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2.
Sports Health ; 12(2): 124-131, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31916920

RESUMO

CONTEXT: Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines. EVIDENCE ACQUISITION: Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)-accredited academic orthopaedic surgery programs. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. RESULTS: Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport-specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks. CONCLUSION: Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair. STRENGTH OF RECOMMENDATION TAXONOMY (SORT): Level C.


Assuntos
Artroscopia/reabilitação , Lesões de Bankart/cirurgia , Terapia por Exercício/métodos , Instabilidade Articular/cirurgia , Luxação do Ombro/cirurgia , Artroscopia/métodos , Protocolos Clínicos , Deambulação Precoce , Humanos , Força Muscular/fisiologia , Amplitude de Movimento Articular , Treinamento de Resistência , Restrição Física , Volta ao Esporte , Fatores de Tempo
3.
Medicine (Baltimore) ; 99(4): e18843, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977881

RESUMO

BACKGROUND: Prolonged hospitalization and immobility of critical care patients elevates the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. This systematic review and meta-analysis aims to assess the effects of early mobilization therapy for non-emergency cardiac surgery patients in the intensive care unit (ICU). METHODS: The following databases will be used to search for relevant keywords: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library from inception to September 2018 by 2 researchers independently. Randomized controlled trials (RCTs), will be included if patients are adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who are treated with experimental physiotherapy initiated in the ICU (pre, post, or perioperative). The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous outcomes will be presented as the weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence interval (CI), while dichotomous data will be expressed as relative risk (RR) with 95% CI. If the included studies have existing heterogeneity (P < 0.1), a random-effects model will be used. Otherwise, we will calculate using a fixed effects model. RESULTS: This review will evaluate the effects of early mobilization on length of ICU and hospital stay, physical function and adverse events in patients with cardiac surgery patients in the ICU. CONCLUSION: This systematic review will comprehensively provide conclusive evidence of the therapeutic effect of early mobilization on cardiac surgery patients in the ICU.PROSPERO Research registration identifying number: CRD42019135338.


Assuntos
Procedimentos Cirúrgicos Cardíacos/reabilitação , Deambulação Precoce/métodos , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação , Metanálise em Rede , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
J Craniomaxillofac Surg ; 48(1): 43-48, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31818687

RESUMO

OBJECTIVE: There is lack of standardized management and mobilization strategies after oral and maxillofacial reconstruction surgery. We used prospective randomized controlled trials to explore improvements in postoperative mobilization protocol in such patients. METHODS: A total of 149 patients were randomly divided into tracheotomy control group A (38 cases) and test group A (37 cases), nontracheotomy control group B (38 cases) and test group B (36 cases). Test group patients sat up in bed on the 2nd day after surgery and performed off-bed activity on the 3rd day, whereas control group patients sat up in bed on the 4th day postoperatively and performed off-bed activity on the 6th day. Objective evaluation included free flap success rate, postoperative complications, sleep time, and catheter removal time, among other parameters. Subjective evaluation included postoperative pain and comfort evaluation. RESULTS: The success rate of free flaps was 97.3% in test group A and 100% in the other groups. In terms of mean sleep time, 4.6 ± 1.0 h in test group A, which was longer than 4.1 ± 1.0 h in control group A (P = 0.034); 5.7 ± 1.4 h in test group B, which was longer than 4.9 ± 1.7 h in control group B (P = 0.026). Early activity makes catheter removal time (tracheal incision, nasogastric tube, urethral catheter) shorter and gets higher comfort evaluation scores in both test groups versus control groups (P < 0.05). CONCLUSIONS: The early mobilization protocol for patients undergoing free flap reconstruction was safe, and can effectively improve sleep, shorten the catheter indwelling time, and increase the patient's comfort level.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Bucal , Deambulação Precoce , Humanos , Dor Pós-Operatória , Estudos Prospectivos
5.
J Nurs Care Qual ; 35(1): 20-26, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30889084

