A mobilization poster stimulates early in-hospital rehabilitation after cardiac surgery: a prospective sequential-group study

Abstract

Background: Patients infrequently mobilize at the surgical ward after cardiac surgery. Inactivity results in prolonged hospital stay, readmissions and increased cardiovascular mortality. Next, the course of in-hospital mobilization activities for patients is unclear. The aim was to evaluate early mobilization after heart surgery with a mobilization poster on the Activity Classification Guide for Inpatient Activities score from the American College for Sports Medicine (ACSM). Second, to develop a Thorax Centrum Twente (TCT) score to assess distinctive activities performed.

Methods: A poster was developed for the Moving is Improving! study to stimulate hospital mobilization after heart surgery. In this sequential-group study at a cardiothoracic surgery ward, 32 patients were included in the usual care group and 209 patients in the poster mobilization group. Change of ACSM and TCT scores over time were both defined as primary endpoints. Secondary endpoints included length of stay and survival. A subgroup analysis for coronary artery bypass grafting (CABG) was performed.

Results: ACSM score increased during hospital stay (p < 0.001). No significant increase of ACSM score was observed with a mobilization poster (p = 0.27), nor in the CABG subgroup (p = 0.15). The poster increased mobility to chair, toilet, corridor (all p < 0.01) and cycle ergometer (p = 0.02) as measured by the activity-specific TCT scores, without differences in length of stay or survival.

Conclusions: ACSM score measured day-to-day functional changes, without significant differences between the poster mobilization and usual care group. Actual activities measured with the TCT score did improve. The mobilization poster is now new standard care, and effects in other centers and other departments should be assessed.

Trial registration: This study does not fall under the ICMJE trial definition and was not registered.

Keywords: Cardiac rehabilitation; Early ambulation; Exercise; Physical therapy; Thoracic surgery.

Fig. 1

A Design of mobilization poster to promote early mobilization at cardio-thoracic surgery ward attached to every patient room; B Poster situated in patient room in original language (Dutch)

Fig. 2

Patient Flow diagram of Moving is Improving! Study, based on CONSORT [30]. First the UCG cohort was completed, after which PMG cohort followed. Six patients were in a patient room without a poster and did not receive the poster. Three patients from PMG were excluded because of incomplete data collection. Thus, 241 patients were included for analysis with 32 patients in the UCG cohort and 209 patients in the PMG cohort. ICU = Intensive care unit

Fig. 3

ACSM scores after intensive care unit discharge for the usual care group (UCG; left bars) and poster mobilization group (PMG; right bars). ACSM score changed significantly over time (p < 0.001), no difference between both groups was observed (p = 0.27)

Fig. 4

a–f TCT score development during hospital stay. Every individual TCT score, bed, chair, toilet, corridor, cycle ergometer and stairs was significantly different over time (p < 0.001). A significant improvement of scores chair, toilet, corridor and cycle ergometer was observed in the poster mobilization group (PMG) compared to the usual care group (UCG) as determined with mixed model analysis. Depicted p values are for group effect (UCG vs PMG)