Systematic review describing the effect of early mobilisation after dysvascular major lower limb amputations

Ulla Riis Madsen, Ami Hommel, Connie Bøttcher Berthelsen, Carina Bååth

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Aims and objectives. To assess the effect of early mobilisation of patients after
dysvascular lower limb amputation and to compare the effectiveness of different
mobilisation regimens.

Background. Patients who have undergone dysvascular major lower limb amputations are at high risk of postoperative complications, which include loss of basic functions, and early mobilisation interventions might prevent these complications.

Design. Systematic review.

Methods. Systematic searches were performed on PubMed (including MEDLINE),
CINAHL and EMBASE databases to identify studies investigating the effects of
(early) mobilisation interventions in dysvascular lower limb-amputated patients.
Data collection and quality assessment were performed using the Cochrane Effective Practice and Organization of Care Review Group data collection checklist and the Cochrane Handbook for Systematic Reviews of Interventions, respectively.

Results. Five studies were included in the review: four pre- to post-case studies
and one randomised controlled study. However, none of these studies were of high quality. Four studies investigated early mobilisation promoted by immediate
postoperative prosthesis. One study investigated whether reorganizing care
increases mobilisation and thereby functional outcome.

Conclusions. This systematic review reveals a lack of evidence to determine
whether early mobilisation interventions are beneficial to this vulnerable patient
group. Nevertheless, ambulation from the first postoperative day with temporary
prosthesis is possible among the heterogeneous population of dysvascular lower
limb-amputated patients if the necessary interdisciplinary team is dedicated to the task.

Relevance to clinical practice. Mobilisation is a fundamental care task often missed for several reasons. Moreover, mobilisation of the newly amputated patient is complex, and knowledge of effective strategies to promote postoperative
mobilisation in this vulnerable population is desired. Nurses are urged to take
responsibility for this fundamental care task and to engage the necessary collaborative interdisciplinary team to develop, implement and evaluate ambitious early mobilisation interventions.
Original languageEnglish
JournalJournal of Clinical Nursing
Volume26
Issue number21-22
Pages (from-to)3286-3297
ISSN0962-1067
DOIs
Publication statusPublished - Nov 2017
Externally publishedYes

Keywords

  • ambulation
  • amputation
  • amputee
  • basic functions
  • early mobilisation
  • fundamental care
  • interdisciplinary team work
  • lower limb amputation
  • mobilisation
  • postoperative care

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