RESUMO

BACKGROUND: Hospitalized medical-surgical patients are at risk for adverse health outcomes due to immobility. Despite well-documented consequences, low mobility is prevalent. LOCAL PROBLEM: In a 547-bed hospital, medical-surgical patients were mobilized less frequently than expected. Physical therapists were inappropriately consulted 22% of the time for routine mobility of patients. A preimplementation survey of registered nurses indicated a lack of knowledge and confidence to safely mobilize patients. METHODS: This quality improvement project implemented a nurse-led mobility program in an effort to increase early mobilization, reduce physical therapy referrals for routine mobility, and reduce the sequelae of immobility. INTERVENTIONS: The Bedside Mobility Assessment Tool and standardized interventions were implemented on 5 medical-surgical units. RESULTS: Postimplementation, nurse-led patient mobilizations increased by 40%, inappropriate physical therapy orders decreased 14%, and no significant change in patient falls or pressure injuries was noted. CONCLUSION: A nurse-led mobility program was effective in increasing safe, early mobilization of patients and improving the culture of mobility.


Assuntos
Deambulação Precoce/enfermagem , Enfermagem Médico-Cirúrgica/métodos , Idoso , Idoso de 80 Anos ou mais , California , Deambulação Precoce/tendências , Feminino , Humanos , Masculino , Enfermagem Médico-Cirúrgica/tendências , Pessoa de Meia-Idade , Desenvolvimento de Programas/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Melhoria de Qualidade , Inquéritos e Questionários
6.
J Intensive Care Med ; 35(1): 55-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28847238

RESUMO

PURPOSE: Growing evidence suggests that early mobilization benefits intensive care unit (ICU) patients. However, national practices and the culture of individual ICUs influence mobilization activities. MATERIALS AND METHODS: In a 1-day, Swiss point prevalence study conducted in 35 ICUs (representing 45% of all ICUs), the highest level of mobilization for mechanically ventilated patients was characterized using the validated ICU Mobility Scale, along with data collection for potential safety events and mobilization barriers. RESULTS: Among 161 mechanically ventilated patients, a total of 33% (n = 53) had active mobilization, with walking achieved by only 2% (n = 4). More severe organ failure was associated with lower mobilization (respiratory Sequential Organ Failure Assessment score: P = .037, cardiac: P = .008, neurology: P < .001). Barriers to mobilization were reported in 71% (n = 115), with deep sedation significantly higher among patients receiving passive versus active mobilization (14% vs 0%, P = .005). Potential safety events occurred in 20% (n = 33) of patients without significant differences between passive and active mobilization. Availability of physiotherapists and appropriate equipment were not reported barriers. CONCLUSION: Mobilization during mechanical ventilation occurred infrequently with greater organ failure associated with lower mobilization. Addressing the identified modifiable barriers via structured efforts to achieve multidisciplinary culture change is essential to decrease the common use of bed rest in Swiss ICUs.


Assuntos
Deambulação Precoce , Unidades de Terapia Intensiva/estatística & dados numéricos , Limitação da Mobilidade , Respiração Artificial/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Suíça
8.
BMC Musculoskelet Disord ; 20(1): 418, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506099

