Early enforced mobilisation following surgery for gastrointestinal cancer: feasibility and outcomes

Abstract Objectives To evaluate the feasibility and outcomes of early enforced mobilisation following surgery for gastrointestinal cancer. Design Feasibility study with a separate-sample pre–post-test design. Setting Surgical gastrointestinal ward. Participants Patients with various types of gastroi...

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Bibliographic Details
Published in:Physiotherapy 2016-03, Vol.102 (1), p.103-110
Main Authors: van der Leeden, M, Huijsmans, R, Geleijn, E, de Lange-de Klerk, E.S.M, Dekker, J, Bonjer, H.J, van der Peet, D.L
Format: Article
Language:English
Subjects:
Adult
Aged
Early Ambulation - methods
Female
Gastrointestinal cancer
Gastrointestinal Neoplasms - surgery
Humans
Length of hospital stay
Length of Stay
Male
Middle Aged
Outcome
Physical Medicine and Rehabilitation
Physical Therapy Modalities
Postoperative Complications - epidemiology
Postoperative Complications - prevention & control
Postoperative mobilisation
Postoperative pulmonary complications
Prospective Studies
Surgery
Walking
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Summary:Abstract Objectives To evaluate the feasibility and outcomes of early enforced mobilisation following surgery for gastrointestinal cancer. Design Feasibility study with a separate-sample pre–post-test design. Setting Surgical gastrointestinal ward. Participants Patients with various types of gastrointestinal cancer, before and after implementation of postoperative enforced mobilisation ( n = 55 and n = 61, respectively). Intervention The enforced mobilisation protocol included structured mobilisation by a nurse and walking supervised by a physiotherapist, starting within 24 hours of surgery. Main outcome measures The enforced mobilisation protocol was deemed to be feasible if at least 50% of patients were able to walk the scheduled distance on postoperative day 1. Pre- and postimplementation differences in postoperative pulmonary complications (PPCs), length of hospital stay (LOS) and re-admission rate were analysed using regression analyses, adjusting for relevant co-variables. Results In the various surgical groups, between 48% and 56% of patients were able to walk the scheduled distance on postoperative day 1, which was regarded as feasible. However, none of the patients who had undergone oesophageal resection were able to walk on postoperative day 1. Excluding these patients from the analyses, a significant decrease in PPCs was found (odds ratio 0.08, 95% confidence interval 0.010 to 0.71, P = 0.023) following implementation of enforced mobilisation. Differences in LOS and re-admission rate were not significant. Conclusions Early enforced mobilisation seems to be feasible in patients following surgery for gastrointestinal cancer, except for those undergoing oesophageal resection. The occurrence of PPCs was reduced after implementation of enforced mobilisation. Further research is needed to confirm these results.
ISSN:0031-9406
1873-1465
DOI:10.1016/j.physio.2015.03.3722