Early Mobilization Group Research Articles

Effect of early mobilization on functional recovery in ICU patients with post-COVID ARDS

Background. The COVID-19 pandemic has significantly increased the number of patients requiring intensive care unit (ICU) admissions due to severe complications such as acute respiratory distress syndrome (ARDS). Prolonged ICU stays, often associated with immobility, lead to muscle weakness, ICU-acquired weakness (ICU-AW), and reduced functional status, which impede recovery. Early mobilization in the ICU has been proposed as a beneficial intervention to mitigate these effects, but its impact on patients with post-COVID ARDS remains underexplored. Objective. This study aimed to evaluate the effect of early mobilization on functional recovery in ICU patients with post-COVID ARDS. Methods. A prospective, randomized controlled trial was conducted at Saveetha Medical College and Hospital, Chennai, from August 2021 to August 2024. Two hundred patients with post-COVID ARDS were randomly assigned to either an early mobilization or standard care group. The early mobilization group received structured physical therapy interventions within 48 hours of ICU admission. Functional status was measured using the ICU Mobility Scale (IMS) and Functional Status Scale ICU (FSS ICU) at baseline, weekly, and discharge. Secondary outcomes included the duration of ICU stay, mechanical ventilation, and incidence of ICU-AW. Results. Patients in the early mobilization group demonstrated significantly higher functional recovery, with a mean IMS score of 7.8 ± 1.2 compared to 4.3 ± 1.5 in the standard care group (p < 0.001). The FSS ICU score was also significantly higher in the early mobilization group (90.6 ± 8.3) than in the standard care group (65.4 ± 10.7; p < 0.001). Additionally, early mobilization reduced the mean ICU stay (14.5 ± 3.2 vs. 19.8 ± 4.1 days, p < 0.001), shortened the duration of mechanical ventilation (10.1 ± 2.9 vs. 13.7 ± 3.6 days, p < 0.001), and decreased the incidence of ICU-AW (20% vs. 45%, p = 0.002). Conclusion. Early mobilization significantly improves functional recovery, reduces ICU stay and mechanical ventilation duration, and lowers ICU-AW risk in post-COVID ARDS patients. These findings highlight the importance of integrating early mobility into standard ICU care to enhance patient outcomes.

Early mobilization and its impact on recovery in ICU patients with severe COVID-19: A randomized controlled trial

Introduction. The COVID-19 pandemic has severely impacted critically ill patients, often leading to prolonged immobilization in intensive care units (ICUs), which can result in ICU-acquired weakness (ICUAW) and delayed recovery. Early mobilization has emerged as a promising intervention to counter these effects by promoting faster recovery and reducing complications. This study aims to investigate the effects of early mobilization on physical function, muscle strength, and recovery outcomes in ICU patients with severe COVID-19. Methods. This randomized controlled trial (RCT) included 100 ICU patients (50 in the early mobilization group, 50 in the control group) with severe COVID-19. Early mobilization began within 48 to 72 hours of ICU admission and followed a stepwise progression through four mobility levels. Outcome measures included the Physical Function ICU Test (PFIT), Medical Research Council (MRC) sum score, incidence of delirium, ICU and hospital stay length, ventilator-free days, mortality, and readmission rates. Statistical analysis used intention-to-treat methods, with continuous and categorical variables tested accordingly. Results. The early mobilization group had a significantly shorter time to first mobilization (2.3 days vs. 5.8 days, p < 0.001), higher PFIT scores at ICU discharge (25.4 vs. 18.2, p < 0.001), and improved MRC sum scores (48.6 vs. 35.4, p < 0.001) compared to the control group. The incidence of delirium was significantly lower in the early mobilization group (20% vs. 38%, p = 0.03). ICU and hospital stays were shorter in the early mobilization group (10.4 vs. 14.2 days, p < 0.001; 18.5 vs. 24.1 days, p < 0.001). The early mobilization group had more ventilator-free days (20.3 vs. 14.7, p < 0.001). Mortality and readmission rates were similar between groups. Conclusion. Early mobilization significantly improves functional outcomes, reduces ICU and hospital length of stay, and lowers the incidence of delirium in ICU patients with severe COVID-19. These findings support incorporating early mobilization as standard practice in ICUs to enhance recovery outcomes.

