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Rehabilitation physiotherapy after a long hospital stay · home visits across Hong Kong

Rehabilitation after a long hospital stay,
walking again step by step after long bed rest

After a serious illness, a stay in intensive care or a long time in bed, many older people become weaker and weaker, and may not be able to walk by the time they are discharged. This is called deconditioning, and the patient's muscle, bone and cardiorespiratory function are lost day by day. The research is also very clear, though: starting to move again early and step by stepin the familiar setting of home can reverse this decline. A registered physiotherapist visits the home, starts with exercises at the bedside, and takes the older person step by step to standing and walking again.

  • Registered physiotherapists in Hong Kong
  • Home visits across Hong Kong
  • 1 hour $1,000 · 1.5 hours $1,300
  • Moving again early to reverse the decline
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Understanding the deconditioning caused by long bed rest

Common misunderstandings about long bed rest

After a long hospital stay or serious illness, what harms the body most is not necessarily the original illness. It is the long time of not moving. When the body is not active, muscle building slows and muscle loss speeds up, and muscle strength, bone and cardiorespiratory function decline together. Research shows that about 30% of older people have already lost some of their usual ability to look after themselves in daily life by the time they leave hospital(HAD 30%; Loyd 2020). Breaking this vicious circle depends on starting to move again early and step by step, and not on continuing to rest in bed.

What people assume is right
  • Thinking that after a serious illness the patient should stay in bed and not exert themselvesLong periods in bed without moving actually speed up muscle and bone loss in older people
  • Thinking that activity should wait until the body is fully recoveredThe longer a person lies waiting, the weaker the body becomes, and the result is a vicious circle
  • Thinking that only young people can regain what was lostOlder people regain muscle strength more slowly, but with continuing training they can still recover it gradually
What should actually be done
  • Early, progressive activityIt can begin with the simplest activity at the bedside and wake up bodily function step by step
  • Practise the movements needed in daily life directlyTraining aims at real movements such as standing, walking and everyday self-care
  • Continuing and in sufficient amountRehabilitation does not work after one or two sessions, and the amount of exercise needs to be increased step by step according to the body's condition

The deconditioning caused by long bed rest affects several systems of the body. Besides muscle wasting, bone, cardiorespiratory function and joint flexibility all decline together, and the time to rebuild them is often much longer than the time it took to lose them (especially bone). For patients after a long hospital stay, the point is therefore not “wait until the body improves before moving”but “start moving again early and safely”, so that lost function can be regained more quickly.

Home rehabilitation arranged from easy to hard

Key points of treatment in rehabilitation after a long hospital stay

The core method for improving the decline caused by long bed rest is progressive training from easy to hard. According to the patient's fitness at that moment, we start with simple activity in bed and then increase the amount of exercise step by step, moving on to sitting up, getting out of bed to stand and walking, and targeting the lost physical functions one by one to rebuild them.

01

Joint movement and correct positioning at the bedside (preventing joint contracture)

Passive joint movement with another person's help moves step by step to active movement where the patient makes the effort, together with correct positioning in bed. This keeps the range of joint movement, prevents joint contracture and pressure sores, and wakes up muscles that have not been used for a long time. This step can begin in bed, before the patient is able to get out of bed.

Research39% had joint contractures at ICU discharge (Clavet 2008)
02

Practising sitting up and sitting balance (letting the body adapt to changes in position)

Practising slowly sitting up from lying down trains endurance in sitting and control of the lower back. This also lets the cardiovascular system adapt again to changes in position, and eases dizziness (postural hypotension) when first sitting or standing up.

RCTEarly physical and occupational therapy is safe and feasible (Schweickert 2009)
03

Practising standing and bearing weight on both legs (stimulating bone and leg muscles)

Standing up again with safe support, so that both legs take the weight of the body. This is a key step to stimulate bone and leg muscles and to slow down the loss of bone and muscle strength.

Research17 weeks of bed rest: heel bone mineral density −10.4% (LeBlanc 1990)
04

Rebuilding the ability to walk and physical endurance

Starting with walking with someone's support or a walking frame and moving on to walking unaided, the patient slowly rebuilds a normal gait, endurance and cardiorespiratory function, with enough protein to help muscle growth, so that the patient moves on from the first “activity in bed” to “walking again”.