RESUMO

BACKGROUND: Resuming walking after lumbar surgery is a common focus of early post-operative rehabilitation, however there is no knowledge about whether increased walking is associated with better functional outcomes. This study aimed to determine whether time spent walking in the week after lumbar surgery, along with co-morbidities, pre-operative pain duration, pre-operative physical activity or function, or surgical variables predict substantial improvement in physical function six months after lumbar surgery. METHODS: A prospective cohort study design was utilized. Participants undergoing lumbar surgery (discectomy, decompression, fusion) were recruited between April and November 2016. Predictor variables were collected pre-operatively (age, sex, smoking status, obesity, diabetes, depression, anxiety, pre-operative pain duration, neurological deficit, physical activity levels, mobility restriction, function) and early post-operatively (post-operative walking time, surgical procedure, single/multi-level surgery). Outcome variables (physical function, back pain and leg pain severity) were measured pre-operatively and six-months post-operatively. Logistic regression analysis was used to establish prediction of substantial improvement in outcome at six months. RESULTS: Participants (N = 233; 50% female; age 61 (SD = 14) years) who walked more in the first post-operative week were more likely to have substantially improved function on the Oswestry Disability Questionnaire at six months (OR 1.18, 95%CI 1.02-1.37), as were participants with < 12 months pre-operative pain (OR 2.71, 95%CI 1.28-5.74), and those with lower pre-operative function (OR 4.02, 95%CI 2.33-6.93). Age < 65 years (OR 2.36, 95%CI 1.14-4.85), and < 12 months pre-operative pain (OR 3.52 95%CI 1.69-7.33) predicted substantial improvement on the SF-36 Physical Component Summary. There were no significant predictors for substantial improvement in either leg or back pain. CONCLUSIONS: Walking time in the week after lumbar surgery is one of several predictors of substantial improvement in function at six months. Further research is required to determine whether intervention designed to increase walking early after lumbar surgery results in improved longer-term recovery of function. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), registration number 12616000747426 . Retrospectively registered on the 7th of June 2016.


Assuntos
Dor nas Costas/cirurgia , Discotomia/reabilitação , Deambulação Precoce/métodos , Recuperação de Função Fisiológica , Doenças da Coluna Vertebral/cirurgia , Idoso , Austrália , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Avaliação da Deficiência , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Caminhada
9.
Fisioter. Pesqui. (Online) ; 26(3): 227-234, jul.-set. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1039884

RESUMO

RESUMO O objetivo deste estudo foi avaliar os efeitos do exercício passivo precoce em cicloergômetro na espessura muscular (EM) do quadríceps femoral (EMQ) de pacientes críticos admitidos em uma Unidade de Terapia Intensiva (UTI) de um hospital universitário terciário. O método utilizado foi um estudo-piloto randomizado controlado conduzido em uma amostra de 24 pacientes (51±18,11 anos, 16 do sexo masculino), com 24 a 48 horas de ventilação mecânica (VM), aleatoriamente divididos em dois grupos: grupo-controle (n=12), que recebeu a fisioterapia convencional; e grupo-intervenção (n=12), que recebeu o exercício passivo em cicloergômetro, uma vez ao dia, durante o período de sete dias do protocolo, em adição à fisioterapia convencional. A EMQ foi mensurada através da ultrassonografia. A primeira medida ultrassonográfica foi realizada entre as primeiras 48 horas de VM e a segunda ao término do protocolo. Não houve diferenças significativas na EMQ esquerda (27,29±5,86mm vs. 25,95±10,89mm; p=0,558) e direita (24,96±5,59mm vs 25,9±9,21mm; p=0,682) do grupo-controle e na EMQ esquerda (27,2±7,38mm vs 29,57±7,89mm; p=0,299) e direita (26,67±8,16mm vs 28,65±8,04mm; p=0,381) do grupo-intervenção. Na comparação entre os grupos, não houve alterações significativas em relação à EMQ esquerda (3,61±1,07mm; p=0,248) e a EMQ direita (2,75±0,85mm; p=0,738). Os resultados deste estudo-piloto demonstraram que a aplicação precoce do exercício passivo em cicloergômetro não promoveu mudanças significativas na espessura da camada muscular avaliada. No entanto, nossos achados sinalizam que a fisioterapia convencional foi capaz de preservar a EMQ de pacientes críticos admitidos em UTI.


