What is the rationale for early mobilization and walking in patients after hospital admission or surgery?

Rationale for Early Mobilization and Walking in Hospitalized Patients

Early mobilization and walking should be initiated within 24-48 hours of hospital admission or surgery for most patients to reduce complications, decrease length of stay, and improve overall outcomes. 1, 2

Benefits of Early Mobilization

Early mobilization provides multiple significant benefits:

Reduced Complications

• Respiratory benefits: Decreases risk of pneumonia, atelectasis, and pleural effusions 1
• Cardiovascular benefits: Reduces risk of venous thromboembolism 2
• Functional benefits: Improves physical capacity (VO2 max and 6-minute walking test) 1

Improved Hospital Outcomes

• Decreased ICU length of stay 1, 2
• Enhanced functional recovery with patients achieving functional objectives more rapidly 1
• Improved patient satisfaction compared to simple mobilization 1
• Reduced risk of hospital-acquired functional decline, which affects approximately 35% of hospitalized patients 3

Long-term Benefits

• Reduced medium and long-term mortality (at 1 year and 10 years) when part of comprehensive rehabilitation 1
• Improved cognitive outcomes with significant decrease in cognitive impairment at one year after hospital discharge 1

Timing of Mobilization

The optimal timing depends on the clinical context:

• Cardiac surgery patients: Mobilization should begin within the first postoperative day 1
• Stroke patients: Mobilization should typically begin between 24-48 hours after stroke onset if there are no contraindications 1
• General surgery patients: Mobilization should begin within 24 hours post-surgery 2
• ICU patients: Light sedation strategies should be employed to enable early mobilization 1

Implementation Strategies

Progressive Approach

1. Start with sitting up in bed
2. Progress to sitting at edge of bed
3. Advance to standing
4. Begin walking with appropriate assistance
5. Gradually increase frequency and duration 1

Frequency and Duration

• More frequent, shorter sessions are preferable to longer, less frequent sessions 1
• Each additional mobilization session improves odds of favorable outcome by 13% and improves odds of walking 50m unassisted by 66% 1
• However, excessive duration per session may be counterproductive - every extra 5 minutes of out-of-bed activity reduced odds of favorable outcome in stroke patients 1

Removing Barriers to Mobility

• Remove thoracic drains, urinary catheters, and arterial/central venous catheters as soon as safely possible 1, 2
• Address pain management with multimodal analgesia to facilitate mobility 2
• Consider changing patient attire from pajamas to day clothes, as wearing pajamas during daytime is negatively associated with mobilization level 3

Assistive Devices for Mobilization

When needed, appropriate assistive devices can significantly improve functional mobility:

• Canes: Suitable for patients who need minimal support and have good balance 4
• Walkers: Provide greater stability for patients with poor balance or bilateral lower limb weakness 4
• Two-wheel rolling walkers: More functional and easier to maneuver than standard walkers 4
• Four-wheel rolling walkers (rollators): For higher-functioning individuals who need rest breaks 4

Research shows that assistive walking devices improve functional mobility in rehabilitation patients, with two patients needing to be treated with a cane or combined devices for one to improve functional mobility 5.

Cautions and Contraindications

Early mobilization may not be appropriate for all patients. Contraindications include:

• Arterial puncture for an interventional procedure
• Unstable medical conditions
• Low oxygen saturation
• Lower limb fracture or injury 1
• High-dose, very early mobilization (within 24 hours) after stroke may reduce odds of favorable outcome 1

Nursing Role in Mobilization

Nurses play a critical role in patient mobilization:

• Education and training programs targeted for nurses improve willingness to mobilize patients 6
• Adequate staffing levels are necessary for safe transfers and ambulation 6
• Nurses should take responsibility to ensure patients achieve their highest possible level of mobility 3

Conclusion

Early mobilization is a cornerstone of high-quality inpatient care that significantly improves patient outcomes. The evidence strongly supports implementing structured early mobilization protocols that begin within 24-48 hours of admission or surgery when medically appropriate, with frequent but short mobilization sessions tailored to the patient's condition.