caregivers were not involved in physical activities during the NWB period. Additionally, all informal caregivers reported that they did not encourage the NWB rehabilitant to be physically active. Reasons given for not encouraging physical activity include the NWB rehabilitants' existing motivation and unwillingness to listen, the informal caregivers’ perception that encouraging physical activity is not their responsibility, and their belief that they are not sufficiently involved to encourage physical activity. Informal caregivers were not involved in physical activities because the NWB rehabilitant did not want or need help, others took over the care, or they themselves were not around enough to assist. Some informal caregivers chose not to be involved due to their own health issues, feelings of incompetence, believing that it is not their job, and because they already have to assist when the rehabilitant returns home. When asked if there are aspects of physical activity that a rehabilitation center could involve informal caregivers in, one rehabilitant responded as follows:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo, because it is a profession. You are trained for physiotherapy. And then you start doing other things anyway. (Informal caregivers 5)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eInformal caregivers emphasized the importance of being informed by the doctor or therapist when their involvement is required. Without this communication, the rehabilitant might not accept help or may feel uncomfortable asking their informal caregivers for assistance. All informal caregivers agreed that it was their role to provide support once the rehabilitant returns home.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWell, actually, actually from, from someone with more authority. Because she would say, 'no, there's no need, I can do that.' But if it comes from..., from a bit higher up, I think she would accept it more easily. (Informal caregivers 4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eSome rehabilitants reported that their informal caregivers did motivate them by complimenting their performance and offering encouragement. However, rehabilitants were often reluctant to ask their informal caregivers for help. The reasons given were: they did not want to burden their informal caregiver too much, they believed that assisting with physical activities is not their responsibility, and they viewed their role as providing companionship and taking them outside and to places like restaurants.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWell, she is in a wheelchair. She doesn't move that much then. It's mainly the social aspect, being outside. (Informal caregivers 2)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\"\u003e\n \u003ch2\u003eInforming the rehabilitants and informal caregivers\u003c/h2\u003e\n \u003cp\u003eSome rehabilitants emphasized the importance of being adequately informed about the challenges of maintaining independence while adhering to weight-bearing restrictions. They received information about not being allowed to bear weight on the affected leg, along with general and specific instructions regarding physical activities during the NWB period. Instructions for patient-regulated exercises should be provided verbally or in written form and should include pictures. Some rehabilitants preferred both options. Only one rehabilitant received information through e-health. Although she found it convenient, she did not prefer it over written instructions.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYou can watch it again and again, although the picture that was hanging there was also very handy. That showed everything at a glance, now I have to start it up. Because everything else I do on my own laptop. (Rehabilitant 10)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eMost informal caregivers did not receive information about physical activity from the GR center. They did not feel the need to be informed because they trusted the professionals' capabilities, received information from the rehabilitant, or simply asked for information when needed. The informal caregivers expressed a preference for receiving information about the rehabilitation plan when the rehabilitant is allowed to bear weight again. They also wanted details about the process of the rehabilitant returning home, including which assistive devices to purchase.\u003c/p\u003e\n \u003cdiv id=\"Sec23\"\u003e\n \u003ch2\u003eRehabilitation location\u003c/h2\u003e\n \u003cp\u003eIt is important that the rehabilitation location and its immediate surroundings are wheelchair accessible. This includes having no thresholds or sloping floors, wheelchair-accessible elevators and (exit) doors, easy exit access, as well as smooth, even sidewalks outside.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAnd what I think is really important: remove the thresholds in the buildings. Because if they don't place the wheelchair ramp for me, I can't get to the terrace here. (Rehabilitant 10)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\"\u003e\n \u003ch2\u003ePersonal factors\u003c/h2\u003e\n \u003cdiv id=\"Sec25\"\u003e\n \u003ch2\u003eIntrinsic motivation\u003c/h2\u003e\n \u003cp\u003eCoping strategies for staying motivated despite experiencing fear, pain, exhaustion, or reluctance to perform physical activity include thinking ahead to when weight bearing will be allowed again, doing what one is capable of, and maintaining a positive outlook (e.g., things could be worse). Rehabilitants also hope that therapy can help them manage their fear.