Early Mobilization Protocol Research Articles

PP517 Topic: AS23–Rehabilitation: Early Mobilization/Interdisciplinary Care/Developmental Care/Other: FEASIBILITY AND SHORT-TERM IMPACT OF NURSE-DRIVEN EARLY MOBILIZATION PROTOCOL IN A PICU OF A LOW MIDDLE INCOME COUNTRY: A QUALITY IMPROVEMENT STUDY

PP517 Topic: AS23–Rehabilitation: Early Mobilization/Interdisciplinary Care/Developmental Care/Other: FEASIBILITY AND SHORT-TERM IMPACT OF NURSE-DRIVEN EARLY MOBILIZATION PROTOCOL IN A PICU OF A LOW MIDDLE INCOME COUNTRY: A QUALITY IMPROVEMENT STUDY

The effectiveness of early mobilisation on physical function in patients after heart valve surgery: a systematic review

Background/Aims Literature suggests that early mobilisation, defined as the initiation of physical activity within 48 hours following surgery, improves outcomes after cardiac surgery. This systematic review assessed the effectiveness of early mobilisation on physical function and other outcomes, including length of hospital stay and cost following heart valve surgery. Methods The Physiotherapy Evidence Database, MEDLINE, EMBASE, CINAHL and Cochrane Library were systematically searched from inception until May 2022 using relevant key words. Randomised controlled trials comparing early mobilisation and usual care for patients who had received heart valve surgery were included in the review. Methodological quality was assessed using the Physiotherapy Evidence Database scale and risk of bias using the Cochrane Risk of Bias 2 tool. The data were narratively synthesised. Results The search identified 210 articles, with 98 remaining after duplicates were removed. Upon screening for eligibility, nine articles were assessed in full and three randomised controlled trials involving 161 patients were included in the review. Early mobilisation protocols varied across trials. Two trials (n=124) reported significantly greater improvement in physical function with early mobilisation compared to usual care, including handgrip strength (P=0.001). One study (n=41) found early mobilisation significantly reduced the length of hospital stay (P=0.000), in-hospital care costs (P=0.000) and intensive care unit stay (P=0.000) compared to usual care. Methodological quality scores ranged from six to nine on the Physiotherapy Evidence Database scale. The risk of biased judgement was ‘low’ in one study and ‘some concerns’ in two studies. Conclusions Early mobilisation may improve physical function and reduce hospital and intensive care unit stays after heart valve surgery. However, differences in protocols and limited studies indicate further high-quality research is needed, particularly regarding cost-effectiveness. Establishing clear early mobilisation protocols could enhance recovery in this population. Implications for practice Early mobilisation may require the coordinated effort of a multidisciplinary team of physiotherapists, nurses and possibly other medical professionals. For its seamless and effective implementation, it is essential to understand whether this intervention falls under the domain of physiotherapists or requires broader team collaboration. Given these complexities, strategies targeting early mobilisation that balance both safety and resource considerations are advised to improve physical function after heart valve surgery, especially among patients who are frail.

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.

Surgical or non-operative treatment of acute Achilles tendon rupture : What does the current literature say?

The Achilles tendon is the strongest tendon in humans and is frequently injured, especially in the physically active young to middle-aged population. An increasing frequency of Achilles tendon ruptures (ATR) has been reported in several studies. However, there is no international consensus regarding possible non-operative (N-OP) or operative (surgical) treatment (OP). The aim of this article is to semi-quantitatively compare both treatment options for ATR by analyzing the results reported in the literature. For this purpose, relevant categories were identified, and the literature was then evaluated in aPubMed analysis. Tenmeta-analyses and twocost analyses were included. The data was extracted according to the categories and evaluated comparatively. OP and N‑OP for acute ATR can lead to equally good restitution of clinical function if early functional rehabilitation is applied. The lower re-rupture rate is an advantage of OP, whereas the lower general complications speak in favor of N‑OP. The minimally invasive or percutaneous surgical technique (M-OP) appears to be advantageous over the open surgical technique (O-OP), although studies show an increased rate of lesions of the sural nerve. There is no consensus regarding the superiority of OP or N‑OP for acute ATR, as several studies conducted since the introduction of early mobilization protocols have shown similar results for these two interventions. Results and complications of M‑OP and O‑OP are also comparable. Considering the available data on the various surgical procedures, the authors prefer the M‑OP technique with adequate sural nerve protection for repair of acute ATR, combined with an early mobilization protocol.

