Schaub R1, Betschart M2, Maguire C3, Hund-Georgiadis M2
1Bern University of Applied Sciences, Health Division, Department of Health Professions, Master of Science in Physiotherapy, Bern, Switzerland, 2REHAB Basel, Clinic for Paraplegiology and Neurorehabilitation, Basel, Switzerland, 3Bildungszentrum Gesundheit Basel-Stadt, Münchenstein, Switzerland
Background: One of the most important goals of early neurorehabilitation is to achieve the highest possible level of independence by restoring functions such as mobility. Recovery potential and the influence of intervention is greatest within the first 3 months after injury. Recent literature highly recommends early mobilisation including specific frequency and duration (intensity) of interventions. The recommended intensity of mobilisation may be possible through inter-professional work. In Switzerland evidence-based early mobilisation protocols are not routinely implemented in neurological intermediate care units (IMCU- early rehabilitation facilities).
Purpose: The aim of the feasibility study is twofold: firstly, to develop an interprofessional early mobilisation protocol based on the latest ( 5 years) evidence-based guidelines for patients with early subacute stroke, traumatic brain injury and spinal cord injury; secondly, to implement and evaluate this protocol in an IMCU in Switzerland using a systematic implementation concept according to the “knowledge-to-action” protocol by Graham et al.
Methods: A systematic literature search was conducted on PubMed, EMBASE, Joanna Briggs Institute´s database and Cochrane Library. Appropriate inclusion and exclusion criteria were defined using the PIPOH tool (population, intervention, expected outcomes, professionals, health care setting and context). The ADAPTE methodology including the “knowledge-to-action” process was used in the implementation and evaluation project. Outcome measures: percentage of the recommended frequency and duration achieved on a daily level; estimated practicality and acceptance of the protocol by the involved therapists (n=6) and nurses (n=15).
To quantify the feasibility of the protocol, Chi-Square analysis for independent factors will be applied for the factors “frequency” and “duration” of mobilisation. Correlation analysis will be applied for the analysis of a relationship between impairment level (Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM) und Barthel Index (BI)) and the number of stuff present at the ward.
Results: Of the 3045 articles found, 10 guidelines, 9 systematic reviews, 2 randomised controlled trials, 3 cohort studies and 1 topical review were included and used to develop an inter-professional evidence-based mobilisation protocol. Recommendations were: 300 therapy minutes per day with task-specific exercises and therapeutic nursing care, a mobilisation protocol including at least 4 out of bed mobilisations per day according to the mobility level of the patient in order to challenge the patient with task-specific exercises. Data collection for the implementation project is ongoing and will be complete by February 2019.
Conclusion(s): The literature search has enabled the development of specific clinical recommendations for early mobilisation in neurorehabilitation. The implementation strategy allowing the mobilisation protocol to be tested for its practicality within an inter-professional Intermediate Care Unit.
Implications: This mobilisation protocol could serve in the early rehabilitation to support an inter-professional team in the systematic application of current mobilisation guidelines.
Keywords: neurorehabilitation, implementation project, early mobilisation
Funding acknowledgements: no funding
Purpose: The aim of the feasibility study is twofold: firstly, to develop an interprofessional early mobilisation protocol based on the latest ( 5 years) evidence-based guidelines for patients with early subacute stroke, traumatic brain injury and spinal cord injury; secondly, to implement and evaluate this protocol in an IMCU in Switzerland using a systematic implementation concept according to the “knowledge-to-action” protocol by Graham et al.
Methods: A systematic literature search was conducted on PubMed, EMBASE, Joanna Briggs Institute´s database and Cochrane Library. Appropriate inclusion and exclusion criteria were defined using the PIPOH tool (population, intervention, expected outcomes, professionals, health care setting and context). The ADAPTE methodology including the “knowledge-to-action” process was used in the implementation and evaluation project. Outcome measures: percentage of the recommended frequency and duration achieved on a daily level; estimated practicality and acceptance of the protocol by the involved therapists (n=6) and nurses (n=15).
To quantify the feasibility of the protocol, Chi-Square analysis for independent factors will be applied for the factors “frequency” and “duration” of mobilisation. Correlation analysis will be applied for the analysis of a relationship between impairment level (Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM) und Barthel Index (BI)) and the number of stuff present at the ward.
Results: Of the 3045 articles found, 10 guidelines, 9 systematic reviews, 2 randomised controlled trials, 3 cohort studies and 1 topical review were included and used to develop an inter-professional evidence-based mobilisation protocol. Recommendations were: 300 therapy minutes per day with task-specific exercises and therapeutic nursing care, a mobilisation protocol including at least 4 out of bed mobilisations per day according to the mobility level of the patient in order to challenge the patient with task-specific exercises. Data collection for the implementation project is ongoing and will be complete by February 2019.
Conclusion(s): The literature search has enabled the development of specific clinical recommendations for early mobilisation in neurorehabilitation. The implementation strategy allowing the mobilisation protocol to be tested for its practicality within an inter-professional Intermediate Care Unit.
Implications: This mobilisation protocol could serve in the early rehabilitation to support an inter-professional team in the systematic application of current mobilisation guidelines.
Keywords: neurorehabilitation, implementation project, early mobilisation
Funding acknowledgements: no funding
Topic: Neurology; Research methodology & knowledge translation
Ethics approval required: Yes
Institution: EKNZ
Ethics committee: Ethikkommission Nordwest- und Zentralschweiz, Hebelstrasse 53, 4056 Basel
Ethics number: 2018-01016 (in progress for the second part of the project)
All authors, affiliations and abstracts have been published as submitted.
