3. Synthesis of the literature – For each article, write a paragraph discussing the main components (subjects, methods, key findings) and provide rationale for how the article supports your PICOT.
4. Comparison of articles – Compare the articles (similarities and differences, themes, methods, conclusions, limitations, controversies).
5. Suggestions for future research: Based on your analysis of the literature, discuss identified gaps and which areas require further research.
6. Conclusion – Provide a summary statement of what you found in the literature.
You are required to cite four peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Expert Answer and Explanation
Literature Review
One of the major challenges that come with surgery, especially surgeries with long recovery periods like Coronary artery bypass grafting (CABG) is immobilization. Long periods of immobilization have been associated with several adverse effects that affect the patient’s general well-being in the short and long run. Some issues related to immobilization include intensive care unit (ICU)-acquired weakness (ICU-AW), which in turn results in longer hospitalization period and cost of care, increased risk of getting pressure ulcers, and long-term mobilization issues, for example, reduced functional range of motion, and depressed recovery of functional walking capacity, to list a few (Borges et al., 2022).
Early mobilization is one of the interventions suggested by scholars that can help improve patient outcomes for patients who have undergone surgery or are admitted to the ICU. This paper will therefore evaluate the literature on the option of using early mobilization using the following PICOT question; In adult patients after coronary artery bypass graft surgery, what is the impact of early mobilization compared to delayed mobilization in preventing postoperative complications during the first week of postoperative hospital stay?
Search Methods
Having the right search strategy is critical in collecting quality evidence to implement an evidence-based quality improvement change initiative or a clinical inquiry. The first step when conducting a literature search is to identify the right databases from which quality and relevant evidence can be collected. In this case, some of the databases that were considered when looking for the articles include PubMed, CINHAL Plus with full text, Medline, ScienceDirect, and Cochrane Library of Systematic Reviews. After identifying the databases, the researcher conducted a planned search using keywords relevant to the PICOT question.
Some keywords considered included early mobilization after surgery, early mobilization interventions, and enhanced recovery for CABG surgery. The use of Booleans AND and OR were used to narrow and specify the research results to capture articles that were relevant to the PICOT question. Research results were then filtered to only capture peer-reviewed articles and limited the search results to only articles written within the past five years. The researcher then selected the most relevant articles from the list to incorporate into the literature review.
Synthesis of Literature
The first article selected for review is the article by Allahbakhshian et al. (2023). The authors wanted to find out the effects of various early mobilization strategies on patient outcomes. Some outcomes considered in the study include postoperative cognitive dysfunction (POCD), length of hospital stay (LOS), and pain intensity in patients undergoing CABG. The research selected 120 patients undergoing CABG surgery who were randomly assigned to the various intervention and control groups. The participants had almost similar demographic and clinical characteristics. The study was a randomized controlled trial where the participants were assigned to two intervention groups and one control group.
Participants in the first intervention group received a four-phase early mobilization protocol; those in the second intervention group received a three-phase early mobilization protocol; while those in the control group received routine care. The study findings revealed that early mobilization protocol focused on deep breathing exercises and chest physiotherapy had better postoperative outcomes, including POCD and LOS. The results were better than those placed in early mobilization protocol focused on passive and active range of motion activities or routine care. The study provides evidence of the effect of early mobilization on outcomes for patients after CABG. The study also gives directions on the most effective early mobilization protocol for the target population.
The second study is a research by Esmealy et al. (2023). The authors wanted to compare the effects of different mobilization protocols on respiratory parameters and complications in patients following CABG. The participants in the study included 120 participants with comparable demographic and clinical characteristics, who were randomly assigned into three groups. The first group involved a four-phase early mobilization protocol, the second a three-phase early mobilization protocol and the final group was the control group.
The researchers measured the participants’ oxygen saturation, their arterial blood gases, and the incidence of pulmonary complications. The findings indicated that the four-phase and the three-phase early mobilization protocols enhanced respiratory parameters and reduced pulmonary complications for patients after undergoing CABG. The research helps to answer the PICOT by providing evidence of the effectiveness of the early mobilization protocols on patient outcomes.
The third article selected for the literature review is a systematic review by Borges et al. (2022). The authors wanted to describe the prescription of early mobilization in patients undergoing cardiac surgery based on evidence collected from multiple studies. The review considered articles from different sources, including Embase, Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Latin American and Caribbean Health Sciences Literature (or LILACS) databases.