Gestational Diabetes in Women with Fetal Spina Bifida Repair-Influence of Perioperative Management.

Background/Objectives: Fetal spina bifida (fSB) is the most common neural tube defect, and intrauterine repair has become a valid treatment option for selected cases. If fSB repair is offered, the ideal time for surgery is from 24 to 26 gestational weeks (GWs). The preoperative steroids for lung maturation and preoperative tocolytics that are administered are known to increase the prevalence of gestational diabetes (GD), which normally occurs in about 10-15% of all pregnant women. This study assessed the prevalence, possible influencing factors, and consequences on the course of pregnancy regarding GD in this cohort. Methods: Between 2010 and 2022, 184 fSB cases were operated. Those patients operated on after 24 0/7 GWs received steroids before surgery. All the patients received tocolysis, and an oral glucose tolerance test was performed between 26 and 28 GWs at least 7 days after steroid administration. In 2020, we established an early postoperative mobilization protocol. The perioperative management procedures of those patients with and without GD were compared to each other, and also, the patients treated according to the early mobilization protocol were compared to the remaining cohort. Results: Nineteen percent were diagnosed with GD. Corticosteroids were administered in 92%. Neither the corticoid administration nor the interval between the administration and glucose tolerance test was different in patients with or without GD. Further, 99.5% received postoperative tocolytics for at least 48 h. The women with GD had significantly longer administration of tocolytics. The length of stay (LOS) was higher in those patients with GD. The gestational age (GA) at delivery was significantly lower in the cohort with GD. In the early mobilized group, we found a significantly higher GA at delivery (37.1 GWs vs. 36.2 GWs, p = 0.009) and shorter LOS (p < 0.001), and their GD rate was lower (10% vs. 20%), although not statistically significant. Conclusions: The GD incidence in the women after fSB repair was higher than in the usual pregnant population. Early mobilization, rapid tocolytics decrease, and shorter LOS could benefit the pregnancy course after fSB repair and may decrease the risk for GD in this already high-risk cohort without increasing the risk for preterm delivery.

Multiprofessional perceptions and barriers to early mobilization in intensive care: a study at a university hospital

INTRODUCTION: Hospitalization often causes mobility difficulties and hinders daily activities. Progressive mobilization of patients in intensive care units (ICUs) is safe and linked to better clinical and functional outcomes. OBJECTIVE: To assess the perception of a multidisciplinary team in the ICUs of a university hospital regarding early mobilization (EM). METHODS: A prospective observational study was conducted using data collected from professionals and students in the ICU of Clementino Fraga Filho University Hospital at the Federal University of Rio de Janeiro between June and December 2019. Data on EM perception were collected using a questionnaire. Descriptive statistics and Fisher's exact tests were used to analyze the differences between the professional categories. RESULTS: In comparison to physiotherapists (88%), a smaller percentage of physicians (37.5%) and nurses (50%) reported that patients on mechanical ventilation (MV) are mobilized within 48 hours (P&lt;0.05). Additionally, a smaller percentage of physicians and nurses reported that their workload was sufficient to mobilize patients at least once a day (62.5% vs. 62.5% vs. 96%; P&lt;0.05). Physiotherapists reported more frequently than physicians that “patients undergoing procedures” were a barrier (57.7% vs. 18.7%; P&lt;0.05). Conversely, regarding mechanical ventilation (MV), physicians identified this barrier more frequently (43.7% vs. 7.7%; P&lt;0.05). There was overall agreement on the benefits of EM (&gt;80%), with the main perceived barriers being the availability of professionals (58%), the clinical condition of patients (55%) and patients undergoing procedures (45%). CONCLUSION: In a university hospital without an established EM protocol, the multidisciplinary team showed satisfactory knowledge and perceptions of EM. However, creating institutional protocols and guidelines is essential to engage multidisciplinary teams in implementing EM and overcoming barriers.

