title: The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review.
abstract: BACKGROUND
  Early mobilization is considered an important element of postoperative care; however, how best to implement this intervention in clinical practice is unknown. This systematic review summarizes the evidence regarding the impact of specific early mobilization protocols on postoperative outcomes after abdominal and thoracic surgery.
  
  
  METHODS
  The review was performed according to PRISMA guidelines. We searched 8 electronic databases to identify studies comparing patients receiving a specific protocol of early mobilization to a control group. Methodologic quality was assessed using the Downs and Black tool.
  
  
  RESULTS
  Four studies in abdominal surgery (3 randomized controlled trials [RCTs] and 1 observational prospective study) and 4 studies in thoracic surgery (3 RCTs and 1 observational retrospective study) were identified. None of the 5 studies evaluating postoperative complications reported differences between groups. One of 4 studies evaluating duration of stay reported a significant decrease in the intervention group. One of 3 studies evaluating gastrointestinal function reported differences in favor of the intervention group. One of 4 studies evaluating performance-based outcomes reported differences in favor of the intervention group. One of 5 studies evaluating patient-reported outcomes reported differences in favor of the intervention group. Overall methodologic quality was poor.
  
  
  CONCLUSIONS
  Few comparative studies have evaluated the impact of early mobilization protocols on outcomes after abdominal and thoracic surgery. The quality of these studies was poor and results were conflicting. Although bed rest is harmful, there is little available evidence to guide clinicians in effective early mobilization protocols that increase mobilization and improve outcomes.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Tanya
authors.initials: T
authors.lastname: Castelino
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Julio F
authors.initials: JF
authors.lastname: Fiore
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Petru
authors.initials: P
authors.lastname: Niculiseanu
authors.affiliation: Montreal General Hospital Medical Library, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Landry
authors.affiliation: Division of Anesthesia, Montreal General Hospital, Montreal, Quebec, Canada.
authors.forename: Berson
authors.initials: B
authors.lastname: Augustin
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: liane.feldman@mcgill.ca.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000005:Abdomen / Q000601:surgery*; D004434:Early Ambulation; D006801:Humans; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D019616:Thoracic Surgical Procedures / Q000534:rehabilitation*; D016896:Treatment Outcome