Early Mobilisation Post-Thrombolysis is Safe and Improves Outcomes in Mild-Moderate Acute-Stroke Patients

Abstract Background Thrombolysis (tPA) is the delivery of a clot-lysing agent used in acute ischemic stroke, typically followed by ≥24-hour bed rest. This study aimed to compare the safety and effectiveness of early mobilisation (≤24 hours post-tPA) versus ≥24-hour bed rest in patients with mild-moderate stroke. Methods A literature review was conducted leading to the development of an early mobilisation protocol post-tPA. Retrospective (January-July 2023: pre-early mobilisation protocol) and prospective (July 2023-April 2024: post-early mobilisation protocol) data were analysed. Baseline demographics and outcomes were compared between the two groups. Primary outcome was physical function (Modified Rankin Scale (mRS) at hospital discharge. Secondary outcomes included adverse effects, length of stay (LOS) and discharge destination. Results 11 patients met the criteria for early mobilisation in both groups. There were no significant differences in age, the National Institutes of Health Stroke Scale (NIHSS) pre-tPA and mRS at baseline between the two groups (p>0.05). 8 patients in the early mobilisation protocol were male (72.73%), the median (IQR) age was 61 (54-78) years, and NIHSS was 6 (3-8) pre-tPA and 1 (0-2) post-tPA. Patients had a median (IQR) mRS score of 0 (0-0) pre-stroke and time to early mobilisation was 12 (12-17) hours. Patients in the early mobilisation group had significantly lower mRS on discharge (p=0.007), shorter LOS (Median (IQR) 5 (4-7) days, P=0.13) and higher rates of discharge directly home compared to those mobilised post ≥24-hour bed rest. No adverse effects of early mobilisation occurred. Conclusion Compared with 24-hour bed rest, early mobilisation for mild-moderate stroke patients was safe and associated with significantly better physical function.

Effects of early mobilization in elderly patients undergoing cardiac surgery.

Although early mobilization is associated with improved outcomes in postoperative cardiac patients, implementation of early mobilization in elderly patients is still a challenge. In this study, we aimed to design and assess an early mobilization program for cardiac rehabilitation. We conducted a clinical trial in elderly patients aged over 65years after coronary artery bypass graft surgery. Patients were randomly assigned to an early mobilization group (Group A) or a routine therapy group (Group B). Short-Form International Physical Activity Questionnaire (SF-IPAQ), to assessment balance Time Up and Go (TUG), to assessment functional capacity the 2-min walking test (2MWT) and the short physical performance battery (SPPB) were used as a reference to formulate and monitor the early mobilization regimen. A total of 100 patients were enrolled (n = 50 per group). The mean walking distance in Group A was significantly higher at 135.6 ± 9.29 than the mean walking distance in Group B which was lower at 123.4 ± 8.48. Also, the patients in Group B had a mean SF-IPAQ of 389.44 with an SD of 85.7, P < 0.001, whereas the mean SF-IPAQ amount in Group A was 556.16 with an SD of 91.47. In early mobilization group, a strong positive connection was indicated by the correlation coefficient of r = 0.957 between the amount of SF-IPAQ and 2 MWT and there was a significant negative association r = - 0.768 between 2MWT and TUG. Our study's findings suggest that early mobilization and functional exercises enhanced balance, functionality, and life quality for older cardiac patients.

Benefits of early mobilization after atrial fibrillation ablation in geriatrics over 75 years old: A retrospective comparative study

IntroductionDespite early mobilization has been proposed as an effective intervention to improve prognosis of patients in intensive care unit and other clinical settings, the benefits of it in patients with atrial fibrillation undergoing catheter ablation is still unknow. Method273 geriatric patients with atrial fibrillation underwent catheter ablation in our center were included in this retrospective cohort study, with 137 in early mobilization group and 136 in routine care group. ResultAfter in-hospital observation and 90-day follow-up, we found though patients undergoing early mobilization didn't suffer more post-procedural complications, early mobilization didn't either shorten or extend the length of hospital stay. The average score of EQ-5D visual analogue scale and EHRA symptom scale were significantly improved and less unscheduled outpatient visits were recorded in early mobilization group during 90-day follow-up. ConclusionEarly mobilization could be a safe and favorable intervention for patients underwent catheter ablation.