The inclusion criteria focused on only randomized clinical trials concentrating on mobilization protocols performed early in ICU patients after cardiac surgery. From the inclusion and eligibility criteria, 14 articles out of the 1,128 were considered in the final review. The findings from the review revealed that early mobilization protocols were mostly generalist and not individual. Additionally, most of them used low-intensity exercises, through gradual mobilization, with two daily physical therapy sessions lasting between 10 to 30 minutes. The review provides some guidance on the establishment of a standard early mobilization protocol that can be applied in the PICOT intervention.
The fourth article is an article by Shan et al. (2022). The authors wanted to analyze the effect of early exercise rehabilitation on patients’ cardiopulmonary function and quality of life after CABG. The study had 80 participants who underwent CABG between 2020 and 2022, who were equally and randomly distributed into two groups; the intervention and control groups. Various tests like the cardiac function test, quality of life, and 6-minute walking test for the two groups were compared pre-and-post intervention.
Additionally, the researchers recorded the LOS and cost for the two groups. The findings revealed that early exercise rehabilitation is effective in enhancing cardiopulmonary function and exercise tolerance. The intervention also improved patients’ quality of life after CABG. The study provides information concerning the efficacy of the intervention selected in the PICOT.
Comparison of Articles
Out of the four articles, three were randomized controlled trials, and one was a systematic review. Two of the three randomized controlled articles were very similar in that they had the same sample size and three arms of study (two protocols and a control group). However, the structure of intervention protocols varied slightly. The third randomized-control study had 80 participants equally distributed in one intervention and a control group. The ultimate goal of the three studies was to find out the effectiveness of early mobilization strategies on patient outcomes.
The three studies showed affirmatively that early mobilization protocols had a positive impact on patient outcomes. Two of the randomized-control trials found went further to compare the effectiveness of different early mobilization protocols, where it was also noted that the impact on patient outcomes varied. For the systematic review, the authors noted the common structure employed by most mobilization protocols. One common limitation in the three randomized controlled trials was the small sample size, which could affect the level of generalizability in the study.
Suggestions for Future Research
The studies selected were quite elaborate in their design and rigor in methodology. However, more primary research should be done with a larger sample size to reach results with high levels of generalization. Additionally, more research should be done focusing on groups with specific demographic characteristics, for example, the elderly, to understand how the different intervention protocols correspond to different population groups. More studies should also be done to factor in how the early mobilization protocols affect other postoperative outcomes that are yet to be targeted.
Conclusion
The literature reviewed shows that early mobilization strategies help enhance postoperative outcomes for patients after CABG. However, the effects vary based on the structure of the mobilization intervention. In most cases, an intervention with physical therapy sessions lasting between 10 to 30 minutes is effective in achieving positive outcomes.
Some of the effects of early mobilization therapy from the literature review include better postoperative cognitive function, shorter length of hospital stay, lower pain intensity, better respiratory parameters, and reduced pulmonary complications for patients after CABG. Therefore, the literature supports the use of early mobilization strategy as the PICOT intervention to improve patient outcomes.
References
Allahbakhshian, A., Khalili, A. F., Gholizadeh, L., & Esmealy, L. (2023). Comparison of early mobilization protocols on postoperative cognitive dysfunction, pain, and length of hospital stay in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial. Applied Nursing Research: ANR, 73, 151731. https://doi.org/10.1016/j.apnr.2023.151731
Borges, M. G. B., Borges, D. L., Ribeiro, M. O., Lima, L. S. S., Macedo, K. C. M., & Nina, V. J. D. S. (2022). Early mobilization prescription in patients undergoing cardiac surgery: Systematic review. Brazilian Journal of Cardiovascular Surgery, 37(2), 227–238. https://doi.org/10.21470/1678-9741-2021-0140
Esmealy, L., Allahbakhshian, A., Gholizadeh, L., Khalili, A. F., & Sarbakhsh, P. (2023). Effects of early mobilization on pulmonary parameters and complications post coronary artery bypass graft surgery. Applied Nursing Research: ANR, 69, 151653. https://doi.org/10.1016/j.apnr.2022.151653
Shan, R., Zhang, L., Zhu, Y., Ben, L., Xin, Y., Wang, F., & Yan, L. (2022). Effect of early exercise rehabilitation on cardiopulmonary function and quality of life in patients after coronary artery bypass grafting. Contrast Media & Molecular Imaging, 2022, 4590037. https://doi.org/10.1155/2022/4590037