Various recommendations can be made for successful implementation of early
postoperative enforced mobilisation. Effective pain relief using ambulatory thoracic epidural analgesia is essential to encourage postoperative walking. Abdominal drains and urinary
catheters that hinder mobilisation should be avoided whenever possible [11]. Furthermore, it
is important that the patient is well informed by all healthcare providers about the
mobilisation protocol, and is nursed in an environment that encourages early mobilisation. A
prescheduled care plan under supervision of the nursing staff should list daily goals for
mobilisation, including a patient diary to record mobilisation activities [11]. As the validity of
self-reported activities in diaries is questionable, it is recommended that data on the patients’
level of activity should be collected by self-report, combined with objective assessment (e.g.
by accelerometer) in future research. If possible, early enforced walking should be guided by
a physiotherapist. Development of a decision tree to guide physiotherapists when deciding
whether or not enforced walking would be feasible for patients after gastrointestinal surgery
may be helpful. Alternative options for mobilisation, such as seated cycling, could be offered
if walking appears to be unfeasible.
In conclusion, early enforced mobilisation appears to be feasible in patients following
surgery for gastrointestinal cancer, except for those undergoing oesophageal resection. The
occurrence of PPCs was found to be reduced after implementation of enforced mobilisation.
Various recommendations can be made for successful implementation of earlypostoperative enforced mobilisation. Effective pain relief using ambulatory thoracic epidural analgesia is essential to encourage postoperative walking. Abdominal drains and urinarycatheters that hinder mobilisation should be avoided whenever possible [11]. Furthermore, itis important that the patient is well informed by all healthcare providers about themobilisation protocol, and is nursed in an environment that encourages early mobilisation. Aprescheduled care plan under supervision of the nursing staff should list daily goals formobilisation, including a patient diary to record mobilisation activities [11]. As the validity ofself-reported activities in diaries is questionable, it is recommended that data on the patients’level of activity should be collected by self-report, combined with objective assessment (e.g.by accelerometer) in future research. If possible, early enforced walking should be guided bya physiotherapist. Development of a decision tree to guide physiotherapists when decidingwhether or not enforced walking would be feasible for patients after gastrointestinal surgerymay be helpful. Alternative options for mobilisation, such as seated cycling, could be offeredif walking appears to be unfeasible.In conclusion, early enforced mobilisation appears to be feasible in patients followingsurgery for gastrointestinal cancer, except for those undergoing oesophageal resection. Theoccurrence of PPCs was found to be reduced after implementation of enforced mobilisation.
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