Implementation of ERAC-based early postoperative mobilization protocol on the initiative of physical therapists after caesarean section

To report the implementation of ERAC-based early postoperative mobilization protocol on the initiative of PTs after CS.

This was a single-institutional and retrospective study being carried out at a tertiary care center. This study included 269 postpartum women who underwent CS from July 2022 to March 2024. Participants were divided into the ERAC (n=144) and the standard care (control) (n=125) groups. While the control group was defined as postpartum women whose initial postoperative mobilization was performed in midwives-available timing, the  ERAC group was defined as those whose ERAC-based initial mobilization was routinely performed within 8-24 hours of postoperative period under the initiative of PTs.

The exclusion criteria were foreign patients, those undergoing postoperative hysterectomy, and those who underwent surgery during April 2023 (with different intervention methods). Patients’ backgrounds, surgical information, initial mobilization-achievement rates and times within 24 hours after CS, the incidence of secondary complications during hospitalization, and the adverse events during mobilization were evaluated and compared with the control group. Fisher's exact test and the Mann–Whitney U test were used to detect the differences between groups, with p0.05 indicating statistical significance.

The patient demographics and surgical data were not significantly different between the ERAC (n=144) and the standard care (n=125)groups. The initial mobilization-achievement rate within 24 hours after CS was 89.5%. The ERAC group showed a significantly shorter time to initial mobilization (1132.1±306 vs. 1215.3±304minutes, p=0.01), and the incidence of postoperative secondary complications was significantly lower (8.3% vs. 16.8%, p=0.04). The percentage of adverse events was not statistically significant (0.8% vs. 3.2%, p=0.21). While secondary postoperative complications included post-dual puncture headache (PDPH) (p=0.25), pelvic girdle pain (p=0.76), and endometritis (p=0.83) were not significantly different, the ERAC group had a lower percentage of extremity numbness (p=0.01) and atelectasis (p=0.04).

The implementation of early mobilization based on the ERAC protocol under the supervision of PTs resulted in earlier initial mobilization and a reduction in adverse events. These findings suggested that the expertise of PTs contributed to safe postoperative mobilization.

The involvement of PTs may have the potential to provide high-quality and safe post-operative rehabilitation and initial mobilization even in after CS. Our results indicated that the professional skills of PTs can be effective for improving post-CS outcomes.