ArticleBMC musculoskeletal disorders2020
Implementing early mobilisation after knee or hip arthroplasty to reduce length of stay: a quality improvement study with embedded qualitative component.
Article in BMC musculoskeletal disorders, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Enhancing postoperative recovery in total hip arthroplasty: the role of pericapsular nerve group and lateral cutaneous nerve block under spinal anaesthesia.International orthopaedics · 2024Trial
- Higher Perioperative Opioid Use Is Associated With Reduced Early Ambulation Following Total Hip and Knee Arthroplasty.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Article
- Early ambulation within 24 h after joint arthroplasty: a retrospective cohort study.Frontiers in medicine · 2026Article
- Postoperative outcomes following prehabilitationWorld journal of gastrointestinal surgery · 2025Article
- The anesthetic and recovery profiles of low-dose hypobaric mepivacaine and bupivacaine for spinal anesthesia in total hip and knee arthroplasty: a prospective observational study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025Observational
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- HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER): a protocol for a randomised controlled trial.BMJ open · 2024Article
- Enhanced recovery after surgery protocol improves postoperative pain and shortens length of stay among patients undergoing primary total knee arthroplasty.Journal of orthopaedics · 2024Article
- Evaluation of therapy in traumatic elderly falls to return autonomy and functional status.Surgery open science · 2022Article
- Long-term opioid use in seniors following hip and knee arthroplasty in Ontario: a historical cohort study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2022Article
- Non-pharmaceutical treatments to relieve pain or reduce opioid analgesic intake and improve quality of life after total hip replacement: a meta analysis.American journal of translational research · 2022Review
- Effect of Early Mobilization on Hip and Lower Extremity Postoperative: A Literature Review.SAGE open nursingReview
Corrections and comments
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Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundModels of care for managing total knee or hip arthroplasty (TKA, THA) incorporating early mobilisation are associated with shorter acute length-of-stay (LOS). Few studies have examined the effect of implementing early mobilisation in isolation, however. This study aimed to determine if an accelerated mobilisation protocol implemented in isolation is associated with a reduced LOS without undermining care.
methodA Before-After (quasi-experimental) study was used. Standard practice pre-implementation of the new protocol was physiotherapist-led mobilisation once per day commencing on post-operative Day 1 (Before phase). The new protocol (After phase) aimed to mobilise patients four times by end of Day 2 including an attempt to commence on Day 0; physiotherapy weekend coverage was necessarily increased. Poisson regression modelling was used to determine associations between study period and LOS. Additional outcomes to 12 weeks post-surgery were monitored to identify unintended consequences of the new protocol. Time to first mobilisation (hours) and proportion mobilising Day 0 were monitored to assess protocol compliance. An embedded qualitative component captured staff perspectives of the new protocol.
resultsFive hundred twenty consecutive patients (n = 278, Before; n = 242, After) were included. The new protocol was associated with no change in unadjusted LOS, a small reduction in adjusted LOS (8.1%, p = 0.046), a reduction in time to first mobilisation (28.5 (10.8) vs 22.6 (8.1) hrs, p < 0.001), and an increase in the proportion mobilising Day 0 (0 vs 7%, p < 0.001). Greater improvements were curtailed by an unexpected decrease in physiotherapy staffing (After phase). There were no significant changes to the rates of complications or readmissions, joint-specific pain and function scores or health-related quality of life to 12 weeks post-surgery. Qualitative findings of 11 multidisciplinary team members highlighted the importance of morning surgery, staffing, and well-defined roles.
conclusionSmall reductions in LOS are possible utilising an early mobilisation protocol in isolation after TKA or THA although staff burden is increased likely undermining both sustainability and the magnitude of the change. Simultaneous incorporation of other changes within the pathway would likely secure larger reductions in LOS.
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