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes, basically giving her back her confidence. That, to me, is the most important thing you can have. The people who treat her, restore that confidence. (Informal caregivers 3)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eSeveral rehabilitants mentioned experiencing dependency at some point or throughout the entire NWB period. However, most participants emphasized the importance of being independent and trying to do as much as possible on their own.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes of course. You have to arrange everything yourself, you know. You shouldn't press that button every time like, come and help me, you shouldn't do that of course. You have to try it yourself first, and if you really can't do it, well, then you should call someone, but you have to try everything yourself. That's motivation if you want to, like, progress. (Rehabilitant 7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe social aspect, distraction, and a sense of accomplishment motivated the rehabilitants to remain physically active. Participants emphasized the importance of staying active to maintain or improve physical function during the NWB period, including strength, overall progression (e.g., being able to sit up for longer periods of time and to cover longer distances hopping with the walking frame) and physical condition. Other incentives included avoiding prolonged sitting, changing body positions to reduce stiffness and pain, improving balance, and achieving weight loss. The most important goals of performing physical activity were: regaining the ability to walk, returning home, and resuming life as they knew it, including family activities, sports, and traveling without limitations (e.g., driving a car).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI only have one motive, as you know. And that is that I want to walk out the door using both my legs. (Rehabilitant 8)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this article, we describe the perspectives of NWB rehabilitants and their informal caregivers regarding the content and frequency of physical activities, as well as the motivational factors that promote or obstruct performing these activities. Eleven themes emerged from the interviews, which can be categorized into the different domains of the ICF model. The first theme defines what constitutes being physically active during the NWB period. Themes related to the domains of body function and activity and participation include: activity limitations; frequency, duration, and content of physical therapy; patient-regulated exercise; and preferences for group versus individual therapy. Themes within the domains of environmental and personal factors include the therapists\u0026rsquo; and informal caregivers\u0026rsquo; role in facilitating and encouraging physical activity, the dissemination of information, the rehabilitation location, and intrinsic motivation.\u003c/p\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eDefinition of physical activity\u003c/h2\u003e\u003cp\u003eThe most widely accepted definition of physical activity is \u0026ldquo;any bodily movement produced by skeletal muscles that results in energy expenditure\u0026rdquo;, first published by Caspersen et al. (1985) and adopted by many health policies worldwide (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This definition emphasizes muscle activity and energy expenditure, with higher levels of physical activity leading to greater energy expenditure. This aligns with the participants\u0026rsquo; responses, as most considered strength training and other exercises prescribed by physiotherapists to be physical activities. Some also viewed performing ADL activities and self-propelling a wheelchair as being physically active. However, one participant mentioned that propelling the wheelchair only counts as a physical activity if it remains challenging for the arms. Other participants felt that it was impossible to be physically active during the NWB period because they were unable to do their usual body movements, such as walking or carrying out ADL independently. A broader definition by Piggin (2020) states that \u0026ldquo;Physical activity involves people moving, acting and performing within culturally specific spaces and contexts, and influenced by a unique array of interests, emotions, ideas, instructions, and relationships.\u0026rdquo; (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This broader definition increases awareness of the importance of any body movement and highlight that physical activity is still possible despite weight-bearing restrictions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eFrequency of physical activity\u003c/h2\u003e\u003cp\u003eOlder adults find it challenging to remain physically active during inpatient care, spending only 16% of the day engaged in physical activities (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, this may be sufficient to meet the activity guidelines. Most rehabilitants received physical therapy 2\u0026ndash;4 times a week for 30 minutes, combined with patient-regulated exercises. If these activities were of moderate or vigorous intensity, they may have met the physical activity guidelines (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Nevertheless, it is important to avoid long periods of sedentary behavior between exercise sessions. For some rehabilitants, this might include low-intensity activities such as wheelchair mobilization.