GET-UP Trial 1-year results: long-term impact of an early mobilization protocol on functional performance after surgery for chronic subdural hematoma.

Evidence on timing for mobilization after chronic subdural hematoma (cSDH) surgery is heterogeneous, and practices differ considerably among neurosurgical centers. The Impact of an Early Out-of-Bed Paradigm in Postoperative Outcomes of Chronic Subdural Hematomas: GET-UP Randomized Prospective Trial (GET-UP Trial) is a randomized clinical trial comparing a postoperative early mobilization protocol to bed rest. Previously reported results at clinical discharge and 1 month after surgery indicated a decreased risk of medical complications in the early mobilization group. Herein, the authors report outcomes at the 1-year follow-up. The GET-UP Trial is a prospective, randomized, unicentric, open-label study with an intention-to-treat primary analysis designed to evaluate the impact of an early mobilization protocol after burr hole craniostomy for cSDH on the occurrence of medical complications and functional outcomes. Between January 2019 and August 2021, a total of 208 patients were recruited and randomized to either an early mobilization group, in which patients began elevation of the head of the bed within the first 12 hours after surgery, or to a bed rest group, in which patients remained recumbent for 48 hours. Outcomes assessed at the 1-year follow-up included functional status as measured by the Glasgow Outcome Scale-Extended (GOSE) and repeat surgery for hematoma recurrence (surgical recurrence). A total of 203 patients completed 1 year of follow-up: 101 in the bed rest group and 102 in the early mobilization group. No significant baseline pre-randomization clinical differences were observed between the two management groups. At 1 year after surgery, a favorable functional outcome, defined as a GOSE score ≥ 5, was observed in 59 patients (58.4%) in the bed rest group and 78 (76.5%) in the early mobilization group (p = 0.006). Death occurred in 25 patients (24.8%) in the bed rest group and 16 (15.7%) in the early mobilization group (p = 0.108). Surgical recurrence was noted in 6 patients (5.9%) in the bed rest group and 7 (6.9%) in the early mobilization group (p = 0.788). Multivariate analysis showed an independent association between early mobilization and an increase in favorable functional outcomes (OR 2.006, 95% CI 1.076-3.739, p = 0.028). The GET-UP Trial is the first randomized clinical trial assessing the impact of mobilization strategies on medical complications after burr hole craniostomy for cSDH. Regarding functional results 1 year after surgery, early mobilization was associated with an improvement in functional outcomes without an increase in surgical recurrence. These findings support the preference for an early mobilization protocol in cSDH patients over mandatory bed rest strategies.

238 Quality of Life After Chronic Subdural Hematoma Surgery—GET-UP Randomized Clinical Trial's 1 Year Results

INTRODUCTION: Timing for mobilization after chronic subdural hematoma (cSDH) surgery is highly heterogeneous among neurosurgical centers around the world. Nonetheless, there is a scarcity of high-quality evidence addressing this question. METHODS: A total of 208 patients were randomized to either an early mobilization group (EMG), where mobilization is required within the first 12 hours post-op; or to a bed rest group (BRG) where they remain recumbent for 48 hours after surgery. All 208 patients were interviewed by telephone one year after surgery. A score of 16 or more in the Mini Mental State Examination was mandatory for study inclusion. Quality of life was assessed by applying the 36-Item Short Form Health Survey (SF-36). RESULTS: A total of 134 patients (73 in the EMG and 61 in the BRG) were included. EMG patients performed significantly better in six of the eight domains of SF-36 questionnaire. The mean scores obtained were, in the EMG and in the BRG, respectively, 73.4 and 61.7 in the Physical Functioning (p = 0.017); 88.6 and 75.8 in the Social Functioning (p = 0.004); 67.6 and 61.4 in Mental Health (p = 0.029); 87.4 and 78.6 in Emotional Performance (p = 0.036); 61.2 and 50.4 in Vitality (p = 0.011); and 58.5 and 47.1 in General Health (p = 0.007). In the two remaining dimensions, Physical Performance and Body Pain, results were also superior in the EMG but without statistical significance. Quality of life was negatively impacted by the occurrence of medical complications, with the Physical Performance domain reaching statistical significance (p = 0.016). CONCLUSIONS: GET-UP trial’s results argue strongly towards an early mobilization protocol, as this strategy leads to a significant improvement in the quality of life of patients after cSDH surgery.

