The strengths of the present study include the real-life situation on a ward with patients
undergoing various types of surgery, as well as data collection before and after
implementation, with analyses adjusting for relevant co-variables. In addition, the present
study gives a clear description of the enforced mobilisation protocol, allowing for replication
in other settings.
However, various limitations of this study need to be considered. The main limitation
was the design of the study, which precludes definite conclusions about the value of enforced
mobilisation. The results indicate a positive effect of enforced mobilisation on relevant
postoperative outcomes; however, replication is needed in a sufficiently powered randomised
controlled trial. As the CIs in the present study were found to be wide, it is believed that a
larger sample size would lead to a significant decrease in PPCs in the total group of patients
with various types of gastrointestinal cancer. Another limitation is that, with regard to
complications, only PPCs were included in this study. Although a clinically relevant
complication, the risk of other postoperative complications, such as insulin resistance, tissue
oxygenation, muscle loss and thromboembolism, have also been suggested to be reduced by
early mobilisation [22]. The effect of enforced mobilisation on these complications needs
further study. Finally, the number of patients that received enforced mobilisation was rather
small, especially in certain surgical groups such as ‘oesophageal’ (n=5) and ‘stomach’ (n=4).
Therefore, the feasibility of enforced mobilisation in specific surgical groups needs further
investigation.