RESUMEN El presente estudio tuvo como objetivo evaluar los efectos del ejercicio pasivo precoz en cicloergómetro en el espesor muscular (EM) del cuádriceps femoral (EMC) de pacientes críticos ingresados en una Unidad de Cuidados Intensivos (UCI) de un hospital universitario terciario. Se utilizó como método un estudio piloto aleatorizado controlado con una muestra de 24 pacientes (51±18,11 años, 16 varones), con 24 a 48 horas de ventilación mecánica (VM), quienes fueron divididos aleatoriamente en dos grupos: grupo de control (n=12), que recibió fisioterapia convencional; y grupo intervención (n=12), que recibió el ejercicio pasivo en cicloergómetro una vez al día durante el período de protocolo de siete días, además de la fisioterapia convencional. El EMC se midió por ecografía. La primera medición ecográfica se realizó entre las primeras 48 horas de VM, y la segunda al final del protocolo. No hubo diferencias significativas en el EMC izquierdo (27,29±5,86 mm vs. 25,95±10,89mm; p=0,558) y derecho (24,96±5,59mm vs 25,9±9,21mm; p=0,682) del grupo de control; y en el EMC izquierdo (27,2±7,38mm vs 29,57±7,89mm; p=0,299) y derecho (26,67±8,16mm vs 28,65±8,04mm; p=0,381) del grupo intervención. En la comparación entre grupos, no hubo cambios significativos en el EMC izquierdo (3,61±1,07 mm; p=0,248) y en el EMC derecho (2,75±0,85 mm, p=0,738). Los resultados de este estudio piloto demostraron que la aplicación precoz del ejercicio pasivo en cicloergómetro no promovió cambios significativos en el espesor de la capa muscular evaluada. Sin embargo, nuestros hallazgos indican que la fisioterapia convencional pudo preservar el EMC de pacientes críticos ingresados en la UCI.


ABSTRACT The objective of this study was to evaluate the effects of early passive cycling exercise on quadriceps femoris thickness (QFT) in critically ill patients admitted in the intensive care unit (ICU) of a tertiary care university hospital. A controlled randomized pilot study was conducted with a sample of 24 patients (51±18.11 years, 16 male), on mechanical ventilation (MV) from 24 to 48 hours, who were randomly divided into two groups: control group (n=12), receiving conventional physical therapy; and an intervention one (n=12), receiving passive cycle ergometer, once a day, throughout seven days of protocol, in addition to conventional physical therapy. The QFT was measured by ultrasonography. The first ultrasonographic measurement was performed within 48 hours after the start of MV, and the second at the end of the protocol. There were no significant differences in QFT of the left (27,29±5,86mm vs 25,95±10,89mm; p=0,558) and right (24,96±5,59mm vs 25,9±9,21mm; p=0,682) in the control group, and in QFT of the left (27,2±7,38mm vs 29,57±7,89mm; p=0,299) and right (26,67±8,16mm vs 28,65±8,04mm; p=0,381) in the intervention group. There were no significant between-groups differences for left QFT (3,61±1,07mm; p=0,248) and right QFT (2,75±0,85mm; p=0,738). The results of this pilot study demonstrate that application of early passive cycle ergometer exercises has not significantly change the muscle layer thickness. However, our findings indicate that conventional physical therapy is able to preserve the quadriceps femoris thickness in critically ill patients admitted in ICU.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Deambulação Precoce , Músculo Quadríceps/anatomia & histologia , Terapia por Exercício/métodos , Atrofia Muscular/prevenção & controle , Projetos Piloto , Ultrassonografia , Modalidades de Fisioterapia/instrumentação , Músculo Quadríceps/diagnóstico por imagem , Unidades de Terapia Intensiva
10.
Fisioter. Pesqui. (Online) ; 26(3): 235-240, jul.-set. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1039897

RESUMO

RESUMO Ainda há poucos marcadores de desempenho funcional com capacidade de predizer óbito em unidades de terapia intensiva (UTI). O objetivo do presente estudo foi identificar a associação entre a não adoção de postura antigravitacional e óbito em pacientes internados em uma UTI adulto. Trata-se de um estudo retrospectivo e analítico, realizado através da análise de prontuários. A associação entre a não adoção de postura antigravitacional e óbito foi testada por regressão logística múltipla ajustada por sexo, idade, gravidade da doença (mensurada pelo Acute Physiology and Chronic Health Classification System II [Apache II]), tempo de ventilação mecânica invasiva (VMI) e tempo de sedação. A odds ratio (OR) foi estimada com intervalo de confiança de 95%. Foram incluídos no estudo 92 pacientes sequenciais. Houve forte associação entre a não adoção de postura antigravitacional em UTI e óbito (ORajustada=37,7; IC=4,76-293; p=0,001). Conclui-se que pacientes que não adotaram postura antigravitacional durante o internamento em UTI apresentaram chances muito mais elevadas de mortalidade. Essa simples estratégia de classificação da capacidade funcional de pacientes críticos pode ser utilizada rotineiramente por equipes de saúde como uma variável simples e dicotômica de prognóstico de mortalidade em UTI.


