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44 views

Evidencebasedpractice

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api-534814911
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Effects of Early Mobilization After Knee Arthroplasty on Hospital Length of Stay: Literature

Review

Jonathan Rodriguez
Department of Nursing, Azusa Pacific University
GNRS 507: Scientific Writing
Professor Galletly
December 2, 2020
Problem
PICO question: In adult patients that have
undergone knee arthroplasty (P), how
Observation:
An increase in total knee effective is mobilization on day of surgery
arthroplasties (TKA) due to the steady (I) compared to mobilization the day after
increase in age. surgery (C)on decreasing hospital length of
stay (O)?
Average length of stay (LOS) for a
TKA is 3.7 days

In 2015, the average cost for hospital


inpatient stay was $2000

Early mobilization is a factor that


(Cram et al. in Moses et al., 2018; Kaiser Family Foundation
affects LOS, but how early is too
data in Moses et al.,2018)
early?
Databases Searched: PubMed
Literature Review Keywords phrases: early mobilization,
arthroplasty and hospital length of stay
Inclusion Criteria
▪Articles published between 2015-2020
▪English language
▪Randomized controlled trials (RCT) and
cohort studies

Found:
▪three retrospective cohort studies (Karim et
al., 2016; Moses et al., 2018; Yakkanti et al.,
2019)
▪two randomized controlled trials
(Gnanakumaran et al., 2017; Bohl et al., 2019)
Results Karim et al. (2016): POD-0 LOS 2.8 days vs. POD-1 LOS 2.35
days (p>.005)
Moses et al. (2018):POD-0 LOS 2.0 days vs. POD-1 LOS 3.9
days (p<.001)
Yakkanti et al. (2019):POD-0 LOS 2.44 days vs. POD-1 LOS 2.8
days (p<.002)
Bohl et al. (2019): POD-0 LOS 31 hours vs. POD-1 LOS 32
hours (p=.12)
Gnanakumaran et al. (2017): POD-0a LOS 3.6 vs. POD-0b LOS
6.6 days (p=0.34)

Overall:
Early mobilization after a TKA reduced
hospital LOS in all the studies, but whether the
results were statistically significant was
inconclusive.
Barriers and Design of study

Limitations Sample size bias

If early mobilization does not significantly affect


LOS then nurses should not encourage this
intervention due to risk:.
Nursing ● Increased pain and swelling
Implications ● injury/falls

If the intervention does significantly affect LOS

● Patients spend less time in hospitals


● Decrease hospital/patient cost

*Nurses need to weigh the patient’s safety and


outcomes before advocating for an intervention
References
Bohl, D., Li, J., Calkins, T., Darrith, B., Edmiston, T., Nam, D., Gerlinger, T., Levine, B., & Valle, C. (2019). Physical therapy on postoperative day zero

following total knee arthroplasty: A randomized controlled trial of 394 patients. The Journal of Arthroplasty, 34(7).

https://doi.org/10.1016/j.arth.2019.02.010

Gnanakumaran, S., Li, F., White, M., Shiel, N., Walker, P., & Rappo, T. (2017). The effect of early mobility in patients after total knee replacement on hospital

length of stay, pain and function: A randomized control trial. Physiotherapy Practice and Research, 38(2), 121–125.

https://doi.org/10.3233/ppr-170093

Karim, A., Pulido L, & Incavo, S. (2016). Does accelerated physical therapy after elective primary hip and knee arthroplasty facilitate early discharge?

American Journal of 45(6), E337-E342.

Moses, M., Novikov, D., Anoushiravani, A., Deshmukh, A., Poultsides, L., & Schwarzkopf, N. (2018). The role of physical therapy in decreasing length of stay

following total knee arthroplasty in a public hospital setting. International Journal of Orthopaedics, 5(4), 943–947.

https://doi.org/10.17554/j.issn.2311-5106.2018.05.271

Yakkanti, R., Miller, A., Smith, L., Feher, A., Mont, M., & Malkani, A. (2019). Impact of early mobilization on length of stay after primary total knee

arthroplasty. Annals of Translational Medicine, 7(4), 69–69. https://doi.org/10.21037/atm.2019.02.02

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