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eMotivational factors\u003c/h2\u003e\u003cp\u003eUnderstanding the motivational factors that promote or obstruct physical activity can help to find ways to encourage it. Physical activity behavior is influenced by knowledge, awareness, and attitude. Barriers to physical activity include unwillingness to move, physical health status, symptoms, and fear (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). These barriers are consistent with those identified during the NWB period. Motivating physical activity involves removing or addressing these barriers. This study highlights the important role of healthcare providers, particularly physiotherapists, in promoting and facilitating physical activity. Methods they can use, as mentioned in this study, include educating rehabilitants, encouraging independence in ADL, providing group therapy, making therapy enjoyable (e.g., using e-health), and offering patient-regulated exercises. However, therapists' responsibility to promote physical activity may decrease as rehabilitants become more independent (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Another important motivator is found in the rehabilitants\u0026rsquo; own coping strategies and short- and long-term goals. Involving participants in goal setting is found important in GR, because it leads to patient-centered care, even if it does not necessarily improve physical function (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). While supporting and involving informal caregivers are seen as important promotors of physical activity (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), our study found that their involvement was almost nonexistent. This indicates a gap between the expectations of the caregivers\u0026rsquo; role and reality, as well as potential bias in the study results due to the selected group of informal caregivers willing to participate (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eTo the best of our knowledge, this is the first study to explore the perspectives of geriatric rehabilitants and their informal caregivers regarding physical activity during the non-weight-bearing period. A strength of this study is the timing of the interviews, which were conducted during the final week of the predetermined non-weight-bearing period. This ensured that both the rehabilitants and their informal caregivers had experience with the non-weight-bearing period while still being in that situation. Another strength is that we interviewed rehabilitants from four different rehabilitation centers, making sure that the outcomes are not location-specific.\u003c/p\u003e\u003cp\u003eWe had difficulty finding informal caregivers willing to participate. While all of the NWB rehabilitants we contacted agreed to participate, not all of them had an informal caregiver available for an interview, or they did not want to burden their informal caregiver with an interview. As a result, we were only able to interview two informal caregivers who were related to participating rehabilitants. We recruited the other four informal caregivers of NWB-rehabilitants after reaching data saturation with rehabilitants. This may have led to differences in responses regarding encouragement from informal caregivers or preferences for group versus individual therapy between the caregivers and rehabilitants.\u003c/p\u003e\u003cp\u003eWe conducted interviews at different locations, one of which was the workplace of one of the interviewers. Although we did not include rehabilitants for whom the interviewer was the primary physiotherapist, some of the participants from that location recognized the interviewer as a therapist, which might have influenced their responses. The interviewer\u0026rsquo;s background as a physiotherapist may have shaped some of the questions she asked. To mitigate interview bias, we used a topic list that was discussed with the research team and piloted.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePhysical activity during the non-weight-bearing (NWB) period should be tailored to the rehabilitant and their informal caregivers. It is important to inform the rehabilitant and discuss with them the physical activities that they can perform during therapy or individually. The most important goals of engaging in physical activity are regaining the ability to walk and returning home.\u003c/p\u003e\u003cp\u003eWe recommend integrating the perspectives of NWB rehabilitants and their informal caregivers into their rehabilitation plans and addressing any differences between these perspectives and those of healthcare providers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the non-weight-bearing participants and informal caregivers for participating in this study and the healthcare providers who facilitated contact between the potential participants and the researcher.