Network meta-analysisEarly mobilisation within 72 hours shortened hospital stay (Daum 2024)

Why treatment at home

Training spots at home after leaving hospital

The biggest benefit of home physiotherapy is that the patient can practise getting up on the bed they normally sleep in and practise walking along the corridor in their own home, so the ability regained can be applied directly to daily life. The therapist can also find the places at home where tripping or slipping is likely and suggest improvements on the spot, working on both exercise training and the home environment to lower the risk of falls. The four places at home below are the ones we use most often for training.

Rehabilitation training map of the home TRIGGER MAP

Bedside and getting-up spotBed: the first step from lying to sitting upPractising sitting up from lying and then standing up from the edge of the bed, together with correct positioning in bed, to lower the risk of falling when getting up to go to the toilet in the middle of the night.
Corridor and straight pathCorridor: practising gait and walking enduranceStarting with holding on to the wall or using a walking frame and moving on to walking unaided, the walking distance is increased gradually to rebuild a steady gait and endurance.
Toilet door and narrow spotsTurning is where falls happen mostBathrooms and toilets are high-risk places for falls at home. We practise turning, sitting down and standing up from the toilet safely here, with non-slip surfaces or visual cues added.
Sofa and dining chairMechanics of sitting and standingIn the living room the patient practises standing up from a chair or sofa to rebuild the weight-bearing strength of the legs, and the therapist assesses on the spot whether the height of the furniture needs to be adjusted.
Guiding carers on the spot:The therapist teaches family members directly when to reach out and help and when to let go and let the patient make the effort themselves, because if family members do everything for the patient or support too much, the patient's recovery slows down.

Clinical evidence

Research on deconditioning after a long hospital stay

Research data EVIDENCE

About 30%Share of older people who have already lost some of their ability to look after themselves (HAD) by the time they leave hospitalMeta-analysis combining 15 studies and 7,375 people (Loyd et al., JAMDA 2020)
−17.7%Loss in cross-sectional area of the rectus femoris muscle of the thigh within 10 days of bed rest in critically ill patientsAlready −10.3% by day 7; acute disuse muscle loss (Puthucheary et al., JAMA 2013)
59% vs 35%Share of patients who regained independent function at discharge after early physical or occupational therapyCritically ill patients vs usual care (Schweickert et al., Lancet 2009)

High-quality RCT evidence for early mobilisation is still accumulating (Doiron 2018 Cochrane considers it not yet enough to “settle” the overall effect), but the direction is consistent, the mechanism is clear and early mobilisation is safe. The real value lies in continuing, sufficient and individualisedprogressive training, and it does not work in one go.

If you are not sure whether a family member, or you yourself, is suited to training after leaving hospital, contact us and tell us the situation, and a physiotherapist will answer your questions.

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FAQ · Fees and results

Frequently asked questions about rehabilitation after a long hospital stay

NOVA HEALTH・FAQ01 – 06
Why do people become weaker and weaker and unable to walk after a long hospital stay?

This is called deconditioning, together with a short period of whole-body vulnerability after discharge (post-hospital syndrome; Krumholz 2013). When a person lies in bed without moving, muscle building falls and muscle breakdown rises, and muscle strength, bone and cardiorespiratory endurance are all lost together. In healthy older people, just 10 days of bed rest reduced knee extensor strength by about 13% (Kortebein 2008). About 30% of older people admitted to hospital have already lost some of their ability to look after themselves in daily life by discharge (HAD 30%; Loyd 2020). For older people, “resting more” can therefore sometimes do harm.

Is it too late to start rehabilitation only after going home from hospital?

No. Early intervention is ideal, but progressive rehabilitation started at home after discharge works just as well, and the key is that it is continuing, of sufficient amount and individualised. The direction of the evidence is consistent: early, meaningful activity restarts function, whereas continuing to lie in bed does not. To be balanced, high-quality randomised controlled trial evidence is still accumulating (Doiron 2018 Cochrane), but the physiological mechanism is clear and early mobilisation is safe.

Can the muscle strength and self-care ability lost in hospital be regained?

