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Introduction 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. Methods 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. Results 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 5.9 days ( p  < 0.001) and ventilation duration by 6.7 days ( p  = 0.001). However, no significant differences were observed in PhAs. Conclusion 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.

Purpose The hypothesis was that early functional mobilization would reduce the incidence of deep venous thrombosis (DVT) during leg immobilization after Achilles tendon rupture surgery. A secondary aim was to evaluate if the amount of weightbearing and daily steps influenced the risk of sustaining a DVT. Methods One-hundred and fifty patients with Achilles tendon rupture repair were randomized to treatment with early functional mobilization, encouraging full weightbearing and ankle motion in orthosis, or treatment-as-usual, i.e., 2 weeks of unloading in plaster cast followed by 4 weeks weightbearing in orthosis. At 2 and 6 weeks postoperatively, all patients were screened for DVT using compression duplex ultrasound. During the first 2 weeks postoperatively, patient-reported loading, pain and step counts were assessed. Results At 2 weeks, 28/96 (29%) of the patients in early functional mobilization group and 15/49 (31%) in the control group (n.s) had sustained a DVT. At 6 weeks, the DVT rate was 35/94 (37%) in the early functional mobilization and 14/49 (29%) in the control group (n.s). During the first postoperative week, the early functional mobilization group reported low loading and higher experience of pain vs. the control group ( p  = 0.001). Low patient-reported loading ≤ 50% (OR = 4.3; 95% CI 1.28–14.3) was found to be an independent risk factor for DVT, in addition to high BMI and higher age. Conclusions Early functional mobilization does not prevent the high incidence of DVT during leg immobilization in patients with Achilles tendon rupture as compared to treatment-as-usual. The low efficacy of early functional mobilization is mainly explained by postoperative pain and subsequent low weightbearing. To minimize the risk of DVT, patients should be encouraged to load at least 50% of body weight on the injured leg 1 week after surgery. Level of evidence Therapeutic, level 1

BackgroundThe aim was to complete a feasibility study that would test the methods of the main trial, that will investigate whether early thoracic and shoulder girdle exercises reduce chronic pain in patients with blunt chest wall trauma, when compared with normal care.MethodsA single centre, parallel, feasibility randomised controlled trial was completed at a University Teaching Hospital in Wales between June and September 2019. Adult patients with blunt chest wall trauma, admitted to hospital for greater than 24 hours, with no concurrent, immediately life-threatening injuries, were included. The intervention was a simple physiotherapy programme comprising thoracic and shoulder girdle exercises. Feasibility outcome measures included: primary outcomes: (1) 80% or more of identified eligible patients were approached for potential recruitment to the trial (2) 30% or less of approached, eligible patients dissented to participate in the trial; secondary outcomes: (3) follow-up data for patient secondary outcomes can be collected for 80% or more of patients, (4) there should be no greater than 10% increase in serious adverse events in the intervention group compared with the control group.ResultsA total of 19/19 (100%) patients were deemed eligible for the trial and were approached for participation, 5/19 (26%) eligible patients declined to participate in the trial, follow-up data were collected for n=10/14 (71%) patients and there were no serious adverse events reported in either group.ConclusionsWe have demonstrated that a fully powered randomised clinical trial of the EarLy Exercise in blunt Chest wall Trauma Trial is feasible.Trial registration number ISRCTN16197429

