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The aim of this study was to quantify changes in patients’ activity levels, location and people present, within one acute stroke unit (ASU) and one inpatient rehabilitation unit (IRU) with respect to change in hospital design. A prospective observational study using behavioural mapping. We observed participants from 8 am till 5 pm every 10 minutes across two days and compared participant activity (physical, social and cognitive), location and people present pre and post-transition to new units. Built design, staffing levels and models of care were contrasted. We recruited 73 participants (63% stroke): old-ASU ( n  = 19); new-ASU ( n  = 15); old-IRU ( n  = 19); new-IRU ( n  = 20). Compared to old, new units had more single rooms, larger floor spaces and higher staffing levels. We found no significant change in participants’ activity levels between the old and new ASU. Participants in the new IRU showed increased physical activity (43.4% vs. 54.4%,  p  = 0.02) but social and cognitive activity remained similar. Participants were more alone (ASU 47.4% vs. 66.7%,  p  = 0.01; IRU 41.7% vs. 58.3%,  p  &lt; 0.001), and less often with nursing staff (ASU 17.7% vs. 6.7%,  p  = 0.04; IRU 18.8% vs. 5.7%,  p  &lt; 0.001) in new units. Hospital design appears to impact on patients’ physical activity. Single rooms may increase isolation and reduce interaction with nursing staff.Implications for rehabilitationDesign of new rehabilitation units needs to consider patients’ social engagement with family, friends, other patients and staff in addition to privacy and infection control.A change in built design of rehabilitation units should prompt observation of patients’ activity levels and engagement with people and available space to ensure optimal use of new environments.Promotion of communal spaces and activities away from the bedroom to encourage social engagement is recommended for patients recovering in rehabilitation facilities.Less time in contact with nursing staff in rehabilitation environments with predominantly single rooms suggests a review of clinical practice and patient safety is warranted. Design of new rehabilitation units needs to consider patients’ social engagement with family, friends, other patients and staff in addition to privacy and infection control. A change in built design of rehabilitation units should prompt observation of patients’ activity levels and engagement with people and available space to ensure optimal use of new environments. Promotion of communal spaces and activities away from the bedroom to encourage social engagement is recommended for patients recovering in rehabilitation facilities. Less time in contact with nursing staff in rehabilitation environments with predominantly single rooms suggests a review of clinical practice and patient safety is warranted.

Does hospital design impact on patient activity levels and time spent alone?