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Fernandes C, Sousa JA, Bernardo-Castro S, Silva F, Donato H, Sargento-Freitas J. Early Mobilization Decision after an Acute Ischemic Stroke: Protocol for an Umbrella Review. ACTA MEDICA PORT 2024. [PMID: 38489931 DOI: 10.20344/amp.20715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/19/2023] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Stroke is considered one of the greatest public health challenges worldwide, with the ischemic subtype being the most prevalent. Various acute stroke clinical guidelines recommend early rehabilitation interventions, including very early mobilization. However, despite the studies conducted in recent years regarding when to initiate mobilization after an acute stroke, there are few systematic and personalized protocols based on the factors for which patient mobilization should ideally be performed. We aim to conduct an umbrella review of systematic reviews and meta-analyses to study the early mobilization decision after an acute ischemic stroke in comparison with conventional care and correlate the different approaches with patient clinical outcomes. METHODS AND ANALYSIS We will perform a systematic search on PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Epistemonikos and Web of Science Core Collection databases. Retrieved studies will be independently reviewed by two authors and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias in the selected studies. We will use the 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist as the critical appraisal tool to assess cumulative evidence and risk of bias of the different studies. This will be the first umbrella review that compares early mobilization approaches in post-acute ischemic stroke. This study may help to define the optimal early mobilization strategy in stroke patients. PROSPERO registration number: CRD42023430494.
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Affiliation(s)
- Catarina Fernandes
- Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra. Portugal
| | - João André Sousa
- Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra. Portugal
| | | | - Fernando Silva
- Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra. Portugal
| | - Helena Donato
- Documentation and Scientific Information Service. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - João Sargento-Freitas
- Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra; Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
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Hauff T, Petosic A, Småstuen MC, Wøien H, Sunde K, Stafseth SK. Patient mobilisation in the intensive care unit and evaluation of a multifaceted intervention including Facebook groups: A quasi-experimental study. Intensive Crit Care Nurs 2023; 74:103315. [PMID: 36192314 DOI: 10.1016/j.iccn.2022.103315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 12/14/2022]
Abstract
AIMS To describe prevalence and time to mobilisation in intensive care unit patients defined as a minimum sitting in an upright position in bed, and evaluate the impact of a multifaceted quality improvement campaign on likelihood of patients being mobilised. RESEARCH METHODOLOGY/DESIGN Quality improvement project using a quasi-experimental study design, comparing patient cohorts before (Before) and after (Intervention) a campaign including educational sessions, audit and feedback of intensive care unit quality indicators via closed Facebook-groups and e-mail and local opinion leaders. Secondary analysis of mobilisation data from adult intensive care patient stays extracted from electronical medical charts. Likelihood of being mobilised was analysed with Multivariate Cox-regression model and reported as Sub-hazard Ratio (SHR). SETTING Four intensive care units in a university hospital. MAIN OUTCOME MEASURES Prevalence and time to first documented mobilisation, defined as at least "sitting in bed" during the intensive care unit stay. RESULTS Overall, 929 patients were analysed, of whom 710 (76 %) were mobilised; 73 % (356/ 489) in Before vs 81 % (354/ 440) in Intervention (p = 0.007). Median time to mobilisation was 69.9 (IQR: 30.0, 149.8) hours; 71.7 (33.9, 157.9) in Before and 66.0 (27.1, 140.3) in Intervention (p = 0.104). Higher SAPS II-scores were associated with lower likelihood (SHR 0.98, 95 % CI 0.97-0.99), whereas admissions due to gastroenterological failure (SHR 2.1, 95 % CI 1.4-3.0), neurological failure (SHR 1.5, 95 % CI 1.0-2.2) and other causes (intoxication, postoperative care, haematological-, and kidney failure) (SHR 1.7, 95 % CI 1.13-2.6) were associated with higher likelihood of mobilisation vs respiratory failure. CONCLUSION A quality improvement campaign including use of Facebook groups is feasible and may improve mobilisation in intensive care unit patients. Most patients were mobilised within 72 hours following intensive care unit admission, and SAPS II scores and causes for intensive care unit admission were both associated with likelihood of being mobilised.
