Effects of Early Mobilization to Patient who have Undergone CABG Surgery

EBP Synthesis Paper
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EBP Synthesis Paper
Problem Identification
My PICOT question: What is the effect or impact of early mobilization among patients who have undergone coronary artery bypass graft (CABG) surgery on hospitalization duration? The goal is to assess the difference between patients who undergo early mobilization and those who do not. This paper will use the IOWA model regarding the EBP model. The model is crucial in developing mechanisms or approaches needed to help enhance patient care. According to Bergbower et al. (2020), introducing early movement and mobility exercises to patients is effective in helping enhance the quality of care. This paper seeks to synthesize research to determine the viability and reliability of using early mobilization as a way of helping to reduce hospitalization duration for patients who have undergone CABG.
Literature Review
Search Method
Research for this paper was conducted in July 2022 with the idea of trying to establish the efficacy of early mobilization. For the timeliness and relevance of the research studies assessed, the research was limited to studies conducted in the last five years, between 2017 and 2022. The main search engine for this research was the National Center for Biotechnology Information. This search engine offers access to a myriad of databases like PubMed, which was a key database in helping to find the needed materials. To streamline the search, several keywords were used, including “early mobilization,” “impact of early mobilization,” “coronary artery bypass graft surgery,” and “early mobilization and hospitalization duration.” To further streamline the search results, Boolean operators AND and OR were used during the research process.
Review of Literature
Kanejima et al. (2020) conducted a meta-analysis of 6 randomized controlled trials. The study aimed to clarify how early mobilization impacts the physical functionality of patients who have undergone cardiac surgery. The study was assessed by comparing six-minute walk tests at discharge time. The studies selected were chosen against a total of 591 studies. All six chosen studies conducted CABG surgery, and early mobilization started within the first two days after surgery. As per the results, the distance walked by patients increased by 54 meters. The confidence interval was at 95%, but it is crucial to note that this was only the case in four selected studies. Further, the I2 and the P-value showcased moderate heterogeneity, with their values found to be 52% and 0.06, respectively. The study had several limitations, including a limited number of randomized controlled trials, the use of studies over five years old, and 60% of the sample was from a single study.
Afxonidis et al. (2021) conducted a double-blinded randomized controlled trial with the purpose of investigating the impact of early and enhanced respiratory physiotherapy and mobilization on patients’ hospitalization duration, oxygen saturation levels, and PO2 and lactate levels. The sample size for the study was 78. 39 participants were assigned to an intervention group or the Early and Enhance Physiotherapy (EEPC) group, while the remaining 39 were in the control group or the Conventional Physiotherapy Care (CPC). Data collection happened on post-operation day zero for both groups, and this was done pre-and post-intervention. As per the results, there was a significant difference in the length of stay with the CPC clients staying longer in the ICU and hospital. The EEPC group stayed at the hospital and ICU for 8.1 ± 0.4 days and 23.2 ± 0.6 hours, respectively, while the CPC group clocked 8.9 ± 0.6 days and 25.4 ± 3 hours, respectively. Regarding oxygen concentration levels, PO2 levels, and lactate levels, the two groups posted statistical differences with values of p = 0.022, 0.027, and 0.001. However, regardless of the above, the study’s sample size limits its generalizability capabilities.
Najjar et al. (2021) surveyed the nurses, physicians, and physiotherapists’ attitudes, beliefs, and knowledge regarding patient mobilization within the cardiovascular intensive care unit (CICU). The survey was conducted in two CICU units with 142 participants. The nurses were 67, physicians 59, and the physiotherapists made up the remaining 16. The 26-item questionnaire examined attitude, behavior, and knowledge of patient mobilization. As per the results, nurses posted an average barrier score of 34.2 while physicians posted an average barrier score of 44.2. On the other hand, physiotherapists had the lowest average barrier score, with 21.6. Therefore physicians posted a higher overall barrier score than nurses and physiotherapists (p < .001). Physicians also posted higher barriers on training/education and beliefs (p < .001). The study also had several limitations, including the transferability problem, prior experience with early mobilization by some participants, and the questionable credibility of physiotherapists who were not part of the cardiovascular units.
Moradian and others (2017) undertook a randomized clinica...