Association Between Early Mobilization and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Propensity Score-Matched Study.

Early mobilization has been shown to promote functional recovery and prevent complications in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the efficacy of early mobilization in patients with aSAH remains unclear. This study aimed to investigate the association between early mobilization and functional outcomes in patients with aSAH. This multicenter retrospective study was conducted in Japan and included patients with aSAH who received physical therapy with or without occupational therapy from April 2014 to March 2019. The primary outcome was the modified Rankin Scale (mRS) score, with a favorable functional outcome defined as an mRS score of 0-2 and an unfavorable outcome with an mRS score of 3-5. Patients initiating walking training within 14days of aSAH onset were classified into the early mobilization group, whereas those initiating training after 14days were classified into the delayed mobilization group. Propensity score matching analysis was performed to assess the association between early mobilization and favorable outcomes. A total of 718 patients were screened, and 450 eligible patients were identified. Before matching, 229 patients (50.9%) were in the early mobilization group and 221 (49.1%) were in the delayed mobilization group. After matching, each group consisted of 122 patients, and the early mobilization group exhibited a higher proportion of favorable outcomes than did the delayed mobilization group (81.1% vs. 52.5%, risk difference 28.7%, 95% confidence interval 17.4-39.9, p < 0.001). This multicenter retrospective study suggests that initiating walking training within 14days of aSAH onset is associated with favorable outcomes.

Impact of Early Mobilization on Patients With Acute Ischemic Stroke Treated With Thrombolysis or Thrombectomy: A Randomized Controlled Trial

Background Early mobilization (EM) within 24 to 72 hours post-stroke may improve patients’ performance and ability. However, after intravenous thrombolysis (IVT) or mechanical thrombectomy (MT), the increased risk of hemorrhagic complications impacts the implementation of early out-of-bed mobilization. Few studies have investigated EM after IVT or MT for acute ischemic stroke (AIS), and its impact in these patients is unknown. Objective To investigate the effect of EM on AIS treated with IVT or MT.| Methods We recruited 122 patients with first AIS; 60 patients were treated with IVT, and 62 patients were treated with MT. For each IVT and MT cohort, the control groups received standard early rehabilitation, and the intervention groups received an EM protocol. The training lasted 30 minutes/day, 5 days/week until discharge. Main Outcomes Measures The effectiveness of the interventions was evaluated using the motor domain of the Functional Independence Measure (FIM-motor) and the Postural Assessment Scale for Stroke Patients (PASS) at baseline, 2-week, 4-week, and 3-month post-stroke, the Functional Ambulation Category 2-week post-stroke, and the total length of stay at the stroke center. Results Both IVT and MT treatment groups showed improved FIM-motor and PASS scores over time; however, only the IVT EM group had significantly improved FIM-motor performance within 1 month after stroke than the control group. Conclusion. An EM protocol with the same intervention time and session frequency per day as in the standard care protocol was effective in improving the functional ability of stroke patients after IVT.

