Download 1 Table 1. Safety of Mobilizing Hospitalized Adults Author Study

1
Table 1. Safety of Mobilizing Hospitalized Adults
Author
Study design
Population
Objective
Conclusion
Bernhardt
et al.
(2008)
Prospective,
open,
randomized,
controlledtrial, blinded
outcome
assessment
Stroke patients
(n=71)
To test whether a very
early rehabilitation
protocol, with a focus
on mobilization, was
safe and feasible to
administer across
multiple sites
No difference in safety
measures between the
standard care group and the
early mobilization group
among stroke patients.
Junger et
al. (2006)
Randomized
study
DVT patients
prescribed strict
bed rest for at least
five days (n=51),
and DVT patients
instructed to
ambulate around
the unit during the
same five days
(n=52).
To evaluated the
outcomes of
pulmonary embolism,
progression of
thrombosis,
nosocomial infections,
serious events, and
death between the best
rest and ambulation
groups
(13.5%) of the mobile group
and (28.0%) of the immobile
group developed at least one
of the evaluated outcomes. No
significant differences were
found between those who
ambulated and those who
remained on bed rest,
indicating that prescribing bed
rest for this patient population
is not a necessity.
Langhorne
et al.
(2010)
Observerblinded, pilot
randomized
controlled
trial
Stroke patients
within 36 hours of
symptom onset
(n=32).
To study the safety of
early mobilization in
patients hospitalized
with an acute stroke
Stroke patients in the early
mobilization group had no
significant increase in falls,
fatigue, or stroke progression
compared to the control
group, indicating the safety of
early mobilization of acute
stroke patients.
TrujilloSantos et
al. (2005)
Observational Deep Vein
study
Thrombosis
(DVT) patients
(n=2,038) and
pulmonary
embolism (PE)
patients (n=612)
To explore whether
ambulation of acute
DVT and PE patients
posed increased risk of
developing new events
of pulmonary
embolism
There was no significant
difference in the development
of new PE, fatal PE, or
bleeding complications
between patients on bed rest
and those allowed to
ambulate.
Medical
Cardiac Procedure
Best et al.
Prospective
Left heart
To determine the
There was no difference in
2
(2010)
nonconcurrent
design with a
retrospective
control.
Boztosun
et al.
(2007)
catheterization
(LHC) sheath
removal patients.
Traditional threeto four-hour
ambulation
protocol group
(n=402). 90
minute group
(n=193).
safety of ambulating
patients at 90
minutes post-LHC
sheath removal
compared to the
current practice of
ambulation at three
to four hours postsheath removal.
complication rates
for the two groups. The results
suggest that early ambulation
for
selected patients at 90 minutes
is safe
Observational Heart
catheterization
patients (n=1,650)
To explore whether
mobilizing selected
patients after 2 hours
of bed rest would
increase vascular
complications
Patients ambulated after 2 hours
had less incidence of
ecchymosis and small
hematoma that those with
longer periods of bed rest
(P<.001). it is both
safe and feasible to ambulate
selected patients at 2 hours
following 6-French diagnostic
left heart catheterization.
Butterfield
et al.
(2000)
Observational Patients
study
undergoing
peripheral and
renal angioplasty
using a sheath size
up to 6 French
(n=128)
To assess the
incidence of
puncture site
compilations in inpatients undergoing
early mobilization
following
angioplasty
Mobilization at 4 hours after the
procedure was successful in
90% of cases, while 10%
required more prolonged bed
rest at four hours.
Chair et al.
(2007)
Quasiexperimental
Cardiac
catheterization
patients. (n=43)
ambulated at 4 hrs
post procedure &
(n=43) ambulated
12-24h after the
procedure.
To compare patient
outcomes of back
pain, vascular back
complications, and
urinary discomfort
between patients
ambulated at 4 hours
and 12–24 hours
post-transfemoral
cardiac
catheterization
There was no difference
between the two groups on
vascular complications. The
control group had significantly
more back pain intensity (P <
.001) and higher levels of
urinary discomfort (P = 006).
Dowling et
al. (2002)
Prospective
randomized
study
Angiography
patients
randomized to
group ambulating
To assess the
feasibility and safety
of early ambulation
after transfemoral
No significant difference in
hematoma formation,
pseudoaneurysm development
or other groin complications of
3
6 hours after
procedure (n=47),
and 3 hours after
procedure (n=63)
angiography
patients ambulated at either 3 or
6 hours after catheter or sheath
removal.
Gall et al.
(2006)
Prospective
study
Coronary
angiography
patients (n=1,000)
To assess the safety
of ambulating
patients after 90
minutes of bed rest
following coronary
angiography
The 90 minute protocol was
safe for patients undergoing
elective 6-Fr coronary
angiography performed via the
right femoral artery.
Mah et al.
(1999)
Retrospective
chart data
Cardiac
catheterization
patients, (n=472)
in the 5-hour
ambulation group
and (n=408) in the
3-hour ambulation
group.
To evaluate the
effects of
ambulating patients
3 hours after cardiac
catheterization with
a 7 French arterial
catheter on bleeding,
hematoma
formation, and
vascular
complications
Patients who received the 3hour ambulation protocol
experienced a significantly
lower rate of bleeding and
hematoma formation (13%)
than patients who received the
5-hour ambulation protocol
(24.4%) (p < 0.001).
Ambulating patients 3 hours
post cardiac catheterization with
a 7F catheter was found to be
safe.
Miracapillo Randomized
et al.
(2006)
Pacemaker
patients. (n=57)
mobilized after 3
hours, (n=77)
mobilized after 24
hours.