RESUMEN Aún existen pocos marcadores de desempeño funcional con capacidad de predecir la muerte en Unidades de Cuidados Intensivos (UCI). El presente estudio tuvo como objetivo identificar la asociación entre la no adopción de postura antigravitacional y el óbito en pacientes hospitalizados en una UCI adulto. Se trata de un estudio retrospectivo y analítico, realizado mediante análisis de historia clínica. La asociación entre la no adopción de postura antigravitacional y el fallecimiento fue probada por regresión logística múltiple ajustada por sexo, edad, gravedad de la enfermedad (medida por la Acute Physiology And Chronic Health Classification System II [Apache II]), tiempo de ventilación mecánica invasiva (VMI) y tiempo de sedación. Se estimó la odds ratio (OR) con intervalo de confianza (IC=95%). Se incluyeron en el estudio 92 pacientes secuenciales. Se observó una fuerte asociación entre la no adopción de postura antigravitacional en UCI y el óbito (ORajustada=37,7; IC=4,76-293; p=0,001). De esta forma, se puede concluir que pacientes que no adoptaron postura antigravitacional durante la hospitalización en UCI tuvieron posibilidades mucho más elevadas de mortalidad. Esta simple estrategia de clasificación de la capacidad funcional de pacientes críticos puede ser utilizada de manera rutinaria por el equipo de salud como una variable simple y dicotómica de pronóstico de mortalidad en UCI.


ABSTRACT Until now, few functional performance markers are able to predict death in Intensive Care Units (ICUs). This study aimed to identify the association between non-adoption of antigravity posture and death in patients admitted to an adult ICU. It is a retrospective and analytical study, performed through the analysis of medical records. Association between non-adoption of antigravity posture and death was tested by multiple logistic regression adjusted for gender, age, disease severity (measured by Acute Physiology and Chronic Health Classification System II [Apache II]), time of invasive mechanical ventilation (IMV), and period of sedation. The odds ratio (OR) with confidence interval (CI=95%) was estimated. A total of 92 sequential patients were included in the study. A strong association between the non-adoption of antigravity posture in the ICU and death (ORadjusted=37.7, CI=4.76-293, p=0.001) was observed. Thus, one can conclude that patients who did not adopt an antigravity posture during ICU admission had a much higher odds of mortality. This simple strategy to classify functional capacity of critical patients can be routinely used by the team as a simple and dichotomous variable for ICU mortality prognosis.


Assuntos
Humanos , Masculino , Feminino , Adulto , Morte , Terapia por Exercício , Unidades de Terapia Intensiva , Reabilitação , Registros Médicos , Estudos Retrospectivos , Cuidados Críticos , Deambulação Precoce
11.
Health Psychol ; 38(8): 748-758, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368756

