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PubMed2003

Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection.

INTRODUCTION: In an era of dwindling hospital resources and increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. Although several protocols have been reported to reduce postoperative stay, no Level I evidence exists for their use in routine clinical practice. METHODS: Sixty-four patients undergoing laparotomy and intestinal or rectal resection were randomly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care. Time to discharge from hospital, complication and readmission rates, pain level, quality of life, and patient satisfaction scores were determined at the time of discharge and at 10 and 30 days after surgery. Subgroups were defined to evaluate those who derived the optimal benefit from the protocol. RESULTS: Pathway patients spent less total time in the hospital after surgery (5.4 vs. 7.1 days; P = 0.02) and less time in the hospital during the primary admission than traditional patients. Patients younger than 70 years old had greater benefits than the overall study group (5 vs. 7.1 days; P = 0.01). Patients treated by surgeons with the most experience with the pathway spent significantly less time in the hospital than did those whose surgeons were less experienced with the pathway (P = 0.01). There was no difference between pathway and traditional patients for readmission or complication rates, pain score, quality of life after surgery, or overall satisfaction with the hospital stay. CONCLUSIONS: Patients scheduled for a laparotomy and major intestinal or rectal resection are suitable for management by a pathway of controlled rehabilitation with early ambulation and diet. Pathway patients have a shorter hospital stay, with no adverse effect on patient satisfaction, pain scores, or complication rates. Patients younger than 70 years of age derive the optimal benefit, and increased surgeon experience improves outcome.

Adult↗
PubMed2001

Coronary angiography using 4 Fr catheters with acisted power injection: A randomized comparison to 6 Fr manual technique and early ambulation.

Coronary angiography using 4 Fr catheters may reduce access site complications, promote better utilization of outpatient facilities, but at a cost of suboptimal image quality. To determine whether 4 Fr diagnostic angiography with power injection (Acist, Minneapolis, MN) was equivalent to 6 Fr manual technique, 101 unselected patients were randomized to transfemoral coronary angiography with 4 or 6 Fr catheters. Procedural characteristics, angiographic quality scores, and results of 90 min ambulation were analyzed. Coronary angiographic quality scores using 4 Fr and 6 Fr catheters were equivalent (left coronary artery 4.73 +/- 0.6 vs. 4.80 +/- 0.65, P = 0.28; right coronary artery 4.98 +/- 90.13 vs. 4.97 +/- 0.16, P = 0.48). However, 4 Fr left ventriculographic image score was lower (4.53 +/- 0.68 vs. 4.83 +/- 0.42, P = 0.0002), attributed, in part, to a smaller injected contrast volume (32 +/- 11 vs. 37 +/- 4 mL, P = 0.001). The total study contrast volume was significantly less in the 4 Fr group (119 +/- 35 vs. 159 +/- 52 mL, P = 0.001). Complications related to early ambulation at 90 min were similar and minimal in both groups. Compared to 6 Fr manual contrast injection technique, diagnostic angiography through 4 Fr catheters with power contrast injection resulted in equivalent coronary angiographic image quality, slightly reduced but diagnostic left ventricular image quality, and significantly less contrast volume. Four Fr angiography facilitates early ambulation without compromising safety and image quality.

Adult↗
PubMedDate not supplied

[Early ambulation].

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Early Ambulation↗
PubMed1951

[Early ambulation].

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Early Ambulation↗
PubMed2003

The influence of early ambulation and other factors on headache after lumbar myelography.

In order to determine the influence of early ambulation and other factors on headaches occurring after lumbar myelography we randomised 207 patients (127 men and 80 women) into two groups. Following the investigation, we allowed the 101 patients (65 men and 36 women) in group A to sit or stand freely, while we confined the 106 patients (62 men and 44 women) in group B to bed for 20 hours. The nine patients in group B who could not maintain bed rest were excluded. There was no significant difference between the two groups as regards the prevalence of spinal headache (8.9% in group A v 14.4% in group B). Patients who reported headaches, however, were significantly more likely to be women (18.7%) than men (73%), be younger (mean age 45 years v 56 years), have a higher cerebrospinal pressure before removal of fluid (mean values 172 v 137 mm H2O) and a lower systolic (mean values 120 v 134 mmHg) and diastolic blood pressure. We conclude that, although other factors may be associated with headaches, late ambulation is not effective in preventing spinal headaches after lumbar myelography.

Adult↗
PubMed1993

Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing.