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Dutch Zorgondersteuningfonds. KPO 72, 2023/05/01, Leiden. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study sponsor had no role at any stage in preparing the manuscript or any other stage of the work. All authors\u0026rsquo; have contributed significantly to the article, approved the submitted version and have agreed to be personally accountable for the author\u0026rsquo;s own contributions and the resolution documented in the literature.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUnited Nations Department of Economic and Social Affairs, Population Division (2024). World Population Prospects 2024: Summary of Results (UN DESA/POP/2024/TR/NO. 9).\u003c/li\u003e\n\u003cli\u003eCairns C AJ, Kang K. Emergency department visit rates by selected characteristics: United States, 2022. . NCHS Data Brief, no 503 Hyattsville, MD: National Center for Health Statistics 2024.\u003c/li\u003e\n\u003cli\u003eStam C. Letsels 2022, Kerncijfers LIS VeiligheidNL. 2022;Rapport 969.\u003c/li\u003e\n\u003cli\u003eThomas G, Whalley H, Modi C. Early mobilization of operatively fixed ankle fractures: a systematic review. Foot Ankle Int. 2009;30(7):666\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eBrown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009;57(9):1660\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eRamsey KA, Loveland P, Rojer AGM, Denehy L, Goonan R, Marston C, et al. Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings. Journal of the American Medical Directors Association. 2021;22(12):2432\u0026ndash;9.e1.\u003c/li\u003e\n\u003cli\u003eRojer AGM, Ramsey KA, Trappenburg MC, Meskers CGM, Twisk JWR, Goonan R, et al. Patterns of Objectively Measured Sedentary Behavior and Physical Activity and Their Association with Changes in Physical and Functional Performance in Geriatric Rehabilitation Inpatients. Journal of the American Medical Directors Association. 2023;24(5):629\u0026ndash;37.e11.\u003c/li\u003e\n\u003cli\u003eJolliffe L, Collyer TA, Sun KH, Done L, Barber S, Callisaya ML, et al. Geriatric evaluation and management inpatients spend little time participating in physically, cognitively or socially meaningful activity: a time-motion analysis. Age Ageing. 2025;54(3).\u003c/li\u003e\n\u003cli\u003eKortebein P, Symons TB, Ferrando A, Paddon-Jones D, Ronsen O, Protas E, et al. Functional impact of 10 days of bed rest in healthy older adults. 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Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study. BMC Geriatr. 2021;21(1):332.\u003c/li\u003e\n\u003cli\u003eGrund S, Gordon AL, van Balen R, Bachmann S, Cherubini A, Landi F, et al. European consensus on core principles and future priorities for geriatric rehabilitation: consensus statement. European Geriatric Medicine. 2020;11(2):233\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eLubbe AL, van Rijn M, Groen WG, Hilhorst S, Burchell GL, Hertogh CMPM, et al. The quality of geriatric rehabilitation from the patients\u0026rsquo; perspective: a scoping review. Age and Ageing. 2023;52(3).\u003c/li\u003e\n\u003cli\u003eHoffmann T, Bakhit M, Michaleff Z. Shared decision making and physical therapy: What, when, how, and why? Braz J Phys Ther. 2022;26(1):100382.\u003c/li\u003e\n\u003cli\u003eSagen JS, Kjeken I, Habberstad A, Linge AD, Simonsen AE, Lyken AD, et al. Patient Involvement in the Rehabilitation Process Is Associated with Improvement in Function and Goal Attainment: Results from an Explorative Longitudinal Study. J Clin Med. 2024;13(2).\u003c/li\u003e\n\u003cli\u003eLee MJ, Yoon S, Kang JJ, Kim J, Kim JM, Han JY. Efficacy and Safety of Caregiver-Mediated Exercise in Post-stroke Rehabilitation. Ann Rehabil Med. 2018;42(3):406\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eTijsen LM, Derksen EW, Achterberg WP, Buijck BI. Challenging rehabilitation environment for older patients. Clin Interv Aging. 2019;14:1451\u0026ndash;60.\u003c/li\u003e\n\u003cli\u003evan Dijk M, Vreven J, Deschodt M, Verheyden G, Tournoy J, Flamaing J. Can in-hospital or post discharge caregiver involvement increase functional performance of older patients? A systematic review. BMC Geriatr. 2020;20(1):362.\u003c/li\u003e\n\u003cli\u003eVloothuis JD, Mulder M, Veerbeek JM, Konijnenbelt M, Visser-Meily JM, Ket JC, et al. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev. 2016;12(12):Cd011058.\u003c/li\u003e\n\u003cli\u003evan Garderen E, Visser M, Achterberg WP. Physical activity interventions to improve physical function in temporarily non-ambulant older persons: A scoping review. . European Review of Aging and Physical Activity. (in press).\u003c/li\u003e\n\u003cli\u003eClarke V, Braun V. Successful Qualitative Research: A Practical Guide for Beginners2013.\u003c/li\u003e\n\u003cli\u003eTeherani A, Martimianakis T, Stenfors-Hayes T, Wadhwa A, Varpio L. Choosing a Qualitative Research Approach. J Grad Med Educ. 2015;7(4):669\u0026ndash;70.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eGale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). International classification of Functioning, Disability and Health (ICF). Geneva. 2001.