RESUMO

OBJECTIVE: Enhanced recovery after surgery (ERAS) programs fast-track recovery for surgical procedures, including colorectal and gynecological oncology surgery. Early mobilization is a postoperative ERAS module that can be self-managed by patients, but poor adherence is common. Visualization is increasingly being used to improve patient understanding and adherence to health behaviors. This study tested whether an animated visualization intervention could improve adherence to postoperative mobilization. METHOD: Ninety six colorectal and gynecological oncology surgery patients were randomized to intervention, active control, or standard care groups. Intervention participants saw an animated intervention on a computer tablet at Day 1 postsurgery. All participants wore fitness trackers from day of discharge to 7 days postdischarge, and completed psychological measures at baseline, Day 1 postsurgery, and 7 days postdischarge. RESULTS: Step count data was available for 57 colorectal surgery participants. A main effect of group demonstrated that intervention participants had a significantly higher average daily step count from discharge across the week following discharge (Madj = 2,294.60, 95% confidence interval [CI] [1,746.11, 2,744.89]) compared with control participants (Madj = 1,347.25, 95% CI [826.51, 1,871.20]; p = .05). At postsurgery, intervention participants reported significantly greater perceived quality of recovery and less difficulty in being mobile compared with control participants. There were no between-group differences in self-reported exercise or perceptions of surgery and recovery. CONCLUSION: This brief intervention appears effective in improving perceptions of early mobilization, and initial evidence suggests improvements in adherence to postsurgical mobilization. This intervention has high clinical applicability and could be incorporated into postoperative standard care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Visualização de Dados , Deambulação Precoce/métodos , Cuidados Pós-Operatórios/métodos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade
12.
Med Klin Intensivmed Notfmed ; 114(8): 759-764, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31428799

RESUMO

BACKGROUND: Early mobilization is defined as intervention within the first 72 h after intensive care unit (ICU) admission. According to the current state of relevant studies, evidence on early mobilization in critically ill patients is still inconsistent. This leads to insecurity in caretakers and subsequently to incomplete implementation in German ICUs. OBJECTIVES: What type of intervention is suitable for certain patient groups? Which issues remain unresolved? RESULTS: To obtain best possible outcomes, early mobilization should be initiated during the first 72 h after ICU admission. Implementation of early mobilization improves clinical outcome and should be integrated in a patient-centered bundle (such as ABCDEF). Mechanical ventilation is not a contraindication to intervention. Evidence in neurocritical care as well as functionally dependent patients is still low. Mode of intervention and dosage of early mobilisation remain unclear. CONCLUSION: Early mobilization is safe and feasible, resulting in improved outcomes in surgical and medical ICU patients. Further studies are necessary to evaluate the optimal dosage and duration of intervention, especially in neurocritical care patients.


Assuntos
Deambulação Precoce , Unidades de Terapia Intensiva , Estado Terminal , Humanos , Respiração Artificial
13.
Stud Health Technol Inform ; 264: 1805-1806, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438353

RESUMO

More and more researchers have recommended critically ill patients to start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low for patients in the intensive care units (ICU) because of various factors. In order to promote the rehabilitation of critically ill patients, a multidisciplinary research team, including academic researchers, ICU head nurses, respiratory therapists, and a software engineer, has developed a virtual reality system for early mobilization in ICU. This system has four main features-the diverse forms of mobilization based on muscle strength, the integration of exercise and cognitive training, the visualization of the mobilization process and the record of the trajectory during mobilization exercises. This paper presents and discusses the development process of this system.


Assuntos
Deambulação Precoce , Realidade Virtual , Estado Terminal , Terapia por Exercício , Humanos , Unidades de Terapia Intensiva
14.
Neurology ; 93(7): e717-e728, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31350296

RESUMO

OBJECTIVE: To determine whether early and more frequent mobilization after stroke affects health-related quality of life. METHODS: A Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), phase 3 randomized controlled trial, spanning 2006-2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from -0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0. RESULTS: No significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range [IQR] 0.07-0.81) and usual care (median 0.49, IQR 0.08-0.81) groups was identified (p = 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all p < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age. CONCLUSIONS: Earlier and more frequent mobilization after stroke did not influence quality of life. CLINICAL TRIAL REGISTRATION: anzctr.org.au; ACTRN12606000185561 CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.