Treatment strategies for simple elbow dislocation - a systematic review

BackgroundCurrent treatment concepts for simple elbow dislocation involve conservative and surgical approaches. The aim of this systematic review was to identify the superiority of one treatment strategy over the other by a qualitative analysis in adult patients who suffered simple elbow luxation.Study designA systematic review in accordance with the PRISMA guidelines and following the suggestions for reporting on qualitative summaries was performed. A literature search was conducted using PubMed and Scopus, including variations and combinations of the following keywords: elbow, radiohumeral, ulnohumeral, radioulnar, luxation, and therapy. Seventeen studies that performed a randomized controlled trial to compare treatment strategies as conservative or surgical procedures were included. Reviews are not selected for further qualitative analysis. The following outcome parameters were compared: range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand outcome measure (Quick-DASH), recurrent instability, pain measured by visual analog scale (VAS) and time to return to work (RW).ResultsEarly mobilization after conservative treatment strategies showed improved ROM compared to immobilization for up to 3 weeks after surgery with less extension deficit in the early mobilization group (16° ± 13°. vs. 19.5° ± 3°, p < 0.05), as well as excellent clinical outcome scores. Surgical approaches showed similar results compared to conservative treatment, leading to improved ROM (115 vs. 118 ± 2.8) and MEPS: 95 ± 7 vs. 92 ± 4.ConclusionConservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation. The surgical procedure provides similar outcomes compared to conservative treatment regarding MEPS and ROM for patients with slight initial instability in physical examination and radiographs. People with red flags for persistent instability, such as severe bilateral ligament injuries and moderate to severe instability during initial physical examination, should be considered for a primary surgical approach to prevent recurrent posterolateral and valgus instability. Postoperative early mobilization and early mobilization for conservatively treated patients is beneficial to improve patient outcome and ROM.

Effects of early mobilization within 48 hours of injury in patients with incomplete cervical spinal cord injury

Objective To investigate the effects of early mobilization within 48 h of injury on motor function and walking ability in patients with incomplete cervical spinal cord injury (SCI). Design A retrospective observational study. Setting Intensive care unit or high care unit of a university hospital emergency center. Participants Of 224 patients with SCI having American Spinal Injury Association impairment scale grades C and D, 158 consecutive patients hospitalized for at least 3 weeks after injury were included. Interventions Patients were categorized into two groups: an early mobilization group in which patients were mobilized within 48 h of injury and a delayed mobilization group in which they were mobilized after 48 h of injury. Outcome measures The upper extremity motor score (UEMS), lower extremity motor score (LEMS), and Walking Index for Spinal Cord Injury II (WISCI II) were compared using propensity score matching analysis. Results Of the 158 patients who met the eligibility criteria, 32 were matched between the groups. There was a significant difference in the change in LEMS from the initial assessment to the assessment 2 weeks postoperatively in the early mobilization group (median 9 points vs. 3 points, p < 0.05). There were no significant differences in UEMS or WISCI II. Conclusion Early mobilization within 48 h may improve lower extremity motor function in patients with acute incomplete cervical SCI.

Early versus delayed mobilization after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of efficacy and safety.

A central tenet of Enhanced Recovery After Surgery (ERAS) is evidence-based medicine. Survivors of aneurysmal subarachnoid hemorrhage (aSAH) constitute a fragile patient population prone to prolonged hospitalization within neurointensive care units (NICUs), prolonged immobilization, and a range of nosocomial adverse events. Potentially, well-monitored early mobilization (EM) could constitute a beneficial element of ERAS protocols in this population. Therefore, the objective was to summarize the available evidence on EM strategies in patients with aSAH. The authors retrieved prospective and retrospective studies that reported efficacy or safety data on EM (defined as EM in the NICU starting ≤ 7 days after ictus) versus delayed mobilization (DM) (any strategy that comparatively delayed mobilization) after aSAH and were published after January 1, 2000, in PubMed/MEDLINE, Embase, and the Cochrane Library. Random-effects meta-analysis was performed. Ten studies analyzing 1292 patients were included for quantitative synthesis, including 1 randomized, 1 prospective nonrandomized, and 8 retrospective studies. Modified Rankin Scale scores at discharge were not different between the EM and DM groups (mean difference [MD] [95% CI] -0.86 [-2.93 to 1.20] points, p = 0.41). Hospital length of stay in days was markedly reduced in the EM group (MD [95% CI] -6.56 [-10.64 to -2.47] days, p = 0.002). Although there was a statistically significant reduction in radiological vasospasms (OR [95% CI] 0.65 [0.44-0.97], p = 0.03), the reduction in clinically relevant vasospasms was nonsignificant (OR [95% CI] 0.63 [0.31-1.26], p = 0.19). The odds of shunting were significantly lower in the EM group (OR [95% CI] 0.61 [0.39-0.95], p = 0.03). The rates of mortality, pneumonia, and thrombosis were similar among groups (p > 0.05). Due to a lack of high-quality studies, vastly varying protocols, and resulting statistical clinical and statistical heterogeneity, the level of evidence for recommendations regarding EM in patients with aSAH remains low. The currently available data indicated that mobilization within the first 5 days after aneurysm repair was feasible and safe without significant excessive adverse events, that neurological outcome with EM was almost certainly not worse than with prolonged immobilization, and that there was likely at least some reduction in length of hospital stay. Radiological and clinical vasospasms were not more frequent-with signals even trending toward a decrease-in patients who mobilized early. Higher-quality studies and implementation of full ERAS protocols are necessary to evaluate efficacy and safety with a higher level of evidence and to guide practical implementation through increased standardization. Clinical trial registration no.: CRD42023432828 (www.crd.york.ac.uk/prospero).

