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Current Geriatrics Reports

Erschienen in:

04.12.2020 | Geriatric Orthopedics (C Quatman and C Quatman-Yates, Section Editors)

Mobility in Acute Care for Geriatric Patients with Orthopedic Conditions: a Review of Recent Literature

verfasst von: Madison Peck, Amy Holthaus, Katelyn Kingsbury, Marka Gehrig Salsberry, Vijay Duggirala

Erschienen in: Current Geriatrics Reports | Ausgabe 4/2020

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Abstract

Purpose of Review

The purpose of this literature review is to appraise the current research surrounding the impact of mobility for geriatric patients presenting with orthopedic conditions in the acute care setting.

Recent Findings

A literature search in the PubMed database yielded 53 results which underwent a title and abstract screening to reveal a total of 22 articles eligible for full-text review. Two authors screened each article and a third author was responsible for reconciling any conflicts. Following the full-text screen, 10 total articles were extracted and evaluated to determine what the current literature has concluded about the impact of mobilization for geriatric patients with orthopedic conditions in the acute care setting. Studies are inconsistent in their dosage parameters of mobility for geriatric orthopedic patients and range in initiating protocols 6 to 24 h following surgery. Protocols and activity standards vary from 1.8 to 8.3 METs, 0 to 1000 steps per day, 15 min walks, or a 5-day mobility protocol focused on functional and strengthening activities. Studies range in reported length of stay (LOS) but infer that the earlier mobility is initiated the risk of prolonged LOS is decreased. Finally, studies report greater success with mobility protocols when multiple disciplines are educated and involved in implementation.

Summary

Despite the limitations of this study and existing literature, it is clear that integrating mobility within the first 24 h following the injury or surgical intervention does not produce additional adverse effects or increase pain intensity. This review suggests that emphasizing interprofessional collaboration when implementing a mobility protocol is vital to the success and safety of patients.

Hastings SN, Choate AL, Mahanna EP, et al. Early mobility in the hospital: lessons learned from the STRIDE Program. Geriatr Basel Switz. 2018;3(4). https://doi.org/10.3390/geriatrics3040061.

2.•

Lisi C, Caspani P, Bruggi M, et al. Early rehabilitation after elective total knee arthroplasty. Published online 2017:6. This study provided data that confirms the benefit of rehabilitation started as soon as 24 h after minimally invasive surgery on the achievement of early recovery of walking controlling pain.

Abeles A, Kwasnicki RM, Pettengell C, Murphy J, Darzi A. The relationship between physical activity and post-operative length of hospital stay: a systematic review. Int J Surg Lond Engl. 2017;44:295–302. https://doi.org/10.1016/j.ijsu.2017.06.085.CrossRef

4.•

Daskivich TJ, Houman J, Lopez M, et al. Association of wearable activity monitors with assessment of daily ambulation and length of stay among patients undergoing major surgery. JAMA Netw Open. 2019;2(2):e187673. https://doi.org/10.1001/jamanetworkopen.2018.7673This study provided data about dosage of ambulation during hospitalization and the impact the amount of steps taken has on functional outcomes and length of stay.CrossRefPubMedPubMedCentral

Ravi B, Croxford R, Reichmann WM, Losina E, Katz JN, Hawker GA. The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007. Best Pract Res Clin Rheumatol. 2012;26(5):637–47. https://doi.org/10.1016/j.berh.2012.07.014.CrossRefPubMed

Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporos Int. 2013;24(10):2725–8. https://doi.org/10.1007/s00198-013-2375-9.CrossRefPubMedPubMedCentral

Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev. 2005;11(2):115–9. https://doi.org/10.1136/ip.2004.005835.CrossRefPubMedPubMedCentral

Scheerman K, Raaijmakers K, Otten RHJ, Meskers CGM, Maier AB. Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: a systematic review. BMC Geriatr. 2018;18(1):288. https://doi.org/10.1186/s12877-018-0965-2.CrossRefPubMedPubMedCentral

Oxford Centre for Evidence-based Medicine - Levels of evidence (March 2009). CEBM. Published June 11, 2009. Accessed June 14, 2020. https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/.

10.

Asplin G, Carlsson G, Zidén L, Kjellby-Wendt G. Early coordinated rehabilitation in acute phase after hip fracture – a model for increased patient participation. BMC Geriatr. 2017;17(1). https://doi.org/10.1186/s12877-017-0640-z.

11.