In most cases yes, but it has to be done step by step. Among critically ill patients who received early physical and occupational therapy, the proportion who regained independent function at discharge rose from 35% to 59% (Schweickert 2009). Bone recovers more slowly. After 17 weeks of bed rest, heel bone mineral density fell by about 10.4%, and was still not fully back after several months (LeBlanc 1990). The earlier the person stands and bears weight again, the better.

What complications can long bed rest and hospital stays cause?

Besides loss of muscle strength, there are disuse osteoporosis, joint contracture (39% of patients had contractures at ICU discharge; Clavet 2008), and a chain of disuse effects such as deep vein thrombosis (DVT), pressure sores, pneumonia and dizziness on standing (postural hypotension) (Parry & Puthucheary 2015). Most of these can be prevented through early mobilisation and correct positioning, so prevention is better than cure.

How does home physiotherapy help patients after a long hospital stay?

It uses a progressive approach, from easy to hard: joint range of movement in bed (to prevent contracture), then sitting up at the bedside and sitting balance, then standing and weight bearing (to stimulate bone and muscle), then walking and rebuilding endurance, together with enough protein to protect muscle function (Ferrando 2010). Nova Health brings the whole process to the familiar home, and safely takes the patient from moving again to walking again.

How is home rehabilitation after a long hospital stay charged? Is there a minimum charge?

Physiotherapy is HK$1,000 for 1 hour and HK$1,300 for 1.5 hours. There is no minimum charge, and single visits can be booked as needed. Transport is included in the main districts of Hong Kong Island, Kowloon and the New Territories, and remote areas (such as the outlying islands, Ma On Shan and Sai Kung) may carry a $100–200 transport surcharge. For details, see the pricing page.

If you or a family member is weak after a long hospital stay or serious illness, the earlier progressive rehabilitation starts, the easier it is to catch up. Message us at any time with your questions.

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1 hour $1,000 · 1.5 hours $1,300 · no minimum charge · All service fees at a glance

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.

References

  1. Loyd, C., Markland, A. D., Zhang, Y., et al. (2020). Prevalence of hospital-associated disability in older adults: a meta-analysis. Journal of the American Medical Directors Association, 21(4), 455–461.e5. PubMed
  2. Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., et al. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451–458. PubMed
  3. Krumholz, H. M. (2013). Post-hospital syndrome — an acquired, transient condition of generalized risk. New England Journal of Medicine, 368(2), 100–102. DOI
  4. Puthucheary, Z. A., Rawal, J., McPhail, M., et al. (2013). Acute skeletal muscle wasting in critical illness. JAMA, 310(15), 1591–1600. DOI
  5. Kortebein, P., Symons, T. B., Ferrando, A., et al. (2008). Functional impact of 10 days of bed rest in healthy older adults. The Journals of Gerontology: Series A, 63(10), 1076–1081. DOI
  6. Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., et al. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 373(9678), 1874–1882. DOI
  7. LeBlanc, A. D., Schneider, V. S., Evans, H. J., et al. (1990). Bone mineral loss and recovery after 17 weeks of bed rest. Journal of Bone and Mineral Research, 5(8), 843–850. DOI
  8. Clavet, H., Hébert, P. C., Fergusson, D., et al. (2008). Joint contracture following prolonged stay in the intensive care unit. CMAJ, 178(6), 691–697. DOI
  9. Ferrando, A. A., Paddon-Jones, D., Hays, N. P., et al. (2010). EAA supplementation to increase nitrogen intake improves muscle function during bed rest in the elderly. Clinical Nutrition, 29(1), 18–23. DOI
  10. Daum, N., Drewniok, N., Bald, A., et al. (2024). Early mobilisation within 72 hours after admission of critically ill patients in the intensive care unit: a systematic review with network meta-analysis. Intensive & Critical Care Nursing, 80, 103573. DOI
  11. Parry, S. M., & Puthucheary, Z. A. (2015). The impact of extended bed rest on the musculoskeletal system in the critical care environment. Extreme Physiology & Medicine, 4, 16. DOI
  12. Doiron, K. A., Hoffmann, T. C., & Beller, E. M. (2018). Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database of Systematic Reviews, (3), CD010754. DOI