Consequences Of Immobility Research Articles

EARLY MOBILIZATION AND ITS PROTOCOLS AT HOSPITAL DISCHARGE IN ADULT PATIENTS IN THE INTENSIVE CARE UNIT

Introduction: The highly complex hospital environment was created with the aim of providing intensive care to patients with severe acute conditions or system instability, with the potential for recovery. A growing number of individuals survive the initial stage of treatment but do not show good progress. Poor progress in critically ill patients is due to immobility, which can cause several complications that influence recovery. The authors warn that the consequences of immobility can last up to 5 years after hospital discharge. Several published studies have highlighted that MP is associated with a reduction in the patient's time in hospital units. Several arguments based on other studies indicate that MP has been proposed as a promising intervention for critically ill patients, important for preventing postoperative complications and reducing hospital stay. Objective: To describe the influence of MP and its protocols on hospital discharge in adult patients in the ICU. Methods: Descriptive research by systematic literature review with the PICO strategy. Results and Discussion: Research conducted in the databases found 96 articles, of which 79 were discarded and 7 articles met all the inclusion criteria for this study. This study analyzed the influence of MP and its protocols on hospital discharge in adult patients in the ICU in the selected articles. Many issues should be investigated for a more assertive and guiding opinion, thus further highlighting the benefits of MP and its significant influence on hospital discharge. There is a need to outline a model to meet the specific needs according to the profile of patients and thus systematize MP in the ICU. Conclusion: We consider it important to conduct more studies to systematize the practice and highlight the improvements in the protocols and, thus, benefit the patient, favoring their recovery, hospital discharge and quality of life.

MODULATION OF MITOCHONDRIAL THIOREDOXIN IN AGE-RELATE MUSCLE ATROPHY AND INJURY

Abstract Maintenance of skeletal muscle is vital to health and wellbeing. Over the course of age there is a progressive decline in muscle mass and function. This decline results in frailty, reduced independence, reduced quality of life and elevated risk of mortality. Lean muscle mass contributes approximately 50% of body mass in a young adult while only 25% in an individual in their 80s. Critically, this decline in muscle mass is not continuous but composed of periods of stability punctuated by rapid declines. The chief driver of such events is loss due to injury related inactivity. Bed rest, is an essential part of recovering from injuries, however, long periods of inactivity can lead to skeletal muscle atrophy. A study of just 10 days bed rest in older adults produced a 6% decline in lower extremity lean muscle mass and a 15% decline in muscle function. Importantly much of the muscle mass lost even from short bed rest events are thought to never be recovered and to accelerate age related muscle declines. For this reason, development of interventions which reduce bed rest induced muscular atrophy would have considerable benefits in maintenance of independence for older adults. In my research project I am investigating a novel genetic target to ameliorate muscle atrophy as a consequence of immobility. We have found the protein TXNIP, a critical driver of apoptosis, to be induced under limb. Using TXNIP knockdown and TXNIP inhibitors I’m testing the hypothesis that prevention of TXNIP induction can reduce muscle atrophy.

“I am just trying to live a life!” –a qualitative study of the lived experience of pressure ulcers in people with spinal cord injuries

BackgroundPressure ulcers (PUs) are frequently reported in people with spinal cord injuries (SCI). Wound management in people with SCI involves relieving pressure on the affected area by means of immobilisation and bed rest. The healing time of a PU can vary, but often takes several months or even years, causing people to stay in bed for prolonged periods of time. Objective: This study aims to explore the perspectives and lived experiences of people with SCI who are affected by PUs. Designand method: This study is a qualitative explorative study that employs individual semi-structured in-depth interviews to obtain the narratives of people with SCI and a pressure ulcer. We used a phenomenological-hermeneutic approach that was inspired by Ricoeur's theory of interpretation. The analysis was performed in three levels: Naïve reading, structural analysis and critical interpretation and discussion. Participantsand setting: Ten people with SCI who were being treated in the Danish healthcare system for their PU participated in this study: six participants had experienced a complete traumatic SCI, three had an incomplete traumatic SCI, and one had a non-traumatic complete SCI. The study included nine men and one woman, aged 49–81 years (mean 64). Nine had a PU in the seating area, while one had the ulcer on the leg. ResultsThe analysis revealed three themes: 1. Struggling to balance prevention with an active, meaningful life, 2. Challenges and consequences of pressure relief protocols and bed rest, 3. Experiencing prolonged and incoherent treatment with varying levels of staff engagement and competencies. ConclusionsPeople with SCI and a PU have difficulty balancing their active, redefined lives when subjected to a strict pressure relief protocol. The consequences of immobility caused by pressure relief include reduced social and community participation and decreased quality of life. PU treatment is experienced as incoherent and unnecessarily lengthy, leading to a deterioration in the wounds. Improving PU treatment for people with SCI is of utmost importance and has the potential to benefit not only the people with SCI but also the healthcare system and the economy.

