title: Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review.
abstract: OBJECTIVE
  To systematically review the effect of early mobilization after hip or knee joint replacement surgery on length of stay in an acute hospital.
  
  
  METHODS
  Randomized controlled trials were selected from electronic databases based on inclusion criterion requiring an experimental group mobilizing (sitting out of bed/walking) earlier than a comparison group post joint replacement surgery of the hip or knee in an acute hospital. Clinically homogeneous data were analyzed with meta-analysis.
  
  
  RESULTS
  Five randomized controlled trials (totaling 622 participants) were included for review. A meta-analysis of 5 trials found a reduced length of stay of 1.8 days (95% confidence interval 1.1 to 2.6) in favor of the experimental group. In 4 of the 5 trials the experimental group first sat out of bed within 24 hours post operatively. In 4 of the 5 trials the experimental group first walked within 48 hours post operatively. Individual trials reported benefits in range of motion, muscle strength and health-related quality of life in favor of the experimental group. There were no differences in discharge destinations, incidence of negative outcomes or adverse events attributable to early mobilization when compared to the comparison groups.
  
  
  CONCLUSIONS
  Early mobilization post hip or knee joint replacement surgery can result in a reduced length of stay of about 1.8 days. Trials that reported these positive results showed that early mobilization can be achieved within 24 hours of operation. This positive gain was achieved without an increase in negative outcomes.
authors.affiliation: Physiotherapy Department, Eastern Health, Melbourne, Victoria, Australia mark.guerra@easternhealth.org.au.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Guerra
authors.affiliation: Orthopaedic Consultant, Eastern Health, Melbourne, Victoria, Australia.
authors.forename: Parminder J
authors.initials: PJ
authors.lastname: Singh
authors.affiliation: Allied Health Clinical Research Office, Eastern Health, Australia Department of Physiotherapy, La Trobe University, Australia.
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Taylor
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D004434:Early Ambulation; D006801:Humans; D007902:Length of Stay; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*
keywords: Early mobilization; hip joint replacement; knee joint replacement; length of stay