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Affiliation(s)
- Tonje Hauff
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. https://twitter.com/@HauffTonje
| | - Antonija Petosic
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway; The Norwegian Intensive Care Registry, Haukeland University Hospital, Helse Bergen, Bergen, Norway. https://twitter.com/@AntonijaPetosic
| | - Milada Cvancarova Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Public Health, Oslo Metropolitan University, Oslo, Norway.
| | - Hilde Wøien
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway. https://twitter.com/@ien_hilde
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Siv K Stafseth
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway.
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Borges MGB, Borges DL, Ribeiro MO, Lima LSS, Macedo KCM, Nina VJDS. Early Mobilization Prescription in Patients Undergoing Cardiac Surgery: Systematic Review. Braz J Cardiovasc Surg 2022; 37:227-238. [PMID: 35244377 PMCID: PMC9054150 DOI: 10.21470/1678-9741-2021-0140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive impact. Methods This is a systematic review of studies published until September 2020 in the Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase, Physiotherapy Evidence Database (or PEDro), Scientific Electronic Library Online (or SciELO), and Latin American and Caribbean Health Sciences Literature (or LILACS) databases. Randomized clinical trials describing mobilization protocols performed early in ICU patients after cardiac surgery were included. Results According to the eligibility criteria, only 14 of the 1,128 articles found were included in the analysis. Early mobilization protocols were initiated in the immediate postoperative period or first postoperative day. The resources and technics used were progressive mobilization, cycle ergometer, early bed activities, walking protocols, resistance exercise, and virtual reality. Intensity of the mobilization activities was determined using the Borg scale and heart rate. Conclusion Early mobilization protocols are generalist (not individual), and low-intensity exercises are used, through progressive mobilization, with two daily physical therapy sessions, during 10 to 30 minutes.
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Affiliation(s)
- Mayara Gabrielle Barbosa Borges
- Department of Physiotherapy, Hospital Universitário da Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil.,Postgraduate Program in Health Sciences, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil
| | - Daniel Lago Borges
- Department of Physiotherapy, Hospital Universitário da Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil
| | | | - Lara Susan Silva Lima
- Multiprofessional Residency Program, Hospital Universitário da Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil
| | | | - Vinicius José da Silva Nina
- Postgraduate Program in Health Sciences, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil
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Svensson-Raskh A, Schandl AR, Ståhle A, Nygren-Bonnier M, Fagevik Olsén M. Mobilization Started Within 2 Hours After Abdominal Surgery Improves Peripheral and Arterial Oxygenation: A Single-Center Randomized Controlled Trial. Phys Ther 2021; 101:6178886. [PMID: 33742678 PMCID: PMC8136304 DOI: 10.1093/ptj/pzab094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/09/2020] [Accepted: 02/17/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate if mobilization out of bed, within 2 hours after abdominal surgery, improved participants' respiratory function and whether breathing exercises had an additional positive effect. METHODS Participants were 214 consecutively recruited patients who underwent elective open or robot-assisted laparoscopic gynecological, urological, or endocrinological abdominal surgery with an anesthetic duration of >2 hours. They were recruited to a randomized controlled trial. Immediately after surgery, patients were randomly assigned to 1 of 3 groups: mobilization (to sit in a chair) and standardized breathing exercises (n = 73), mobilization (to sit in a chair) only (n = 76), or control (n = 65). The interventions started within 2 hours after arrival at the postoperative recovery unit and continued for a maximum of 6 hours. The primary outcomes were differences in peripheral oxygen saturation (SpO2, as a percentage) and arterial oxygen pressure (PaO2, measured in kilopascals) between the groups. Secondary outcomes were arterial carbon dioxide pressure, spirometry, respiratory insufficiency, pneumonia, and length of stay. RESULTS Based on intention-to-treat analysis (n = 214), patients who received mobilization and breathing exercises had significantly improved SpO2 (mean difference [MD] = 2.5%; 95% CI = 0.4 to 4.6) and PaO2 (MD = 1.40 kPa; 95% CI = 0.64 to 2.17) compared with the controls. For mobilization only, there was an increase in PaO2 (MD = 0.97 kPa; 95% CI = 0.20 to 1.74) compared with the controls. In the per-protocol analysis (n = 201), there were significant improvements in SpO2 and PaO2 for both groups receiving mobilization compared with the controls. Secondary outcome measures did not differ between groups. CONCLUSION Mobilization out of bed, with or without breathing exercises, within 2 hours after elective abdominal surgery improved SpO2 and PaO2. IMPACT The respiratory effect of mobilization (out of bed) immediately after surgery has not been thoroughly evaluated in the literature. This study shows that mobilization out of bed following elective abdominal surgery can improve SpO2 and PaO2. LAY SUMMARY Mobilization within 2 hours after elective abdominal surgery, with or without breathing exercises, can improve patients' respiratory function.