Background Catastrophic thinking and fear-avoidance belief are negatively influencing severe acute pain following surgery causing delayed ambulation and discharge. We aimed to examine if a preoperative intervention of cognitive-behavioural therapy (CBT) could influence the early postsurgical outcome following lumbar spinal fusion surgery (LSF). Methods Ninety patients undergoing LSF due to degenerative spinal disorders were randomly allocated to either the CBT group or the control group. Both groups received surgery and postoperative rehabilitation. In addition, the CBT group received a preoperative intervention focussed on pain coping using a CBT approach. Primary outcome was back pain during the first week (0–10 scale). Secondary outcomes were mobility, analgesic consumption, and length of hospitalisation. Data were retrieved using self-report questionnaires, assessments made by physical therapists and from medical records. Results No difference between the groups’ self-reported back pain ( p  = 0.76) was detected. Independent mobility was reached by a significantly larger number of patients in the CBT group than the control group during the first three postoperative days. Analgesic consumption tended to be lower in the CBT group, whereas length of hospitalisation was unaffected by the CBT intervention. Conclusion Participation in a preoperative CBT intervention appeared to facilitate mobility in the acute postoperative phase, despite equally high levels of self-reported acute postsurgical pain in the two groups, and a slightly lower intake of rescue analgesics in the CBT group. This may reflect an overall improved ability to cope with pain following participation in the preoperative CBT intervention. Trial registration The study was approved by the Danish Protection Agency (2011-41-5899) and the Ethics Committee of the Central Denmark Region (M-20110047). The trial was registered in Current Controlled Trials ( ISRCTN42281022 ).

ABSTRACT OBJECTIVE Patients with cervical radiculopathy and/or myelopathy are often treated with anterior cervical discectomy and fusion. Cervical arthroplasty has recently been advocated as an alternative treatment. Theoretically, arthroplasty should permit early return to activity and protect against adjacent segment disease. Early mobilization and return to activity may, theoretically, reduce cost to the workers' compensation program. METHODS A subgroup analysis of workers' compensation patients from the randomized controlled trials comparing Prestige ST and Bryan (Medtronic Sofamor Danek, Memphis, TN) cervical arthroplasty to fusion was performed. Primary outcome measures were work status, time to return to work, and neck disability. Secondary outcome measures were neck and arm pain and Medical Outcomes Study Short-Form 36-Item Health Survey score. RESULTS One thousand four patients were enrolled in the studies, 93 of whom were workers' compensation patients. At 6 weeks and 3 months, significantly more patients in the arthroplasty group were working compared with the fusion group. At 6 months and later, there was no significant difference in return-to-work rates. Overall, patients returned to work at a median of 101 days after arthroplasty, compared with 222 days after anterior cervical discectomy and fusion. This difference was not significant when controlling for sex, study, and preoperative work status. At all time points, the Neck Disability Index was consistently lower in the arthroplasty group compared with the fusion group; however, the difference was not significant at 24 months. There was no statistically significant difference in secondary outcomes, neurological events, or pain-related events. CONCLUSION In this workers' compensation cohort, it was observed that a greater number of patients in the arthroplasty group returned to work at 6 weeks and 3 months after surgery. A trend toward an earlier return to work was also seen, although this was not statistically significant when controlling for differences in the studies.

Background The current study presents a technique (navigated posterior lumbar fusion) which takes a 5-cm incision to accomplish a 2-level posterior lumbar fusion (PLF) and compared its efficacy and efficiency with those of conventional PLF. Methods Forty patients who were indicated for 2-level lumbar fusion were included and randomized to either navigated PLF group or conventional PLF group. Blood loss, operation time, incision length, complications, bed rest period, and length of hospitalization were recorded. Oswestry Disability Index (ODI) scoring was also performed for each patient before surgery, 3 months after surgery, and 2 years after surgery. Results The incision length was significantly shorter in the navigated PLF group than in the conventional PLF group (4.8 vs. 10.9 cm, p  = 0.001). Accordingly, the blood loss was also significantly less in the navigated PLF group than in the conventional PLF group (209.0 vs. 334.0 ml, p  = 0.047). There was no significant difference in total operation time between the two groups (160.7 vs. 144.4 min, p  = 0.116). Compared to the conventional PLF group, the navigated PLF group showed significantly less postoperative blood loss, less time to mobilization, and shorter length of hospital stay. The ODI score improved significantly in the both groups immediately after surgery, and maintained well in the following 2 years. Conclusion Compared to conventional PLF, navigated PLF proved to be superior with regard to incision length, blood loss, time to mobilization, and shorter length of hospital stay.

