Development of a neuro early mobilisation protocol for use in a neuroscience intensive care unit

ObjectiveThrough evaluation of the literature and working with a team of multidisciplinary healthcare providers, our objective was to refine an interprofessional Neuro Early Mobilisation Protocol for complex patients in the Neuroscience Intensive Care Unit.Research methodologyUsing the literature as a guide, key stakeholders, from multiple professions, designed and refined a Neuro Early Mobilisation Protocol.SettingThis project took place at a large academic medical center in the southeast United States classified as both a Level I Trauma Center and Comprehensive Stroke Center.Main outcome measuresGoals for protocol development were to: (1) simplify the protocol to allow for ease of use, (2) make the protocol more generalizable to the patient population cared for in the Neuroscience Intensive Care Unit, (3) receive feedback from those using the original protocol on ways to improve the protocol and (4) ensure patients were properly screened for inclusion and exclusion in the protocol.ResultsUsing expert feedback and the evidence, an evidence-based Neuro Early Mobilisation Protocol was created for use with all patients in the Neuroscience Intensive Care Unit.ConclusionFuture work will consist of protocol implementation and evaluation in order to increase patient mobilisation in the Neuroscience Intensive Care Unit.     

Short-term effects of mobilisation with movement in patients with post-traumatic stiffness of the knee joint

Background

Mobilisation with movement treatment techniques have been used to increase the range of motion following pathologies associated with shoulder, elbow and ankle joints. Lack of posterior tibial glide and reflex muscle inhibition are common physical impairments in individuals with post-traumatic stiffness of the knee joint. Current evidence is lacking for the benefits of mobilisation with movement treatment techniques for the knee joint disorders.

Translational Mobilisation Theory: A new paradigm for understanding the organisational elements of nursing work

Translational Mobilisation Theory (TMT) is a generic sociological theory that explains how emergent projects of collective action are progressed in complex organisational contexts. Grounded in a substantial programme of research on healthcare work, it has value for understanding the organisational component of the nursing role for educational, practice and research purposes. This paper introduces Translational Mobilisation Theory, outlines its core components, and considers its application to nursing using ethnographic research on the organising work of nurses as an empirical reference. Organising work is a neglected element of the nursing function and lacks theoretical foundations. As the complexity and intensity of healthcare continues to accelerate this is an important gap in existing frameworks of understanding.     

Evaluation of synthetic glue for the fixation of continuous peripheral nerve catheters

Accidental dislodgement of continuous peripheral nerve catheters remains a frequent problem that causes failure of postoperative analgesia. We have assessed the use of new synthetic glue (Mastisol) to secure and maintain catheters in the correct position among 60 patients. This method allowed securing an effective fixation in 94% of cases,resulting in efficient ambulatory orthopedic surgery postoperative analgesia. No nervous or infectious complications were observed. This technique offers a simple, complementary method to secure peripheral nerve catheters.     

Physical activity of patients with critical illness undergoing rehabilitation in intensive care and on the acute ward: An observational cohort study

BackgroundThere are limited published data on physical activity of survivors of critical illness engaged in rehabilitation in hospital, despite it plausibly influencing outcome.ObjectiveThe aims of this study were to measure physical activity of patients with critical illness engaged in rehabilitation in the intensive care unit (ICU) and on the acute ward and report discharge destination, muscle strength, and functional outcomes.MethodsThis was a single-centre, prospective observational study. Adults with critical illness, who received ≥48 h of invasive mechanical ventilation, and who were awake and able to participate in rehabilitation were eligible. To record physical activity, participants wore BodyMedia SenseWear Armbands (BodyMedia Incorporated, USA), during daylight hours, from enrolment until hospital discharge or day 14 of ward stay (whichever occurred first). The primary outcome was time (minutes) spent performing physical activity at an intensity of greater than 1.5 Metabolic Equivalent Tasks. Secondary outcomes included discharge destination, muscle strength, and physical function.ResultsWe collected 807 days of physical activity data (363 days ICU, 424 days ward) from 59 participants. Mean (standard deviation) duration of daily physical activity increased from the ICU, 17.8 (22.8) minutes, to the ward, 52.8 (51.2) minutes (mean difference [95% confidence interval] = 35 [23.8–46.1] minutes, P < .001). High levels of activity in the ICU were associated with higher levels of activity on the ward (r = .728), n = 48, P < .001.ConclusionsPatients recovering from critical illness spend less than 5% of the day being physically active throughout hospital admission, even when receiving rehabilitation. Physical activity increased after discharge from intensive care, but had no relationship with discharge destination. Only the absence of ICU-acquired weakness on awakening was associated with discharge directly home from the acute hospital. Future studies could target early identification of ICU-acquired weakness and the preservation of muscle strength to improve discharge outcomes.     