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Affiliation(s)
- Anna Svensson-Raskh
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden,Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden,Address all correspondence to Ms Svensson-Raskh at:
| | - Anna Regina Schandl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Department of Anesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Agneta Ståhle
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden,Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Monika Fagevik Olsén
- Department of Neuroscience and Physiology, Division of Health & Rehabilitation/Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Eggmann S, Kindler A, Perren A, Ott N, Johannes F, Vollenweider R, Balma T, Bennett C, Silva IN, Jakob SM. Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series. Phys Ther 2020; 101:5930365. [PMID: 33492400 PMCID: PMC7665777 DOI: 10.1093/ptj/pzaa194] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/27/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this case series was to describe the experience of Swiss physical therapists in the treatment of patients with COVID-19 during their acute care hospital stay and to discuss challenges and potential strategies in the clinical management of these patients. METHODS We report 11 cases of patients with COVID-19 from 5 Swiss hospitals that illustrate the various indications for physical therapy, clinical challenges, potential treatment methods, and short-term response to treatment. RESULTS Physical therapists actively treated patients with COVID-19 on wards and in the intensive care unit. Interventions ranged from patient education, to prone positioning, to early mobilization and respiratory therapy. Patients were often unstable with quick exacerbation of symptoms and a slow and fluctuant recovery. Additionally, many patients who were critically ill developed severe weakness, postextubation dysphagia, weaning failure, or presented with anxiety or delirium. In this setting, physical therapy was challenging and required specialized and individualized therapeutic strategies. Most patients adopted the proposed treatment strategies, and lung function and physical strength improved over time. CONCLUSION Physical therapists clearly have a role in the COVID-19 pandemic. Based on our experience in Switzerland, we recommend that physical therapists routinely screen and assess patients for respiratory symptoms and exercise tolerance on acute wards. Treatment of patients who are critically ill should start as soon as possible to limit further sequelae. More research is needed for awake prone positioning and early breathing exercises as well as post-COVID rehabilitation. IMPACT To date, there are few data on the physical therapist management of patients with COVID-19. This article is among the first to describe the role of physical therapists in the complex pandemic environment and to describe the potential treatment strategies for countering the various challenges in the treatment of these patients.
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Affiliation(s)
- Sabrina Eggmann
- Address all correspondence to Ms Eggmann at: , @SabrinaEggmann
| | - Angela Kindler
- Department of Physiotherapy, Insel Group, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Perren
- Department of Physiotherapy, Insel Group, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Natalie Ott
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Frauke Johannes
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Vollenweider
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Théophile Balma
- Department of Surgery and Anesthesia, Cardio-Respiratory Physiotherapy, Lausanne University Hospital, Lausanne, Switzerland
| | - Claire Bennett
- Intensive Care Unit, Department of Acute Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Ivo Neto Silva
- Intensive Care Unit, Department of Acute Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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