Assuntos
Atividades Cotidianas , Deambulação Precoce , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adolescente , Adulto , Idoso , Ensaios Clínicos como Assunto , Cognição/fisiologia , Feminino , Humanos , Masculino , Reabilitação do Acidente Vascular Cerebral/métodos , Fatores de Tempo
15.
Pain Res Manag ; 2019: 9292617, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281560

RESUMO

Introduction: Osteoporotic vertebral fracture treatment options include vertebroplasty, in which development of new fractures is among the possible complications which may develop during the postoperative period. We aim to evaluate whether or not postoperative mobilization time has effect on occurrence of new fractures. Materials and Methods: A total of 126 patients, consisting of 30 (39.7%) males and 96 (60.3%) females, who underwent sedation-assisted vertebroplasty under local anesthesia between January 2014 and June 2017 were retrospectively evaluated. Preoperative and postoperative visual analogue scores (VASs) and mobilization time (hours) were assessed. Day of new fracture occurrence during follow-up was assessed. Results: The mean follow-up period was 9 months (7-13 months). The most common fracture segment was the L1 vertebra (15.9%). The preoperative VAS was 8.29 ± 0.95, and the postoperative VAS was 2.33 ± 0.91. The change in VAS was statistically significant (p=0.01, p < 0.05). Of all the patients, 21 (16.66%) had developed new fractures. No statistical difference was observed between mobilization time (hours) and formation of new fractures (p=0.48, p > 0.05). Conclusion: We came to the conclusion that mobilization time (hours) was not a risk factor in the development of new fractures. In addition, there is no relationship between mobilization time and localization of new fractures.


Assuntos
Deambulação Precoce/efeitos adversos , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Idoso , Feminino , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Fatores de Tempo
17.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352385

RESUMO

Lateral ankle sprains are a common injury with an estimated occurrence rate of 23 000 per day in the USA. Prolonged immobilisation and delayed referral to physical therapy are associated with poorer outcomes. The patient was a 49-year-old woman working as a surgical technologist. She sustained an inversion injury to her left ankle while descending from a stool. Her primary care physician examined her, issued a Controlled Ankle Movement (CAM) walking boot and immobilised her ankle for 6 weeks. Patients with grade I and II lateral ankle sprains who are treated with early mobilisation and referral to physical therapy have demonstrated earlier return to function compared with patients who are treated with prolonged immobilisation and delayed referral. Nevertheless, it remains common for individuals who have sustained a lateral ankle sprain to be immobilised. This case study highlights the importance of early mobilisation and early physical therapy referral for patients with lateral ankle sprains.


Assuntos
Traumatismos do Tornozelo/reabilitação , Articulação do Tornozelo/fisiopatologia , Imobilização , Modalidades de Fisioterapia , Amplitude de Movimento Articular/fisiologia , Entorses e Distensões/reabilitação , Suporte de Carga/fisiologia , Traumatismos do Tornozelo/fisiopatologia , Deambulação Precoce , Feminino , Humanos , Pessoa de Meia-Idade , Exame Físico , Encaminhamento e Consulta , Entorses e Distensões/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(29): e16552, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335737

RESUMO

We report the outcomes of mechanical prophylaxis and chemoprophylaxis in patients who underwent elective surgery for idiopathic adolescent scoliosis (AIS).We retrospectively studied the patients who underwent posterior spinal instrumentation for AIS. The patients were divided into three groups: Group A low-molecular-weight heparin (LMWH) started at 8 hours after surgery; Group B LMWH started at 24 hr after surgery; Group C did not receive chemoprophylaxis. The data about wound oozing, need for transfusion, preoperative and postoperative hemoglobin level, length of stay in hospital, interval from the surgery to removal of closed suction drainage tube, postoperative blood loss from closed suction drain, deep venous thrombosis (DVT), and pulmonary embolism (PE) were investigated.The mean age and Lenke classification for all the groups were similar. No DVT or PE was detected in any group. The mean blood loss from the drain was higher in Group A (400 mL) and Group B (450 mL) when compared to Group C (150 mL) (P = .001). There were more wound oozing in Groups A (5) and B (6) than in Group C (3) (P = .585). Three patients in Group B, 3 patients in Group A, and no patient in Group C had superficial infections. However, there was no statistical difference between the groups (P = .182). Postoperative hospital stay was significantly longer in Groups A (6 days) and B (6 days) then in Group C (5 days) (P = .001).Our current study claims that chemoprophylaxis is not necessary for the patients without risk factors after AIS surgery. Early mobilization and mechanoprophylaxis represents adequate prophylaxis in addition to pain management and well hydration in patients' routine treatment. The complications of chemoprophylaxis are not correlated to the initiation time of prophylaxis.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Embolia Pulmonar/prevenção & controle , Escoliose/cirurgia , Trombose Venosa/prevenção & controle , Adolescente , Anticoagulantes/efeitos adversos , Transfusão de Sangue , Esquema de Medicação , Deambulação Precoce , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Hemoglobinas/metabolismo , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/terapia , Estudos Retrospectivos , Fatores de Risco , Meias de Compressão , Sucção , Infecção da Ferida Cirúrgica , Procedimentos Desnecessários
19.
J Clin Nurs ; 28(21-22): 4044-4052, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31264747