One-day surgery is safe and effective in unicompartmental knee arthroplasty: A prospective comparative study at 1 year of follow-up.

To compare the outcomes and complications of two perioperative protocols for the management of patients who underwent medial unicompartmental knee arthroplasty (UKA): 24 h (1-day surgery [OS]) versus 72 h (enhanced recovery after surgery [ERAS]) of the length of hospital stay (LOS). In our hypothesis, the reduction of the LOS from 3 to 1 day did not influence the outcomes and complications. A total of 42 patients (21 in each group) with isolated anteromedial knee osteoarthritis and meeting specific criteria were prospectively included in the study. Clinical outcomes included Knee Society Score (KSS) and Forgotten joint score while pain evaluation was performed using a Visual Analogue Scale (VAS). Functional outcomes were assessed measuring the knee range of motion (ROM) while radiographic outcomes were evaluated measuring the amelioration of the varus deformity through the hip-knee-ankle angle (HKA). Clinical and functional outcomes did not significantly differ between the two groups. Complications occurred in 9.5% of OS and 4.7% of ERAS group patients. Significant improvements in knee ROM, VAS pain, KSS and HKA angle were observed postsurgery, with no significant differences between groups except in KSS expectations and function trends. The OS protocol is safe and effective and LOS, in a well-defined fast-track protocol, did not significantly impact clinical and functional outcomes. OS may lead to reduced hospitalisation costs and potential reductions in complications associated with prolonged stays, benefiting both patients and healthcare facilities. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings. Early mobilisation and rehabilitation protocols are key components of successful patient recovery following UKA procedures. Level II.

Effect of Early Mobilization and Bed Positioning on Mobility among Patients with Traumatic Brain Injury

Background: Traumatic brain injury is defined as the disturbance in the function of the brain , or indication of pathology of brain, by the application of an exterior bodily force. Early mobilization exercises are explained as physiotherapy exercises of altering degree that are clinically safe and accurate developmentally started within 2 to 3 days of admission in neurological ICU. This early mobilization exercises helps in improving TBI patients recovery. Objective: The purpose of this study is to validate and evaluate the effect of early mobilization and bed positioning on mobility among patients with traumatic brain injury. Methods: This quasi-experimental study included 28 TBI patients. This study was conducted at general hospital, Lahore, and Jinnah hospital Lahore. Early mobilization and bed positioning therapies protocol were performed for 6 weeks. There were three sessions per week. Each session was 30 minutes. Mobilization scale and Norton scale were used as evaluation parameters before and after 6 weeks. Results: The data’s regularity was assessed by the Shapiro-Wilks test. Following statistical analysis, the regimen for early mobilization and bed positioning therapy’s efficacy for all examined variables was confirmed. The scores on early mobilization and Norton scales differ significantly. Conclusion: The results suggested that early mobilization and bed positioning therapies has improved mobility in TBI patients. This therapy protocol has also improved the TBI patients’ quality of life. Keywords: Bed positioning, Mobility and Traumatic brain injury.

Lack of Consensus on the Management of Medial Collateral Ligament Tears in the Setting of Concomitant Anterior Cruciate Ligament Injury: A Critical Analysis.

» There is no clear agreement on the optimal timing or superior type of fixation for medial collateral ligament (MCL) tears in the setting of anterior cruciate ligament (ACL) injury.» Anatomic healing of medial knee structures is critical to maintain native knee kinematics, supported by biomechanical studies that demonstrate increased graft laxity and residual valgus rotational instability after ACL reconstruction (ACLR) alone in the setting of concomitant ACL/MCL injury.» Historically, most surgeons have favored treating acute combined ACL/MCL tears conservatively with MCL rehabilitation, followed by stress radiographs at 6 weeks after injury to assess for persistent valgus laxity before performing delayed ACLR to allow for full knee range of motion, and reduce the risk of postoperative stiffness and arthrofibrosis.» However, with the advancement of early mobilization and aggressive physical therapy protocols, acute surgical management of MCL tears in the setting of ACL injury can have benefits of avoiding residual laxity and further intra-articular damage, as well as earlier return to sport.» Residual valgus laxity from incomplete MCL healing at the time of ACLR should be addressed surgically, as this can lead to an increased risk of ACLR graft failure.» The treatment of combined ACL/MCL injuries requires an individualized approach, including athlete-specific factors such as level and position of play, timing of injury related to in-season play, contact vs. noncontact sport, and anticipated longevity, as well as consideration of the tear pattern, acuity of injury, tissue quality, and surgeon familiarity with the available techniques.

Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial.

Traumatic brain injury (TBI) is a major cause of neurodisability worldwide, with notably high disability rates among moderately severe TBI cases. Extensive previous research emphasizes the critical need for early initiation of rehabilitation interventions for these cases. However, the optimal timing and methodology of early mobilization in TBI remain to be conclusively determined. Therefore, we explored the impact of early progressive mobilization (EPM) protocols on the functional outcomes of ICU-admitted patients with moderate to severe TBI. This randomized controlled trial was conducted at a trauma ICU of a medical center; 65 patients were randomly assigned to either the EPM group or the early progressive upright positioning (EPUP) group. The EPM group received early out-of-bed mobilization therapy within seven days after injury, while the EPUP group underwent early in-bed upright position rehabilitation. The primary outcome was the Perme ICU Mobility Score and secondary outcomes included Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), the length of stay in the intensive care unit (ICU), and duration of ventilation. Among 65 randomized patients, 33 were assigned to EPM and 32 to EPUP group. The EPM group significantly outperformed the EPUP group in the Perme ICU Mobility and FIM-motor scores, with a notably shorter ICU stay by 5.9days (p < 0.001) and ventilation duration by 6.7days (p = 0.001). However, no significant differences were observed in PhAs. The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI. Our study's results support further investigation of EPM through larger, randomized clinical trials. Clinical trial registration ClinicalTrials.gov NCT04810273 . Registered 13 March 2021.

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.

Mobilizing Progress: A Comprehensive Review of the Efficacy of Early Mobilization Therapy in the Intensive Care Unit.

Early mobilization therapy has emerged as a crucial aspect of intensive care unit (ICU) management, aiming to counteract the detrimental effects of prolonged immobility in critically ill patients. This comprehensive review examines the efficacy of early mobilization therapy in the ICU setting, synthesizing evidence from clinical trials, meta-analyses, and guidelines. Key findings indicate that early mobilization is associated with numerous benefits, including reduced muscle weakness, a shorter duration of mechanical ventilation, decreased ICU and hospital length of stay, and improved functional outcomes. However, safety concerns, staffing limitations, and patient-specific considerations pose significant barriers to widespread adoption. Despite these challenges, early mobilization is important for improving ICU patient outcomes. This review underscores the critical need for continued research and implementation efforts to optimize early mobilization protocols, address remaining challenges, and expand access to this beneficial therapy. By working collaboratively to overcome barriers and prioritize early mobilization, healthcare providers can enhance the quality of care and improve outcomes for critically ill patients in the ICU.

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.

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.

Abstract WP33: Impact of Early Mobilization on Length of Stay in Acute Ischemic Stroke

Background: IV rt-tPA is standard of care in patients presenting within 4.5 hours of acute ischemic stroke (AIS) symptom onset. Despite its short half-life, concerns regarding the safety of early mobilization remain, which may delay patients’ time to rehabilitation evaluation. We previously demonstrated the safety of early mobilization, using stratification based on stroke severity. This study aims to compare time from mobility order to PT/OT evaluation and total length of stay between patients whose mobility orders were congruent with institutional guidelines to those with incongruent orders. Methods: This is a retrospective case-cohort study of AIS patients who received IV tPA and/or mechanical thrombectomy (MT), admitted to our center April 2018 to December 2019. Prior to this, a 24 hour bedrest protocol post-rtPA was in place. In April of 2018, a new mobility protocol was established stratifying bedrest time following tPA and/or MT to 1, 6, or 8 hours, based on NIHSS and clinical stability. All patients in this cohort (N=524) should have been assigned the new mobility protocol. For patients receiving both tPA and MT, the mobility assignment for thrombectomy was assessed. 37 patients were excluded from analysis due to missing data points. Results: A total of 384 patients received tPA only, with 89% (n=354) receiving congruent orderset. 59 patients received tPA and MT, and 74 received MT only. Mean LOS days for tPA only with congruent orderset was 5.33 + 5.76 (n=350) vs. 6.45 + 6.06 (n=55) with incongruent orders. Mean LOS days for MT only with congruent orders was 10.03 + 6.42 (n=58) vs. 10.28 + 7.64 (n=57) with incongruent orders. Mean time in hours from PT/OT order to evaluation for tPA only with congruent orders was 17.72 + 13.01 (n=341) vs. 32.63 + 29.45 (n=41) with incongruent orders. For MT only patients with a congruent orderset, mean hours from PT/OT order to evaluation was 33.74 + 16.91 (n=54), and 50.7 + 34.12 (n=47) for incongruent orders. Conclusions: There was an increase in both PT/OT order to evaluation time and total LOS for patients with incorrect orders. Following the early mobilization protocol leads to an earlier PT/OT evaluation and disposition.