‘God Gave us Legs to Walk!’

Domestic work is a major source of income for many Black African women in South Africa. The experience of domestic workers is mainly shaped along racial and class lines – this is a result of the remnants of the legacy of apartheid, where many Coloured and African women were dependent on employment in the domestic work sphere. This article considers the experiences of a group of Coloured female domestic workers in a coastal town in South Africa. Drawing on ten qualitative interviews, I show how their experiences are framed around issues of mobility – this includes moving to work and moving at work and the consequences of immobility in the world of work. Most research that deals with issues of mobility in domestic work focuses on migration patterns. This novel approach to understanding the notion of mobility for domestic workers contributes to the existing literature on domestic work in South Africa but extends the conceptualisation of movement beyond migration patterns. The article also makes a much-needed contribution to understanding the experience of domestic work in rural settings in South Africa. This is done by exploring the coping strategies that the participants employ to support themselves and their families. Networks and family ties form an essential component of the financial and emotional survival of this group of women. The role of social capital is also investigated as it plays an important role in forging trust and reciprocity among participants of this study.

Immobility and the High Risk of Not Recovering Function in Older Adults

The objective of the study was to explore the experiences of older adults with immobility posthospitalization. We conducted a focused ethnography qualitative study. Data collection included in-depth interviews with 10 individuals ages 69-82 years who had been hospitalized for at least 1 week, field notes, and observations of mobility. An inductive approach was used to analyze the data. Older adults believe mobility is a central element in their life. Hospitalizations lasting 1 week or longer often result in a loss of the older adult's ability to function as before, a pattern that we identified as The Crushing Assault: Consequences of Immobility. Rehabilitation involves a Rocky Road to Regaining Mobility that is challenging but possible. Immobility after hospitalization has unexpected and profound consequences that are life-changing and distressing for older adults at home. Recovering function is prolonged and difficult. An individualized training program that includes flexibility and progressive resistance exercises is recommended over longer periods and with extended medical follow-up. Lingering problems with immobility at home are frequently overlooked. Active programming promoting preservation of function and an optimistic attitude as well as focusing on milestones to reach are key to optimal function.

Im]Mobility and trucking disruption: what happened to isolated cities and individuals in Brazil after a supply blockage

ABSTRACT In May 2018, truckers paralysed Brazil producing a series of disruptions causing unprecedented immobility. The event was a logistical disaster, exposing major failures in commodity supply systems and causing monumental economic losses, cancellations of basic services, and the disruption of public services. In this paper, we approach this phenomenon by means of an urban study using the new mobilities paradigm and a dialectical character of social and spatial relations to help us understand what was going on. To accomplish this, we have performed content analysis of the virtual media during the trucking disruption and the 90 days that followed it. Our findings indicate that a paralysed society becomes disoriented and even aggressive when order, routine, and everyday life are disturbed. The paper concludes with notes about the consequences of immobility in daily life.

Physical Therapists Know Function: An Opinion on Mobility and Level of Activity During Hospitalization for Adult Inpatients

ABSTRACTNegative consequences of immobility during hospitalization are widely known and remain undisputed. Evidence of low mobility for general medicine adult inpatients persists. Patients who experience hospital acquired functional decline due to low mobility require costly post-acute care services. The impact of immobility on post-acute care physical function and quality of life is directly at odds with value-based care. New Medicare payment models emphasize value-based care to promote care improvement and better patient outcomes. Quality improvement projects show promise in changing clinical practice using clinical champions, interprofessional collaboration, and teamwork. Physical therapists have a distinct expertise acutely focused on mobility and physical activity during hospitalization. Patients need acute care team members to develop sustainable clinical practice changes and to accept collective responsibility for a culture of mobility. Partnering with physical therapists and using their expertise to direct mobility, executed by the appropriate support personnel, can achieve the Quadruple Aim.

Evidence for the Importance of Vitamin D Status in Neurologic Conditions.