\u003c/li\u003e\n\u003cli\u003eCaspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eOrganization WH. More active people for a healthier world: global action plan on physical activity 2018-2030. (No Title). 2018.\u003c/li\u003e\n\u003cli\u003ePiggin J. What Is Physical Activity? A Holistic Definition for Teachers, Researchers and Policy Makers. Front Sports Act Living. 2020;2:72.\u003c/li\u003e\n\u003cli\u003eBull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451\u0026ndash;62.\u003c/li\u003e\n\u003cli\u003eDijkstra F, van der Sluis G, Jager-Wittenaar H, Hempenius L, Hobbelen JSM, Finnema E. Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review. Int J Behav Nutr Phys Act. 2022;19(1):99.\u003c/li\u003e\n\u003cli\u003eScheerman K, Mesters JW, Borger JN, Meskers CGM, Maier AB. Tasks and responsibilities in physical activity promotion of older patients during hospitalization: A nurse perspective. Nurs Open. 2020;7(6):1966\u0026ndash;77.\u003c/li\u003e\n\u003cli\u003eSmit EB, Bouwstra H, Hertogh CM, Wattel EM, van der Wouden JC. Goal-setting in geriatric rehabilitation: a systematic review and meta-analysis. Clin Rehabil. 2019;33(3):395\u0026ndash;407.\u003c/li\u003e\n\u003cli\u003eWattel EM, de Groot AJ, Deetman-van der Breggen S, Bonthuis R, Jongejan N, Tol-Schilder MMR, et al. Development of a practical guideline for person centred goal setting in geriatric rehabilitation: a participatory action research. Eur Geriatr Med. 2023;14(5):1011\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eEverink IHJ, van Haastregt JCM, Tan FES, Schols JMGA, Kempen GIJM. The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study. BMC Geriatrics. 2018;18(1):285.\u003c/li\u003e\n\u003cli\u003eWelsh A, Hanson S, Pfeiffer K, Khoury R, Clark A, Ashford PA, et al. Perspectives of informal caregivers who support people following hip fracture surgery: a qualitative study embedded within the HIP HELPER feasibility trial. BMJ Open. 2023;13(11):e074095.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Non weight bearing, Geriatric rehabilitant, Informal caregiver, Physical activity","lastPublishedDoi":"10.21203/rs.3.rs-7417603/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7417603/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOlder adults in inpatient rehabilitation often struggle to remain physically active, especially when they are restricted from bearing weight on a lower extremity. Given the negative consequences of inactivity, it is important to provide and encourage physical activities, as well as include the input and views of rehabilitants\u0026rsquo; and their informal caregivers\u0026rsquo; in this process. This qualitative study explores the perspectives of non-weight-bearing rehabilitants and their informal caregivers regarding the content and frequency of physical activities, and the motivational factors for performing such physical activities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eSemi-structured interviews were conducted with geriatric rehabilitants restricted from bearing weight on a lower extremity and their informal caregivers. The interviews were thematically analyzed using the framework method.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eEleven ICF-related themes emerged from the interviews. The participants reported what they consider to be physical activity during the non-weight-bearing period, their preferences regarding the frequency and content of physical therapy sessions and patient-regulated exercises, and the importance of incorporating multiple elements into physical activity, which makes being physical active more enjoyable. They also mentioned the limited involvement of informal caregivers and disciplines other than physiotherapist, and they shared their coping strategies and goals to stay physically active.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePhysical activity during the non-weight-bearing (NWB) period should be tailored to the rehabilitant and their informal caregivers. It is important to inform and discuss the possibilities for being physically active with the rehabilitant. The most important goals for engaging in physical activity were regaining the ability to walk and returning home.\u003c/p\u003e","manuscriptTitle":"Exploring perspectives of geriatric rehabilitants and their informal caregivers on physical activity during the non-weight-bearing period, a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 12:56:33","doi":"10.21203/rs.3.rs-7417603/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revisions","date":"2025-10-10T12:38:51+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-09-04T19:01:17+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-02T16:58:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"European Geriatric Medicine","date":"2025-08-27T08:50:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-23T04:33:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Geriatric Medicine","date":"2025-08-20T08:47:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e4f8e070-127b-433d-ad3c-2dd74ae188ea","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-14T17:54:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 12:56:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7417603","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7417603","identity":"rs-7417603","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}