The Effects of Early Mobilization Protocol on Pre and Post Operative Functional Performance for Individuals with Post Abdominal Surgery

Background: The post surgical period of abdominal incision was accompanied with respiratory muscle dysfunctionand diminished physical capability. Limited upright mobilisation, exhaustion, and restricted lung abnormalities,among other functional issues, are linked to the early postoperative days. Improving pre-operative levels ofphysical functioning in individuals might be beneficial for post operative outcome.Aim: Aim of the study was to find out on which post-operative day the abdominal surgery participants get to thesame functional status as pre-operative status.Method: 40 Individuals hospitalized for abdominal surgery at Saveetha Medical College and Hospital werechosen for the study based on the inclusion and exclusion criteria. The selected participants were treated withdiaphragmatic breathing exercise, Incentive spirometry, thoracic expansion exercise, splinted coughing technique,active range of motion exercise for upper extremity and lower extremity for pre-operative abdominal surgeryparticipants. Post operative participants were treated with physiotherapy from POD 1 till the time their functionalstatus become same as the pre-operative status. Six- minute walk test, hospital anxiety and depression scale wereused in this study. Their scores were calculated and analysed.Result: Similar pre-operative mean (365.25±25.92) was attained at POD-7 (350.75±25.46). Day of POD-5, the HADSscore was normal (0 to7) in depression.Conclusion: This study shows the post-operative status is attained back on POD-7 with using 6MWT. Depressionwas relieved at POD-5 with a value of mean and standard deviation in HADS.

THE EFFECT OF IN-BED LEG CYCLING EXERCISES ON MUSCLE STRENGTH IN PATIENTS WITH INTENSIVE CARE UNIT-ACQUIRED WEAKNESS: A SINGLE-CENTER RETROSPECTIVE STUDY.

To examine the effect of in-bed leg cycling exercise on patients with intensive care unit-acquired weakness (ICU-AW). Single-center retrospective study. Patients admitted to the ICU between January 2019 and March 2023 were enrolled in the ergometer group, and those admitted to the ICU between August 2017 and December 2018 were enrolled in the control group. The ergometer group performed in-bed leg cycling exercises 5 times per week for 20 min from the day of ICU-AW diagnosis. Furthermore, the ergometer group received 1 early mobilization session per day according to the early mobilization protocol, whereas the control group received 1 or 2 sessions per day. The number of patients with recovery from ICU-AW at ICU discharge and improvement in physical functions were compared. Significantly more patients in the ergometer group recovered from ICU-AW than in the control group (87.0% vs 60.6%, p = 0.039). Regarding physical function, the ergometer group showed significantly higher improvement efficiency in Medical Research Council sum score (1.0 [0.7-2.1] vs 0.1 [0.0-0.2], p < 0.001). In-bed leg cycling exercise, in addition to the early mobilization protocol, reduced the number of patients with ICU-AW at ICU discharge.