Impact of an early mobilization protocol on the reduction of medical complications after surgery for chronic subdural hematoma: the GET-UP Trial.

Timing of mobilization after chronic subdural hematoma (cSDH) surgery is highly heterogeneous among neurosurgical centers. Past studies have suggested that early mobilization may reduce medical complications without increasing recurrence, but evidence remains scarce. The purpose of this study was to compare an early mobilization protocol with a 48-hour bed rest practice, with a focus on the occurrence of medical complications. The GET-UP Trial is a prospective, randomized, unicentric, open-label study with an intention-to-treat primary analysis designed to evaluate the impact of an early mobilization protocol after burr hole craniostomy for cSDH on the occurrence of medical complications and functional outcomes. A total of 208 patients were recruited and randomly assigned to either an early mobilization group where they began head-of-bed elevation within the first 12 hours after surgery and proceeded to sedestation, orthostatism, and/or walking as rapidly as tolerated, or to a bed rest group where they remained recumbent with a head-of-bed angle inferior to 30° for 48 hours after surgery. The primary outcome was the occurrence of a medical complication (defined as either an infection, seizure, or thrombotic event) after surgery and until clinical discharge. Secondary outcomes included length of stay measured from randomization to clinical discharge, surgical hematoma recurrence at clinical discharge and 1 month after surgery, and Glasgow Outcome Scale-Extended (GOSE) assessment at clinical discharge and 1 month after surgery. A total of 104 patients were randomly assigned to each group. No significant baseline clinical differences were observed before randomization. The primary outcome occurred in 36 (34.6%) patients included in the bed rest group and 20 (19.2%) in the early mobilization group (p = 0.012). At 1 month after surgery, a favorable functional outcome (defined as GOSE score ≥ 5) was observed in 75 (72.1%) patients in the bed rest group and 85 (81.7%) in the early mobilization group (p = 0.100). Surgical recurrence occurred in 5 (4.8%) patients in the bed rest group and 8 (7.7%) in the early mobilization group (p = 0.390). The GET-UP Trial is the first randomized clinical trial to assess the impact of mobilization strategies on medical complications after burr hole craniostomy for cSDH. Early mobilization was associated with a reduction in medical complications without a significant effect on surgical recurrence, compared with a 48-hour bed rest protocol.

The effects of early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis.

The effects of early mobilization (EM) on intensive care unit (ICU) patients remain unclear. A meta-analysis of randomized controlled trials was performed to evaluate its effect in mechanically ventilated adult ICU patients. We searched randomized controlled trials (RCTs) published in Medline, Embase, and CENTRAL databases (from inception to November 2022). According to the difference in timing and type, the intervention group was defined as a systematic EM group, and comparator groups were divided into the late mobilization group and the standard EM group. The primary outcome was mortality. The secondary outcomes were ICU length of stay, duration of mechanical ventilation (MV), and adverse events. EM had no impact on 180-day mortality and hospital mortality between intervention groups and comparator groups (RR 1.09, 95% CI 0.89-1.33, p = 0.39). Systemic EM reduced the ICU length of stay (LOS) (MD -2.18, 95% CI -4.22--0.13, p = 0.04) and the duration of MV (MD -2.27, 95% CI -3.99--0.56, p = 0.009), but it may increase the incidence of adverse events in patients compared with the standard EM group (RR 1.99, 95% CI 1.25-3.16, p = 0.004). Systematic EM has no significant effect on short- or long-term mortality in mechanically ventilated adult ICU patients, but systematic EM could reduce the ICU LOS and duration of MV.

