Ambulation Orderlies and Recovery After Cardiac Surgery: A Pilot Randomized Controlled Trial

Abstract

Background: One potential strategy to increasing physical activity after surgery is to utilize an ambulation orderly (AO), a dedicated employee whose assures frequent patient walking. However, the impact of an AO on physical and functional recovery from surgery is unknown. Methods: We randomized post-operative cardiac surgical patients to receive either the AO or usual care. We measured average daily step count, changes in 6-minute walk test (6MWT) distance, and changes in functional independence (Barthel Index.) Our primary goal was to test protocols, measure variability in activity, and establish effect sizes. Results: Thirty-six patients were randomized (18 per group, 45% bypass surgery). Overall, patients exhibited significant recovery of physical function from baseline to discharge in the 6MWT (from 83 to 172 meters, p < 0.001) and showed improvement in independent function (Barthel Index, 67 to 87, p <0.001). Moreover, each additional barrier to ambulation (supplemental oxygen, intravenous poles/fluid, walkers, urinary catheters, and chest tubes) reduced average daily step count by 330 steps/barrier, p = 0.04. However, the AO intervention resulted in only a small difference in average daily step counts (2718 vs. 2541 steps/day, Cohen’s d = 0.16, 608 patients needed for larger trial), which we attributed to several trial factors that likely weakened the AO intervention. Conclusions: In this pilot study, we observed significant in-hospital physical and functional recovery from surgery, but the addition of an AO made only marginal differences in daily step counts. Future studies should consider stepped-wedge or cluster trial designs to increase intervention effectiveness. Clinical Trials Registration: Clinicaltrials.gov unique identifier: NCT02375282

Psychometric evaluation of the shortened version of the Functional Difficulties Questionnaire to assess thoracic physical function

“…6 Furthermore, we found a significant difference in the FDQ-s scores at baseline between people using a gait aid compared with those without a gait aid, indicating that the FDQ-s may be able to distinguish mobility impairments early in the postoperative course. 4,26 However, this finding should be interpreted with caution as we did not analyse the predictive utility of the new scale on the need for gait aids in the target population.…”

Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial

“…Appropriate exercise interventions in the hospital can, at the very least, attenuate functional decline. After cardiac surgery, ambulation facilitated by “ambulation orderlies” reduced functional decline and LOS [ 22 , 37 ]. Kosse et al [ 65 ] found in their systematic review that exercise interventions (provided by physical therapists or nurses) improved performance of physical function tests, contributed to fewer discharges to post-acute care facilities, and reduced hospital length of stay in a clinically heterogeneous sample of older adults.…”

“…The AMBULATE study is a multicenter, single-blind, parallel control design, individual-level randomized trial. It builds from our pilot trials, which demonstrated that patients with a MT ambulated more than those receiving usual care, with a small increase in mobility status, reduction in length of stay, and an increased proportion discharging home [ 36 , 37 ].…”