Implementation of an early mobility protocol in the neuroscience ICU

Abstract &#x0D; Background: Early mobility is a safe and effective intervention to improve patient outcomes in the neuroscience intensive care unit (ICU). However, mobilization of patients in a neuroscience ICU within an academic medical center was suboptimal, with less than 36% of patients achieving their highest level of mobility.&#x0D; Aim: The purpose of the quality improvement project was to develop and implement a multidisciplinary early mobility protocol, including a safety-screening tool.&#x0D; Methods: Iterative Plan-Do-Study-Act cycles were implemented from April to August 2022. The screening tool assisted nurses in assessing the patient’s eligibility for early mobilization. A mobility section addressing patient-specific mobility screening, barriers to mobility, and a daily mobility plan was added to the provider note templates. Baseline data were collected from September to November 2021; post-implementation data were collected from April to August 2022.&#x0D; Results: There was a reduction in the mean time between admission to the first documented out of bed activity from 3.24 to 2.01 days, p=.061. The mean number of documented out of bed activities significantly increased from 6.13 to 8.35, p = .002. Hospital length of stay significantly decreased from 19.8 to 12.42 days, p=.006.&#x0D; Conclusions: Implementing an early mobility screening tool and protocol in the neuroscience ICU increased mobility for patients with neurological diagnoses. Other hospitals should consider implementing a similar process to help improve patient outcomes.

Perceived dyspnea and experience of hospitalized patients with acute decompensated heart failure undergoing an early MObilization protocol with immersive Virtual rEality: MOVE study protocol for a parallel superiority randomized clinical trial

BackgroundImmersive virtual reality (VR) is an innovative strategy for inpatient rehabilitation programs. Using immersive VR in early mobilization protocols has not yet been investigated in the setting of hospitalized patients with acute decompensated heart failure (ADHF), especially to improve perceived dyspnea, a common symptom of heart failure (HF).MethodsThis is a single-center parallel superiority randomized clinical trial. The study will be conducted at a public teaching hospital in Brazil from January 2023 to January 2024. The sample will include adult patients with ADHF hospitalized for at least 24 h, randomly assigned in a 1:1 ratio to the control (standard early mobilization protocol conducted in the intensive care unit (ICU)) or intervention group (the same standard early mobilization protocol but associated with immersive VR). The primary outcome will be assessing perceived dyspnea, and the secondary outcome will be assessing patient experience.DiscussionUsing immersive VR in early mobilization protocols in the ICU is expected to improve perceived dyspnea in patients with ADHF as well as patient experience regarding care. This study has the potential to increase patient adherence to early mobilization protocols in the setting of ADHF as well as to promote a positive patient experience. Filling this gap could promote the rational incorporation of technologies in health care.Trial registrationThis study protocol is in its first version. ClinicalTrials.gov NCT05596292. Registered on 1 December 2022.

Postoperative Management Early Active Mobilization of Extensor Tendon Repair at Zone (V-VII)

Background: The extensor tendons are particularly vulnerable to trauma because their superficial location in a clenched fist, the thin mobile subcutaneous tissue offers little protection, and lacerations of the extensor tendons are common over joints that are easily exposed to contamination. Objective: To assess the evaluation of the postoperative early active mobilization protocol of extensor tendon repair at zone (V-VII). Methods: In this prospective study was carried out at Orthopedic Dept., 250 Bed General Hospital, Kishoreganj, Bangladesh from January to June 2023. Total 40 cases of fresh injury of extensor tendon at zone V to VII were treated. A protocol of early active mobilization was undertaken, using an easy to follow rehabilitation plan. Routine history taking with details of the injury, the object causing the injury, the dominant hand and the position during the injury, Physical examination, included the zone, and the possible tendons involved together with any associated injury. Results: Forty patients of fresh extensor tendon injuries were included in this study, their ages ranged from 20 to 55 years. There were 33 males (82.5%) and 7 females (17.5%). The dominant hand was involved in 29 of patients (72.5%). The nature of injuries was sharp cut in 34 patients (85%), with crush injuries in 6 patients (15%). The most common site of injuries was zone VI, VII and zone V respectively, and the most common tendon injured was EDC, EI, and EDM. Only 7 patients (17.5%) had single tendon injury, While 33 patients (82.5%) had multiple tendon injuries. At the end of the 6th weeks post operatively, the overall outcome result are summarized. Conclusion: The early mobilization of repaired extensor tendon reduces the formation of adhesion as compared to rigid immobilization. We recommend the use of this protocol following extensor tendon repair in the hand at zone V, VI, and VII in cooperative patient. It will give fairly acceptable results.