Vitamin D status has been proposed as relevant to many neurological disorders. Data suggest that vitamin D may be important for the development of the nervous system, and it also plays a role in neuroimmunology and neuroprotection. Lower levels of circulating 25-hydroxyvitamin D have been linked with increased risk of multiple sclerosis (MS) and Alzheimer's disease (AD). While people with amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD), and stroke have lower vitamin D levels than those without the diseases, it is unclear if this is because hypovitaminosis D contributes to disease risk or is a consequence of immobility and other factors caused by the disease. Lower levels of vitamin D have been associated with worse prognosis in MS, PD, ALS, and stroke, while no longitudinal studies have been performed to evaluate such an association in AD. Small pilot trials have been performed to evaluate vitamin D supplementation for some of these diseases, but there have been no phase III studies to support vitamin D supplementation in these patient populations; further, ideal levels of 25-hydroxyvitamin D are not known. Thus, while some expert panels or individuals have suggested routine testing and supplementation for patients with these neurological conditions, it is our opinion that there are currently insufficient data to support high-dose vitamin D supplementation to specifically treat or prevent these conditions.

Activity, Activity Restriction, and Sedentarism in Nursing Research

Noncommunicable diseases (NCDs) such as cardiovascular diseases (CVDs), cancers, diabetes mellitus, and chronic respiratory diseases account for almost two thirds of global mortality, killing millions of people across the world (American College of Sports Medicine, 2011). The socioeconomic impact and years of productive life lost are staggering. In 2011, global leaders met at the United Nations to set a new international health agenda related to NCDs. In the resulting declaration, the United Nations proclaimed that inactivity was one of the leading risk factors for NCDs and called on world leaders and health professionals to develop a multifaceted plan to ameliorate such modifiable risk factors in order to decrease the mortality associated with NCDs (U.N. General Assembly, 2011). This call to action marked only the second time in its history that the U.N. General Assembly met to address a global health issue, with HIV/AIDS having served as the topic for the first such meeting. Prior to the 1940s, health care providers accepted the common wisdom that rest and reduced activity were of value in promoting health and recovery from illness. Decades of research by scientists who studied bed rest and physical activity, however, revealed that the function of almost every organ system is adversely affected by inactivity. The effects on the cardiovascular and musculoskeletal systems, in particular, rapidly lead to deconditioning and, eventually, to a decline in health status. As a result of this research, many providers now encourage early ambulation after illness or medical procedures for the elderly, for surgical patients, and for other hospitalized or institutionalized patients and are beginning to encourage it even in intensive care units. In spite of the evidence, however, health care providers often continue to restrict activity for a variety of reasons, such as to prevent falls and, unfortunately, sometimes to assure convenient provider access to patients. Of concern also is the increasingly sedentary lifestyle many healthy individuals are adopting due to changes in work and leisure environments. Aerobic and resistance or strengthening exercises have both physical and psychosocial benefits including improved cardiac and metabolic indicators and reduced perceptions of fatigue, depression, and anxiety. Such exercise can also help prevent osteoporosis, improve lipid levels, manage weight, reduce falls, and improve quality of life. However, a large percentage of the population does not engage in moderate-to-vigorous physical activity on a regular basis. In addition, many health care providers, including nurses, often lack knowledge about the type and amount of physical activity necessary to achieve specific outcomes such as improved fitness, enhanced bone health, or a healthy body weight, which is associated with reduced risks of diabetes, high blood pressure, heart disease, stroke, and several types of cancer as well as premature mortality. The overall goal of this special section, ‘‘Activity, Activity Restriction, and Sedentarism,’’ was to provide biobehavioral evidence of the effectiveness of interventions or alterations in care that increase appropriate physical activity or reduce sedentarism in healthy and acutely or chronically ill populations. Furthermore, we wanted to publish research examining the unintended consequences of immobility and/or activity restriction that result from acute and chronic disease processes and their treatments. The six articles we selected provide examples of the latest nursing research exploring the full continuum of activity levels, from sedentarism through moderate-to-vigorous exercise. Of these six, four are related to inactivity, with two documenting the decline in physical status when activity is restricted, one describing the correlates of decline in physical activity, and the final article exploring the changes in physical activity levels following a medical procedure. In their article, Mottola and colleagues describe a study in which they identified the detrimental effects of inactivity upon a biomarker of bone resorption when women have been prescribed antepartum bed rest. Their findings lead them to express concern for the effect of bed rest treatment on lifelong maternal bone health. Moes and colleagues examined the effects of neuropathic pain upon activity and muscle mass using an animal model. Their results

Chronic fatigue after myocardial infarction: what of rest and recuperation?

