Early Mobilization
Limited evidence suggests no difference in patient pain, function and opioid use between earlier mobilization and standard treatment.
Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: SOMOS, OTA

Rationale

Twenty high quality (Christersson 2018, Sheps 2015, Bohl 2019, Paschos 2013, Jenssen 2018, Beaupre 2001, Aufwerber 2020, Kimmel 2012, Lehtonen 2003, Hagen 2020, Okamoto 2016, Schroter 2017, Aufwerber 2019, Keener 2014, Dehghan 2016, Iwakiri 2020, Sheps 2019, Mazzocca 2017, Smeeling 2018, Sherrington 2003) and thirteen moderate quality studies (Yashar 1997, Bennett 2005, Kumar 1996, Lee 2012, Johnson 1990, MacDonald 2000, Gross 2016, Liow 2002, De Roo 2015, Zhang 2017, Arndt 2012, Cuff 2012, Mortensen 1999, Suchak 2008) were reviewed. Most studies showed no significant difference in improvement in pain, patient reported outcomes or opioid use. Three high quality and one moderate quality studies showed worsened pain, while one high quality and one moderate quality study showed improved pain. Seven high quality and five moderate quality studies showed improved function, while two high quality and two moderate quality studies showed worsened function.

The Early Mobilization recommendation has been downgraded two levels because of inconsistent evidence.

Benefits/Harms of Implementation

Despite the large number of studies, only one showed significant negative adverse events for this intervention.

Cost Effectiveness/Resource Utilization

Potentially large resource utilization in delivering this level of care in the hospital setting

Acceptability

Would require increased resource utilization which may have some concerns with acceptability.

Feasibility

Intervention has been used extensively and is clearly feasible.

Future Research

Inconsistent results highlight the need for larger studies with an emphasis on heterogenous treatment effects