Soeters R, White PB, Murray-Weir M, Koltsov JCB, Alexiades MM, Ranawat AS. Preoperative physical therapy education reduces time to meet functional milestones after total joint arthroplasty. Clin Orthop. 2018;476(1):40–8. https://doi.org/10.1007/s11999.0000000000000010.CrossRefPubMed

12.•

Zietek P, Zietek J, Szczypior K, Safranow K. Effect of adding one 15-minute-walk on the day of surgery to fast-track rehabilitation after total knee arthroplasty: a randomized, single-blind study. Eur J Phys Rehabil Med. 2015;51(3):8 This study provided data that suggests more intense exercise during the hospitalization period may improve functional recovery without increasing pain for patients following TKA.

13.•

Kataoka H, Ikemoto T, Yoshimura A, et al. Association of early physical activity time with pain, activities of daily living, and progression of vertebral body collapse in patients with vertebral compression fractures. Eur J Phys Rehabil Med. 2017;53(3):11 This article was able to draw the conclusions that coordinated, intensive rehabilitation compared to standard protocols, improved reports of higher levels of perceived participation, greater levels of independence with P-ADL activities of lower body hygiene and dressing at discharge, and decreased help required for walking outdoors and ascend/descend stairs at 1 month follow-up.

14.•

Resnick B, Wells C, Galik E, et al. Feasibility and efficacy of function-focused care for orthopedic trauma patients. J Trauma Nurs. 2016;23(3):144–55. https://doi.org/10.1097/JTN.0000000000000203This article provided insight into how disciplines other than PT and OT can play a key role in the mobilization of patients in the hospital to improve functional outcomes for patients by using the Function-Focused Care in Acute Care (FCC-AC) framework.CrossRefPubMedPubMedCentral

15.•

Polnaszek B, Mirr J, Roiland R, Gilmore-Bykovskyi A, Hovanes M, Kind A. Omission of physical therapy recommendations for high-risk patients transitioning from the hospital to subacute care facilities. Arch Phys Med Rehabil. 2015;96(11):1966–1972.e3. https://doi.org/10.1016/j.apmr.2015.07.013This article included data that showed the rate at which PT recommendations are omitted from the patient’s discharge summary from the hospital for patients transitioning to a sub-acute care facility. Such omissions were shown to lead to negative functional outcomes at a 30-day follow up. This suggests the importance of including PT recommendations into the patient’s discharge summary from hospital for providers at the next level of care, which emphasizes the need for increased intradisciplinary and interdisciplinary collaboration across levels of care.CrossRefPubMedPubMedCentral

16.

Isaac D, Falode T, Liu P, I’Anson H, Dillow K, Gill P. Accelerated rehabilitation after total knee replacement. Knee. 2005;12(5):346–50. https://doi.org/10.1016/j.knee.2004.11.007.CrossRefPubMed

17.•

Goyal N, Chen AF, Padgett SE, et al. Otto Aufranc Award: a multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clin Orthop Relat Res. 2017;475(2):364–72. https://doi.org/10.1007/s11999-016-4915-zThis study provided data that shows a difference in VAS pain scores among those who discharge home on DOS versus those who stay overnight in the hospital. The cause of the increased pain for those who discharge home is unclear; improved counseling on pain management at home (when to take medications, which medications to take, modalities to reduce pain) may be warranted or the increase in pain could be due to the increased mobility required to transition from the hospital to the patient’s home.CrossRefPubMed

18.•

Gromov K, Jørgensen CC, Petersen PB, et al. Complications and readmissions following outpatient total hip and knee arthroplasty: a prospective 2-center study with matched controls. Acta Orthop. 2019;90(3):281–5. https://doi.org/10.1080/17453674.2019.1577049This study provided data comparing readmission rates in patients with either a THA or TKA who were discharged on DOS versus patients with at least 1 overnight stay. No statistical significant differences were found between groups.CrossRefPubMedPubMedCentral

19.

Chen H, Chen H, Wang Y, Chen P, Chien C. Association between rehabilitation timing and major complications of total knee arthroplatsy. J Rehabil Med. 2012;44(7):588–92. https://doi.org/10.2340/16501977-0971.CrossRefPubMed

Titel: Mobility in Acute Care for Geriatric Patients with Orthopedic Conditions: a Review of Recent Literature
verfasst von: Madison Peck
Amy Holthaus
Katelyn Kingsbury
Marka Gehrig Salsberry
Vijay Duggirala
Publikationsdatum: 04.12.2020
Verlag: Springer US
Erschienen in: Current Geriatrics Reports / Ausgabe 4/2020
Elektronische ISSN: 2196-7865
DOI: https://doi.org/10.1007/s13670-020-00347-1

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