Comparing the Impact of Early Versus Delayed Mobilization on Recovery Outcomes in Post-Surgical Patients: A Quantitative Analysis

Abstract Background: Early mobilization is increasingly advocated in postoperative care to enhance recovery outcomes. This study investigates the impact of early versus delayed mobilization on length of hospital stay, pain levels, functional capacity, incidence of complications, and patient satisfaction. Methods: A randomized controlled trial was conducted with 150 surgical patients divided into early and delayed mobilization groups. Data were collected on hospital stay duration, pain levels at 1 week and 1 month, functional capacity using the Functional Independence Measure (FIM), incidence of complications, and patient satisfaction scores. Results: The early mobilization group experienced a significantly shorter hospital stay (mean reduction of 2.5 days), lower pain levels at 1 week and 1 month, higher FIM scores at all follow-up points, and higher patient satisfaction scores. No significant differences were observed in the incidence of complications between the two groups. Conclusion: Early mobilization significantly improves postoperative recovery by reducing hospital stays, decreasing pain levels, enhancing functional capacity, and increasing patient satisfaction without increasing the risk of complications. These findings support the implementation of early mobilization protocols in surgical recovery plans.

Randomized Controlled Trial Comparing Early Mobilization vs Six Weeks of Immobilization in a Walking Cast Following Total Ankle Replacement

Rehabilitation for patients after total ankle replacement traditionally involves weeks of immobilization in a plaster cast followed by progressive mobilization. In a small randomized trial, we compared teh outcomes of patients who received a 3-component cementless, unconstrained, mobile-bearing prosthesis and were initially immobilised in a plaster cast for 6 weeks to thoese who received the same prosthesis but were allowed to mobilise early. Gait, clinical, patient-reported, and radiologic outcomes were measured. The study included 20 patients, 10 in the plaster cast group and 10 in the early mobilization group, and the demographics of the groups did not differ significantly. All patients were followed-up for 24 months. There were no significant differences between the 2 groups 2 years after surgery in ankle dorsiflexion, spatiotemporal gait characteristics, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, Timed Up and Go Test times, WOMAC (pain, stiffness, function) scores, SF-36 (quality-of-life) scores, or patient satisfaction (pain relief, daily-living, recreational activities, and overall) (all p > .05). Bone mineral density decrease of the medial malleolus and increase at middle tibia, calculated with DEXA scans, was significantly better in early mobilization than plaster cast group at one and 2 years postoperatively, but this was also the case preoperatively. The lack of differences in outcomes suggests that early ankle mobilization may be a safe and reliable method to enhance recovery following ankle arthroplasty with a 3-component cementless, unconstrained, mobile-bearing prosthesis. Compared to traditional plaster casting, patients who are engaged in early mobilization after arthroplasty may enjoy similar functional, mobility, quality-of-life, pain relief, activity level, and satisfaction outcomes.

Early Active Mobilization during Mechanical Ventilation in the ICU

BackgroundIntensive care unit (ICU)–acquired weakness often develops in patients who are undergoing invasive mechanical ventilation. Early active mobilization may mitigate ICU-acquired weakness, increase survival, and reduce disability.MethodsWe randomly assigned 750 adult patients in the ICU who were undergoing invasive mechanical ventilation to receive increased early mobilization (sedation minimization and daily physiotherapy) or usual care (the level of mobilization that was normally provided in each ICU). The primary outcome was the number of days that the patients were alive and out of the hospital at 180 days after randomization.ResultsThe median number of days that patients were alive and out of the hospital was 143 (interquartile range, 21 to 161) in the early-mobilization group and 145 days (interquartile range, 51 to 164) in the usual-care group (absolute difference, −2.0 days; 95% confidence interval [CI], −10 to 6; P=0.62). The mean (±SD) daily duration of active mobilization was 20.8±14.6 minutes and 8.8±9.0 minutes in the two groups, respectively (difference, 12.0 minutes per day; 95% CI, 10.4 to 13.6). A total of 77% of the patients in both groups were able to stand by a median interval of 3 days and 5 days, respectively (difference, −2 days; 95% CI, −3.4 to −0.6). By day 180, death had occurred in 22.5% of the patients in the early-mobilization group and in 19.5% of those in the usual-care group (odds ratio, 1.15; 95% CI, 0.81 to 1.65). Among survivors, quality of life, activities of daily living, disability, cognitive function, and psychological function were similar in the two groups. Serious adverse events were reported in 7 patients in the early-mobilization group and in 1 patient in the usual-care group. Adverse events that were potentially due to mobilization (arrhythmias, altered blood pressure, and desaturation) were reported in 34 of 371 patients (9.2%) in the early-mobilization group and in 15 of 370 patients (4.1%) in the usual-care group (P=0.005).ConclusionsAmong adults undergoing mechanical ventilation in the ICU, an increase in early active mobilization did not result in a significantly greater number of days that patients were alive and out of the hospital than did the usual level of mobilization in the ICU. The intervention was associated with increased adverse events. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; TEAM ClinicalTrials.gov number, NCT03133377.)