Background The impact of early mobilization and rehabilitation protocol (EMRP) on trauma patients admitted to the intensive care unit (ICU) remains unclear owing to limited randomized controlled trials and methodological limitations in observational studies. This study aimed to compare the clinical outcomes of trauma patients admitted to the ICU before and after EMRP implementation. Methods A retrospective pre–post study was conducted on adult trauma patients having an Injury Severity Score ≥ 9 who were admitted to the ICU of a university hospital. Patients admitted from July 2021 to June 2022 comprised the pre-EMRP group, whereas those admitted from July 2022 to August 2023 comprised the post-EMRP group. Outcomes were compared between these two groups using propensity score matching to adjust for confounders. The primary outcome was the proportion of home discharge. The secondary outcomes were the Barthel Index score at hospital discharge, length of stay (LOS) in the ICU and hospital; Functional Status Score for the ICU at ICU discharge; and cumulative rate of patients reaching ICU Mobility Scale (IMS) levels ≥ 3, ≥4, and ≥ 7 within 28 days after ICU admission. Results Among 552 eligible patients, 254 and 298 were admitted during the pre-EMRP and post-EMRP phases, respectively. In the propensity score-matched cohort, the post-EMRP group showed a higher proportion of home discharge (52.1% vs. 41.1%, difference: 11.0%, 95% confidence interval [CI]: 1.7–20.2%), higher Barthel Index score at hospital discharge (95.0 [55.0–100.0] vs. 80.0 [40.0–100.0], P  = 0.007), and shorter LOS in the ICU (5.0 [3.0–11.0] vs. 7.0 [4.0–11.0] days, P  = 0.03) than the pre-EMRP group. EMRP was associated with a higher rate of patients reaching IMS levels ≥ 3 (hazard ratio [HR]: 1.29, 95% CI: 1.06–1.57), ≥ 4 (HR: 1.27, 95% CI: 1.03–1.56), and ≥ 7 (HR: 1.36, 95% CI: 1.08–1.70). Conclusions Compared with pre-EMRP implementation, EMRP for adult trauma patients was associated with a higher proportion of home discharge, an improved Barthel Index score at hospital discharge, and a shorter LOS in the ICU. These findings indicate that EMRP may facilitate returning home by improved physical function.

Early postoperative ambulation is vital to minimizing length of stay (LOS), but few hospitals objectively measure ambulation to predict outcomes. Wearable activity monitors have the potential to transform assessment of postoperative ambulation, but key implementation data, including whether digitally monitored step count can identify patients at risk for poor efficiency outcomes, are lacking. To define the distribution of digitally measured daily step counts after major inpatient surgical procedures, to assess the accuracy of physician assessment and ordering of ambulation, and to quantify the association of digitally measured step count with LOS. Prospective cohort study at Cedars-Sinai Medical Center, an urban tertiary referral center. Participants were patients undergoing 8 inpatient operations (lung lobectomy, gastric bypass, hip replacement, robotic cystectomy, open colectomy, abdominal hysterectomy, sleeve gastrectomy, and laparoscopic colectomy) from July 11, 2016, to August 30, 2017. Use of activity monitors to measure daily postoperative step count. Operation-specific daily step count, daily step count by physician orders and assessment, and a prolonged LOS (>70th percentile for each operation). Among 100 patients (53% female), the mean (SD) age was 53 (18) years, and the median LOS was 4 days (interquartile range, 3-6 days). There was a statistically significant increase in daily step count with successive postoperative days in aggregate (r = 0.55; 95% bootstrapped CI, 0.47-0.62; P < .001) and across individual operations. Ninety-five percent (356 of 373) of daily ambulation orders were \"ambulate with assistance,\" although daily step counts ranged from 0 to 7698 steps (0-5.5 km) under this order. Physician estimation of ambulation was predictive of the median step count (r = 0.66; 95% bootstrapped CI, 0.59-0.72; P < .001), although there was substantial variation within each assessment category. For example, daily step counts ranged from 0 to 1803 steps (0-1.3 km) in the \"out of bed to chair\" category. Higher step count on postoperative day 1 was associated with lower odds of prolonged LOS from 0 to 1000 steps (odds ratio [OR], 0.63; 95% CI, 0.45-0.84; P = .003), with no further decrease in odds after 1000 steps (OR, 0.99; 95% CI, 0.75-1.30; P = .80). In this study, digitally measured step count up to 1000 steps on postoperative day 1 was associated with lower probability of a prolonged LOS. Wearable activity monitors improved the accuracy of assessment of daily step count over the current standard of care, providing an opportunity to identify patients at risk for poor efficiency outcomes.

