title: Early enforced mobilisation following surgery for gastrointestinal cancer: feasibility and outcomes.
abstract: OBJECTIVE
  To evaluate the feasibility and outcomes of early enforced mobilisation following surgery for gastrointestinal cancer.
  
  
  METHODS
  Feasibility study with a separate-sample pre-post-test design.
  
  
  METHODS
  Surgical gastrointestinal ward.
  
  
  METHODS
  Patients with various types of gastrointestinal cancer, before and after implementation of postoperative enforced mobilisation (n=55 and n=61, respectively).
  
  
  METHODS
  The enforced mobilisation protocol included structured mobilisation by a nurse and walking supervised by a physiotherapist, starting within 24hours of surgery.
  
  
  METHODS
  The enforced mobilisation protocol was deemed to be feasible if at least 50% of patients were able to walk the scheduled distance on postoperative day 1. Pre- and postimplementation differences in postoperative pulmonary complications (PPCs), length of hospital stay (LOS) and re-admission rate were analysed using regression analyses, adjusting for relevant co-variables.
  
  
  RESULTS
  In the various surgical groups, between 48% and 56% of patients were able to walk the scheduled distance on postoperative day 1, which was regarded as feasible. However, none of the patients who had undergone oesophageal resection were able to walk on postoperative day 1. Excluding these patients from the analyses, a significant decrease in PPCs was found (odds ratio 0.08, 95% confidence interval 0.010 to 0.71, P=0.023) following implementation of enforced mobilisation. Differences in LOS and re-admission rate were not significant.
  
  
  CONCLUSIONS
  Early enforced mobilisation seems to be feasible in patients following surgery for gastrointestinal cancer, except for those undergoing oesophageal resection. The occurrence of PPCs was reduced after implementation of enforced mobilisation. Further research is needed to confirm these results.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands; Amsterdam Rehabilitation Research Centre/Reade, Amsterdam, The Netherlands. Electronic address: m.vd.leeden@reade.nl.
authors.forename: M
authors.initials: M
authors.lastname: van der Leeden
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Huijsmans
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Geleijn
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: E S M
authors.initials: ES
authors.lastname: de Lange-de Klerk
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Dekker
authors.affiliation: Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Bonjer
authors.affiliation: Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: D L
authors.initials: DL
authors.lastname: van der Peet
mesh_terms: D000328:Adult; D000368:Aged; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D016138:Walking
keywords: Gastrointestinal cancer; Length of hospital stay; Outcome; Postoperative mobilisation; Postoperative pulmonary complications; Surgery