To test a new
No statistical differences were
protocol mobilizing observed between the two
patients 3 hours after groups
receiving a single or
a dual-chamber
pacemaker
RezaeiAdaryani
et al.
(2009)
Patients, who had
undergone a nonemergency 6French
cardiac
catheterization via
To assess the effect
of changing position
and early
ambulation on the
amount of bleeding
and hematoma after
Single-blind
randomized
controlled
trial
The experimental group
produced no significant increase
in the amount
of bleeding and hematoma
when compared with the control
group (P > 0.05).
4
the femoral artery
(n=70)
cardiac
catheterization.
Vlasic et
al. (1999)
Prospective
Study
Cardiac
catheterizaiton
patients (n=50)
To report the effects
of reducing the 6
hour bedrest period
to 2 hours following
cardiac
catheterization
No significant vascular
complications occurred.
Vlasic et
al. (2001)
Randomized
controlled
trial
Patients
undergoing
percutaneous
coronary
intervention
randomly assigned
to 2, 4, or 6 hours
of bed rest (n=354)
To test if reducing
the time to
ambulation from 6 to
2 hours would not
increase vascular
complications
Reducing bed rest, after
percutaneous coronary
intervention, from 6 to 2 hours
was safe and was not associated
with an increased risk of
vascular complications.
Walker et
al. (2008)
Quasiexperimental
Percutaneous
coronary
intervention
procedure patients
(n=338)
To explore groin
complication rates of
patients mobilized at
3, 4, and 6 hours
after femoral arterial
sheath removal
following a
percutaneous
coronary
intervention
procedure.
The length of bed rest after
arterial sheath removal had no
significant effect on bleeding
(P=0.21) or hematoma
formation (P=0.612) at the
groin puncture site for
participants
who mobilized at either 3, 4, or
6 hours after percutaneous
coronary intervention arterial
sheath removal.
Wang et al.
(2001)
Quasiexperimental
design
Left-heart
catheterization
patients (n=118)
receiving 4 or 6
hours of bed rest
To compare the
effects of 4 hours of
bed rest vs. 6 hours
of bed rest on
patients’ safety,
comfort, and
satisfaction levels
No significant differences in
arterial puncture site
complications between
mobilized at 4 hours versus 6
hours.
To examine whether
walking at 4h after
surgery could be a
safe approach to
proceeding with
rehabilitation.
No significant difference in the
amount of drainage, rates of
heart load during walking, pain
scores, or falls. Results
indicated that early mobilization
at 4 hours after surgery was
Surgical
Kaneda et
al. (2007)
Observational Lung cancer
Retrospective patients after a
lobectomy. Group
1 encouraged to
walk 4 hours after
surgery (n=36),
5
Group 2 walked
the day following
surgery (n=50).
feasible.
Rath et al.
(2010)
Randomized
control trial
Foot drop patients
who have
undergone tendon
transfer surgery.
Early active
mobilization group
(n=13),
immobilization
group (n=11).
Explored whether
the early active
mobilization group
would have similar
rates of tendon
insertion pullout
compared to the
immobilization
group
No cases of tendon pullout in
either group, supporting the
safety of early mobilization.
Silvanto et
al. (2004)
Randomized
study
Knee arthroscopy
patients (n=120)
randomized into 3
groups:
Group E- early
ambulation, Group
6-h – ambulation
after 6 hours, &
Group L
ambulation after
18-24 h
To evaluate the
influence of
ambulation time on
the occurrence
of transient
neurologic
symptoms (TNSs)
after spinal
anesthesia with 50
mg of 2% plain
lidocaine for knee
arthroscopy.
TNSs developed in 3 patients
(7.5%) of Group E, in 11
patients (28%) of Group 6-h (P
= 0.05), and in 5 patients (13%)
of Group L. Early ambulation
was not found to be a risk factor
for transient neurologic
symptoms after spinal
anesthesia
Whitney et
al. (2004).
Randomized
Total hip
replacement
patients: (n=27) in
standard treatment
group, (n=31) in
supplemental
activity group
To test whether local
tissue oxygen levels
and wound healing
responses in tissue
close to the surgical
wound of patients
having total hip
replacement were
improved by early,
supplemental
postoperative
physical activity.
Physical activity did not
improve healing measures,
however id did not reduce tissue
oxygenation or wound healing
Prospective
cohort study
ICU patients who
had required
mechanical
ventilation for
more than 4 days
(n= 103)
To explore whether
early activity is safe
and feasible for
respiratory failure
patients.
Early activity was both safe and
feasible with a less than 1%
occurrence of activity-related
adverse events.
ICU
Bailey et
al. (2007)
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Bourdin et
al. (2010)
Quasiexperimental
Stiller et al. Prospective
(2004)
study
ICU patients who
had received
invasive
mechanical
ventilation for 2 or
more days (n=20)
To explore the
feasibility of early
rehabilitation of ICU
patients undergoing
mechanical
ventilation and the
effects on common
physiologic
variables.
Early rehabilitation is feasible
and safe in patients in the ICU
for longer than 1 week. The
most frequent contradictions
were sedation (15%), shock
(11%), and renal support (9%).
Patients in the ICU
for 7 days or more
& on mechanical
ventilation for 2 or
more days (n=31)
To measure the
effects of
mobilization on
heart rate, systolic
and diastolic blood
pressure,
percutaneous
saturation of oxygen,
deterioration in
clinical status, and
intervention required
for it.
Early rehabilitation was feasible
and safe for this population
based on physiologic variables
studied. However, there were
contraindications to the
intervention, including sedation,
shock, renal support, persistent
respiratory failure, impaired
response to simple orders,
agitation, and confusion.