Analyse the effect of varying start times for early exercise interventions on the prevention of intensive care unit-acquired weakness. We conducted a comprehensive search on PubMed, Cochrane Library, Web of Science, Embase, China Biology Medicine Disc, China National Knowledge Infrastructure, Wan Fang Database, and reference lists up to May 2023. We systematically searched the literature for all randomized controlled trials on the effect of early mobilization in patients with critical illness. The primary outcome assessed was the incidence of intensive care unit-acquired weakness. The secondary outcomes included: the Medical Research Council Score, the Barthel Index, duration of mechanical ventilation, length of intensive care unit stay, total length of hospital stay, mortality and incidence of intensive care unit-related complications. The results of meta-analysis showed that compared with routine care, less than 24 hours after admission (RR = 0.44, 95 %CI: 0.28–0.68), more than 24 hours (RR = 0.33, 95 %CI: 0.16–0.67), less than 72 hours after admission (RR = 0.33, 95 %CI: 0.20–0.52) may lead to a lower incidence of intensive care unit-acquired weakness. The results of under surface cumulative ranking showed that early mobilization within 72 hours may have the lowest incidence of intensive care unit-acquired weakness (SUCRA = 81.9 %). The current empirical evidence from intensive care unit patients suggests that initiating mobilization protocols within 24-72 hours timeframe following admission to the intensive care unit could potentially be the most beneficial strategy to reduce the incidence of intensive care unit-acquired weakness and the related medical complications. Moreover, this strategy seems to significantly improve rehabilitation and treatment outcomes for these patients. According to this study, medical and nursing staff in the intensive care unit have the chance to identify the most suitable timing for the implementation of early rehabilitative measures for patients. This can potentially prevent intensive care unit-acquired weakness and enhance various clinical outcomes for patients.

Introduction Mobilisation of patients in the intensive care unit (ICU) is an area of growing research. Currently, there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses. Methods The objectives of the study were to (1) quantify and benchmark baseline levels of mobilisation in Australian and Scottish ICUs, (2) compare mobilisation practises between Australian and Scottish ICUs and (3) identify barriers to mobilisation in Australian and Scottish ICUs. We conducted a prospective, observational, cohort study with a 4-week inception period. Patients were censored for follow-up upon ICU discharge or after 28 days, whichever occurred first. Patients were included if they were >18 years of age, admitted to an ICU and received mechanical ventilation in the ICU. Results Ten tertiary ICUs in Australia and nine in Scotland participated in the study. The Australian cohort had a large proportion of patients admitted for cardiothoracic surgery (43.3 %), whereas the Scottish cohort had none. Therefore, comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery. In total, 60.2 % of the 347 patients across 10 Australian ICUs and 40.1 % of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay ( p  < 0.001). Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort (hazard ratio 1.83, 95 % confidence interval 1.38–2.42). However, the percentage of episodes of mobilisation where patients were receiving mechanical ventilation was higher in the Scottish cohort (41.1 % vs 16.3 %, p  < 0.001). Sedation was the most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts. Physiological instability and the presence of an endotracheal tube were also frequently reported barriers. Conclusions This is the first study to benchmark baseline practise of early mobilisation internationally, and it demonstrates variation in early mobilisation practises between Australia and Scotland.