The Effects of an Early Mobilization protocol

following THA and TKAJustin Williams

The University of the Incarnate Word School of Physical Therapy

It can differ from facility to facility but after researching multiple articles most facilities define it as walking within 24 hours of the operation

What defines “early mobilization”

Protocols will differ from hospital to hospital based on factors such as:◦ The size of the hospital◦ The surgeons performing the surgery ◦ The availability of staff members (therapists,

RN’s, etc.) and resources to perform evaluations and treatments in a timely manner

Hospital protocols

Can early mobilization decrease LOS? Does early mobilization improve functional

outcomes? Does early mobilization play a role in pain

control for pt’s? Does early mobilization decrease the risk

for developing thromboembolisms following total arthroplasty surgeries?

Hypotheses for Effects of Early Mobilization

First article ◦ 900 patients that had TKA and THA

Control group (“standard protocol”)- 569 patients Experimental group (“rapid protocol”- 331 patients

Second article (all TKA) ◦ Control group (walked 2nd day post op)

98 patients ◦ Experimental group (walked within 24 hours)

97 patients

Research studies used

Two articles were researched and used for this presentation. Both articles used a very similar early mobilization protocol to one another which involved:◦ Initial assessment of strength, AROM, and feeling

of sensation to ensure pt was safe enough for ambulation

◦ Have pt transfer to sitting EOB (assess for feelings of dizziness/lightheadedness)

Protocols developed

◦ Have the pt perform transfer to chair ◦ If tolerated transfer to chair, initiate ambulation

(for these studies goal was to ambulate 100 ft)◦ Initiate stair training (expectations were to climb

6 stairs safely before D/C)

Protocols continued….

To be able to go home pt’s needed to be able to:◦ Perform functional transfers/bed mobility safely and

with proper amount of assist available at home◦ Ambulate functional distances needed to cover at

home with proper use of AD and level of assist available at home

◦ Perform stair training with proper use of AD and/or railings if present with proper level of assist available at home

Warrant stay in facility for further rehab if:◦ At time of D/C when pt was medically stable to leave

facility that the pt’s rehab goals had not been met or they were deemed unsafe with functional activities

D/C criteria for studies

Use of anesthesia/nerve block could give possible “false hope” to pt’s

Different comorbidities of patients could effect the healing process

Limitations to studies

LOS decreased with rapid mobilization ◦ Avg. 3.8 days compared to 4.4 days with control

group Efficacy of rapid mobilization protocol for

functional activity ability and D/C home higher than control group ◦ 74% efficiency rate compared to 70% efficiency

rate

Results of first study

Early mobilization pts progressively increased ambulation distance day by day where control group pts had reduction in gait distance◦ 89 out of 90 pt’s increased distance each day ◦ 72% of pt’s in control group had decreased

ambulation distance 2* nausea, syncope and poorly-controlled pain

Pain levels were decreased in early mobilization group compared to control group ◦ 59 in early mob group and 52 in control group used

anesthesia pump for pain control Early mob group required avg of 19 mg compared to 61.5 mg in

control group

Results of second study

Decreased episodes of syncope in early mobilization group ◦ 3 episodes in early mob group and 11 in control

group 2* postural hypotension Decreased prevalence of DVT’s in the early

mobilization group ◦ 1 in early mobilization group ◦ 27 in control group

Results second study cont.’d…

Early mobilization within 24 hours of THA/TKA can provide significant improvements in:◦ Healing◦ LOS◦ Being able to D/C home ◦ Pain control ◦ Improvement in functional activity tolerance ◦ Decreasing chances of developing DVT’s

Discussion/Conclusion

Tayrose, G. Rapid Mobilization Decreased Length-of-stay in Joint Replacement Patients. Bulletin of the Hospital for Joint Diseases, 2013.

Pearse, E. Early Mobilisation after Conventional Knee Replacement May Reduce the Risk of Post-operative Venous Thromboembolism. The Journal of Bone & Joint Surgery, Vol. 89B. March 2007

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