Operative Stabilisierung von per- und subtrochantären Oberschenkelfrakturen mit dem Gammanagel

Zusammenfassung. Einleitung: Ziel dieser retrospektiven Studie ist es, den Einflu? von Alter, Begleiterkrankungen, Frakturform, Operationszeitpunkt, Wahl des Implantats (kurzer oder langer Gammanagel) und Operationsverfahren auf Mobilisationsgrad, radiologischen Heilungsverlauf und m?gliche Komplikationen nach operativer Stabilisierung von per- und subtrochant?ren Oberschenkelbrüchen mittels Gammanagel zu analysieren. Patienten und Methoden: Von 1992 bis 1997 wurden 96 Patienten mit isolierter per- oder subtrochant?rer Oberschenkelfraktur mittels Gammanagel (Howmedica) operiert. Das Durchschnittsalter der Patienten zum Zeitpunkt der Verletzung betrug 72,5 (27–101) Jahre. 27 Patienten waren M?nner, und 69 waren Frauen. Die Operation erfolgte durchschnittlich 1,19 (0–10) Tage nach dem Unfall. Die postoperativen Kontrollen erfolgten nach 3, 6 und 12 Monaten. Hierbei wurden jeweils R?ntgenaufnahmen des Oberschenkels mit Hüftgelenk in 2 Ebenen durchgeführt und der Mobilisationsgrad der Patienten beurteilt. Ergebnisse: Begleiterkrankungen, Operationszeitpunkt, Frakturtyp, Operationsverfahren und Wahl des Implantats (kurzer oder langer Gammanagel) hatten keinen Einflu? auf den Grad der Mobilisation, auf den radiologischen Heilungsverlauf oder auf aufgetretene Komplikationen. ?ltere Patienten ( > 70 Jahre) waren schlechter mobilisierbar (p < 0,001). Ein Jahr nach dem Unfall waren 97 % der Frakturen radiologisch geheilt. Bei 15 Patienten (18 %) kam es zu technischen Komplikationen bei der Verwendung des Gammanagels. Schlu?folgerungen: Per- und subtrochant?re Oberschenkelfrakturen k?nnen mit Hilfe des Gammanagels bei richtiger Handhabung stabil versorgt und die Patienten frühzeitig mobilisiert werden.      

The need for a paradigm shift in the rehabilitation of elective foot and ankle reconstructive surgery patients? An annotation

Current surgeon established protocols encourage late weight bearing and prolonged immobilisation after ankle, hind- and mid-foot fusion surgery. There is no universal guidance regarding early mobilisation and rehabilitation after this type of surgery. There is a paucity of research in this area but early mobilisation may be beneficial in terms of improved clinical and patient reported outcome measures, whilst still offering good union and very few complications.Feasibility work prior to a full-scale trial is now needed to explore the efficacy of early functional mobilisation, prior to any adoption within clinical practice. A paradigm shift in the early post-operative management of this patient group has the potential to improve outcomes for patients and decrease the socioeconomic burden on the health service.     

What is the interest of early mobilization after total hip arthroplasty? Development of French guidelines for clinical practice]

AIMS: To develop clinical practice guidelines for early mobilisation after total hip replacement (THR). METHOD: We used the French Society of Physical and Rehabilitation Medicine (Sofmer) methodology, which associates a systematic review of the literature, the collection of information regarding current clinical practice and external review by a multidisciplinary expert panel. RESULTS: Recommending early mobilisation after THR is not established by a review of the literature. A survey of French clinical practice allows for recommending early mobilisation in the context of complex hip issues. Trials with good methodology must be developed to evaluate the interest of early functional mobilisation corresponding to when patients first stand and take their first steps after surgery. These trials should focus mainly on the final pain, functional status, and reduction of handicap.