Background An external ventricular drain (EVD) is used to relieve elevated intracranial pressure in neurosurgical patients, and remains in place for an average of 8 days post-surgery. The presence of an EVD poses a major barrier to early mobilisation due to safety concerns. Eligibility criteria published in EVD mobilisation protocols only consisted of parameters related to the neurological system (Moyer et al., 2017; Young et al., 2019). Parameters pertaining to cardiovascular, respiratory and musculoskeletal systems deemed safe for mobilisation were not stated. Aims To determine the safety, feasibility and effectiveness of implementing an early mobilisation protocol, which included physiological parameters, in patients with EVDs. Methods A retrospective service evaluation was conducted in a neurological intensive care unit. Medical records were reviewed for 2 periods from October 2017 to March 2018 (pre-protocol period) and October 2019 to March 2020 (protocol period). Eligible patients for out-of-bed mobilisation were screened and identified by physiotherapists. Results After protocol implementation, there was a 64.8% increase in the proportion of patients with EVDs mobilised (95% CI, 35.9–82.1%, p <0.0001). Median time from EVD placement to 1st mobilisation decreased from 14 to 3.5 days (p <0.0001). Moreover, the median intensive care and hospital length of stays were significantly reduced from 8 to 3.5 days (p = 0.037) and 38 to 22.5 days (p = 0.030) respectively. No adverse events were recorded in the protocol period. Conclusion The early mobilisation protocol for patients with EVDs enabled safe, feasible and effective mobilisation. Future prospective, controlled research studies are warranted.
In order to challenge inequalities and mainstream equality in health, individual feedback on the CR services provided should be sought at appropriate intervals 1,4,10,11. In addition, to meet the individual's psychosocial needs and to create the best possible chances of uptake, long-term adherence and self-management of a physically active lifestyle, the BACPR Standards and Core Components recommend that a choice of CR venue (hospital, community or home) is offered 5. Key national guidelines associated with cardiac rehabilitation A number of key publications guide the design and implementation of CR as summarised below: Group Guideline/Policy Website General (all) Scottish Intercollegiate Guidelines Network (SIGN) guidelines for CR (2002) American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) (2006) American College of Sports Medicine (ACSM) (2009) Joint British Societies' (JBS3) Consensus recommendations for the prevention of cardiovascular disease 2014
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