Impact of early mobilization on the duration of delirium in elderly hospitalized patients: A retrospective cohort pilot study.

Development of delirium during hospitalization impairs the activities of daily living in elderly hospitalized patients. In clinical practice, early mobilization from bed is recommended to reduce delirium incidence and hospitalization stay. However, the effects of early mobilization on elderly inpatients with delirium have not been established yet. The aim of this study was to investigate the association between early mobilization and the duration of delirium in elderly inpatients with delirium. This retrospective cohort pilot study examined 45 participants (23 males, 22 females; mean age: 84.5 ± 6.6 years), who developed delirium during hospitalization. Of the participants, 28 were surgically treated and 17 were non-surgically treated. We classified early or delayed mobilization based on the median number of days until the start of mobilization and compared after propensity score matching to adjust for baseline characteristics. Additionally, we examined the correlation between the number of days until the start of mobilization and the duration of delirium. The duration of delirium was significantly shorter in the early mobilization group, particularly in terms of sitting on the bed and wheelchair use than that in the delayed mobilization group {median: 4.0 [interquartile range (IQR): 2.0-6.0] vs 8.0 [IQR: 7.0-14.5] days, P = .013; median: 3.0 [IQR: 2.0-5.5] vs 11.0 [IQR: 7.5-14.5] days, P = .004, respectively}. Moreover, the duration of delirium significantly positively moderate correlated with the time until the start of sitting on the bed and wheelchair use (Spearman r = 0.527; P = .012, Spearman r = 0.630; P = .002, respectively). The results of this study suggest that early mobilization from sitting on the bed or wheelchair use after hospitalization or surgery may shorten the duration of delirium. Because the sample size of this pilot study is small, careful interpretation is needed, and further research is warranted.

Clinical assessment of early mobilization after head and neck free flap reconstruction: A retrospective case-control study.

We examined whether there were any differences in perioperative complications between patients who mobilized on the first postoperative day (early mobilization) and those who mobilized on the second postoperative day after head and neck reconstruction using free tissue transfer. In the control group (n=74), patients were instructed to mobilize on the second postoperative day (April 2019-March 2020), while in the early mobilization group (n=101), patients were instructed to mobilize on the first postoperative day (April 2020-March 2021). Mobilization was defined as maintaining a standing position or walking. Clinical data were collected from medical records and retrospectively analyzed. There were no significant differences in clinical background factors, with the exception of intraoperative blood loss volume. The proportion of patients who successfully mobilized on the day of instruction was significantly lower in the early mobilization group (89.1% vs. 98.7%). One case of total flap loss and four cases of partial flap loss occurred in the control group, and three cases of partial flap loss occurred in the early mobilization group. There was no significant difference in partial or total flap loss between the two groups. There were no significant differences in other perioperative complications (wound infection, postoperative bleeding, and delirium) between the two groups. The median postoperative hospital stay was 24.5 and 25.0 days in the control and early mobilization groups, respectively. In this study, early mobilization on the first day after head and neck free flap reconstruction was safe and feasible.

LIMPER trials: immediate mobilisation versus 2-week cast immobilisation after distal radius fracture treated with volar locking plate – a study protocol for a prospective, randomised, controlled trial

IntroductionOpen reduction and internal fixation with volar locking plate has become the most common fixation method in the treatment of unstable distal radius fracture (DRF). There is, however, no consensus...