Fatigue is a symptom associated with living with chronic conditions. Chronic fatigue and depression, alone or together, are also associated with having had a myocardial infarction (MI). The paper by Alsén et al. (2008) in this issue of Journal of Advanced Nursing describes their study of chronic fatigue in people who have experienced MI. They used grounded theory methods and identified a central theme of living with incomprehensible fatigue along with categories, which refer to its consequences. They set their study and findings in the context of research literature where fatigue has been defined as having a number of constructs such as general fatigue, mental fatigue, reduced motivation and reduced activity. Fatigue also forms part of an adaptive continuum with tiredness and exhaustion as beginning and end points, with each state being an adaptive response to stressors. This is an important study that contributes to our understanding of the psychological and physical impacts of life events and illness on people’s health and wellbeing. Alsén et al. conclude with the contention that identifying stressors and coping strategies following MI could prevent the aggravation of fatigue and that failure to detect tiredness, fatigue and exhaustion by health professionals can lead to incorrect interventions. This paper prompted my thinking about the underlying causes of fatigue and in this case, post-MI, it could also have physiological bases because of illness, raised cardiac enzymes, damaged heart muscle, altered electrical and neural transmissions and a threatened immune system. As Alsén et al. identify, chronic fatigue could be a consequence of MI or a precursor as a result of life stressors and coping responses. What then of the role of rest and recuperation? In order for people and their bodies to heal and recover, time is required for adequate rest and recuperation. In these days of emphasis on efficiency in health services people are expected to recover quickly and to return to being as active as possible. The health service focus is on avoiding hospitalization and delayed discharges, shortened lengths of stay and rapid throughput of patients for cost efficiencies and the prevention of iatrogenic events, such as hospital acquired infections or consequences of immobility. The focus of care is on function with rehabilitation returning people to the resumption of independence, activities of daily living and productivity. Convalescence does not feature in current care processes or pathways, particularly in Western cultures. The days of ‘lying-in’ and ‘1 week’s bed rest as the doctor ordered’ have long gone. In the United Kingdom even respite care is no longer a feature of health care but has been deemed social care. We could take heed of Eastern cultures, in particular the teachings of Buddhism and the importance of ‘being’ and appreciating the positive aspects of each moment lived. In this modern day 24/7 culture, with instant messaging (texts or emails), news transmission and work it is a challenge for people to rest, relax and reflect. In order to prevent chronic fatigue or promote recovery, adequate rest and recuperation in conjunction with individuals’ needs and expressed preferences should be what health professionals recommend.

Moderate-intensity exercise: for our patients, for ourselves.

Even more than the general population, orthopaedic patients suffer from multiple consequences of immobility. Fortunately, most of these patients are physically able to participate in some degree of moderately intense exercise. Helping the orthopaedic patient initiate and adhere to a moderately intense exercise routine is a nursing challenge. This challenge is even more difficult because as nurses, we are often expecting our patients to make a lifestyle change that we have been unable or unwilling to make ourselves. Understanding the health-related benefits that can be derived from participation in moderately intense exercise routines and the recommended guidelines for exercise frequency and intensity is a first step toward initiating a fitness routine. Using information acquired from research, nurses can assess for specific facilitators and barriers to exercise participation. This assessment data can then be used to individualize plans for exercise that meet the fitness needs of our patients and ourselves.

Pressure sores. How to prevent and treat them.

The consequences of immobility among hospitalized and bedridden patients, especially the elderly, can be devastating if pressure sores develop. Such sores are not only painful for the patient and expensive to manage, but they are potentially life-threatening. What can be done to prevent them? Which patients are most vulnerable? The authors address these questions and discuss treatment options.

Integrating physiological principles into the comprehensive management of cardiopulmonary dysfunction.

Impairment of oxygen transport can be conceptualized as a motion disorder based on the framework previously reported by Hislop and Zadai. Extensive literature exists that demonstrates the beneficial effects of body positioning and mobilization on impaired oxygen transport. This article integrates this existing information and attempts to extend the framework of Hislop and Zadai in cardiopulmonary physical therapy. To provide a basis for discussion, we describe the multisystemic consequences of immobility from bed rest. We also discuss the role of body positioning and mobilization as therapeutic interventions that can be used to directly enhance all components of oxygen transport in patients with cardiopulmonary dysfunction. This approach may improve the efficacy of treatment in these patients and thus may address some of the limitations of current methods of practice. Further research is needed, however, to clarify and extend the application of this approach.