Eighteen neurologically intact patients with burst fractures at the thoracolumbar junction were treated with early ambulation in a total contact orthosis. No attempt was made to reduce the associated deformity. Selection criteria excluded patients with posterior column disruption. Hospital stay averaged 10 days. Follow-up averaged 19 months. Mean kyphosis was 19 at time of injury and 20 at follow-up. At follow-up, 15 patients rated their pain as little or none. Seventeen patients had little or no restriction of activity. Follow-up computed tomography (CT) scans obtained in eight patients showed significant resorption of retropulsed bone. No deterioration of neurologic function developed in any patient. In patients with intact posterior elements and thoracolumbar burst fractures, early mobilization in a total contact TLSO can lead to satisfactory functional results. Prolonged bed rest was not required in this series. The authors attribute the good results of nonoperative management to the exclusion of patients with posterior column disruption.

Braces↗
PubMed1992

Early ambulation and discharge in 100 patients with burns of the foot treated by grafts.

Traditional treatment after grafting of foot, ankle, and lower leg burns is bedrest, limb elevation, and gradual ambulation only after 5 to 10 days. In 1982 we suggested that aggressive surgical treatment and early ambulation could shorten hospital stay and decrease morbidity. Our treatment of these burns is excision and grafting, application of an Unna (dome paste) boot immediately in the operating room or the next morning, with normal ambulation 4 hours later and discharge of the patient if there are no other reasons for continued hospitalization. This paper reports the continuation of this plan in 100 patients treated since 1982 with a mean age of 28.8 +/- 16.9 (SD) years and burn size of 3.7% +/- 4.4%. Sheet grafts were applied to 64% with a 96% take and narrowly meshed grafts to 36% with a 97% take. Results were excellent in 85 patients, satisfactory in ten, and poor in three who required another graft. Return to work was in 4.7 +/- 3 weeks. Unna boot application permits immediate ambulation, avoids frequent dressing changes, permits a brief or no hospital stay, and provides excellent graft take with prompt return to work.

Administration, Topical↗
PubMed1993

Headache after lumbar iohexol myelography: the influence of a history of headaches and early ambulation.

Whether a history of headache or "early" versus "late" ambulation (no bed rest or bed rest for 24 h) influence the occurrence of headache after lumbar iohexol myelography was studied by blinded interviews in 158 consecutive patients referred for elective lumbar myelography (LM) because of suspected lumbar disc prolapse or spinal stenosis. Headache after LM occurred more often in patients with a history of headache (57%) than in patients without such a history (29%), P < 0.001. Patients with normal myelographic findings complained of headache after LM more often (55%) than patients with abnormal myelograms (31%), P < 0.008. No difference in the incidence of headache after LM was demonstrated in early versus late ambulation.

Adolescent↗
PubMed1982

Early ambulation with localizer cast following posterior spinal fusion without internal fixation.

One hundred fourteen patients have been treated with posterior spinal fusion with no internal fixation, followed by early ambulation in localizer casts. The group included 114 patients (104 girls and 10 boys) with an average age of 14.5 years at the time of surgery. All patients underwent preoperative Cotrel traction. Localizer casts were fitted during the first postoperative week, and ambulation was begun as soon as supine films in the cast showed acceptable correction. Six months postfusion the localizer casts were removed and replaced with underarm casts, which were maintained for an additional 4 months. We have found this treatment to be quite effective in patients with single curves, with an average curve correction of 44 degrees. Results in patients with double structural curves have been less encouraging, and it would seem that such patients are best treated with internal fixation.

Adolescent↗
PubMed1984

Early ambulation physical activity: myocardial infarction and coronary artery bypass surgery.

The accepted pattern of care for the patient recovering from myocardial infarction or coronary bypass surgery in the 1980s is characterized by an earlier resumption of physical activity, a consequent decrease in imposed invalidism, and earlier discharge from the hospital for appropriately selected patients. Early ambulation has been demonstrated to be desirable, feasible, cost-effective, and safe.

Coronary Artery Bypass↗
PubMed1984

Early ambulation after myocardial infarction. The in-patient exercise program.

At present, the care of patients with myocardial infarction, especially those with few or no complications, is characterized by an abbreviation of the period of bed rest, a decrease in the restriction of activity, earlier resumption of physical activity, and earlier discharge from the hospital for appropriately selected individuals. The physiologic basis for early ambulation is reviewed and a program for rehabilitative physical activity is outlined.

Activities of Daily Living↗
PubMed1954

Early ambulation.

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Early Ambulation↗