RESUMO

AIMS AND OBJECTIVES: To qualitatively evaluate an early mobilisation quality improvement project implemented on a general medicine unit. BACKGROUND: Early mobility quality improvement projects show promising quantitative results yet have failed to collect data from patient and staff experience associated with physical activity during illness and the impact of this change in clinical practice. DESIGN: A mixed methods case study was used to evaluate a mobility quality improvement project. Quantitative results will be published separately. The qualitative evaluation used a phenomenological lens to explore the patient and staff experience. METHODS: Semi-structured interviews with twelve participants (four patients and eight staff) were performed during the project. Data were analysed using open coding, direct interpretation and then categorised into an overarching and four supporting themes. Findings are reported per the Standards for Reporting Qualitative Research. RESULTS: Participants reported that early mobilisation bridged a gap in care. Staff understood the benefits of early mobility. Patients expressed how mobility aligned with personal preferences and their need to prepare for hospital discharge. Greater functional independence and higher mobility levels in patients on the unit reduced staff level of care. When patients were consistently presented with opportunities to be mobile and active, they expected mobility to be a part of their daily care plan. CONCLUSIONS: Findings suggest that early mobility quality improvement projects have the potential to transform clinical practice and improve the quality of care for patients in acute care. RELEVANCE TO CLINICAL PRACTICE: All members of the healthcare team, including the patient, recognise the importance of maintaining mobility and function during hospitalisation yet focus on these needs are often delayed or missed. Early mobility quality improvement projects help to set patient expectations and build a culture that promotes patient mobility and function during acute illness.


Assuntos
Cuidados Críticos/métodos , Deambulação Precoce/psicologia , Equipe de Assistência ao Paciente/organização & administração , Idoso , Cuidados Críticos/organização & administração , Deambulação Precoce/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Melhoria de Qualidade
20.
Crit Care Nurse ; 39(3): 33-42, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154329

RESUMO

Early mobility is an element of the ABCDEF bundle designed to improve outcomes such as ventilator-free days and decreased length of stay. Evidence indicates that adherence to an early mobility protocol can prevent delirium and reduce length of stay in the intensive care unit and the hospital and may decrease length of stay in a rehabilitation facility. Yet many barriers exist to implementing early mobility effectively, including patient acuity, uncertainty about when to start mobilizing the patient, staffing and equipment needs, increased costs, and limited nursing time. Implementation of early mobility requires interdisciplinary collaboration, commitment, and tools that facilitate mobility and prevent injury to nurses. This article focuses on aspects of care that can affect patient outcomes, such as preventing delirium, reducing sedation, monitoring the patient's ability to wean from the ventilator, and encouraging early mobility. It also addresses the effects of immobility as well as challenges in achieving mobility and how to overcome them.


Assuntos
Enfermagem de Cuidados Críticos/organização & administração , Deambulação Precoce/métodos , Unidades de Terapia Intensiva , Tempo de Internação/economia , Qualidade de Vida , Desmame do Respirador/enfermagem , Análise Custo-Benefício , Deambulação Precoce/enfermagem , Medicina Baseada em Evidências , Feminino , Seguimentos , Humanos , Masculino , Alta do Paciente/estatística & dados numéricos , Respiração Artificial , Fatores de Tempo , Resultado do Tratamento
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