The Early Mobilization recommendation has been downgraded two levels because of inconsistent evidence.
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.
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
- Arndt, J., Clavert, P., Mielcarek, P., Bouchaib, J., Meyer, N., Kempf, J. F. Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair: a prospective randomized study. Orthop Traumatol Surg Res 2012; 6: S131-8
- Aufwerber, S., Heijne, A., Edman, G., Gravare Silbernagel, K., Ackermann, P. W. Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 0:
- Aufwerber, S., Heijne, A., Edman, G., Gravare Silbernagel, K., Ackermann, P. W. Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 0:
- Beaupre, L. A., Davies, D. M., Jones, C. A., Cinats, J. G. Exercise combined with continuous passive motion or slider board therapy compared with exercise only: a randomized controlled trial of patients following total knee arthroplasty. Phys Ther 2001; 4: 1029-37
- Bennett, L. A., Brearley, S. C., Hart, J. A., Bailey, M. J. A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study. J Arthroplasty 2005; 2: 225-33
- Bohl, D. D., Li, J., Calkins, T. E., Darrith, B., Edmiston, T. A., Nam, D., Gerlinger, T. L., Levine, B. R., Della Valle, C. J. Physical Therapy on Postoperative Day Zero Following Total Knee Arthroplasty: A Randomized, Controlled Trial of 394 Patients. J Arthroplasty 2019; 7: S173-S177.e1
- Christersson, A., Larsson, S., Sanden, B. Clinical Outcome after Plaster Cast Fixation for 10 Days Versus 1 Month in Reduced Distal Radius Fractures: A Prospective Randomized Study. Scand J Surg 2018; 1: 82-90
- Cuff, D. J., Pupello, D. R. Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol. J Shoulder Elbow Surg 2012; 11: 1450-5
- De Roo, P. J., Muermans, S., Maroy, M., Linden, P., Van den Daelen, L. Passive mobilization after arthroscopic rotator cuff repair is not detrimental in the early postoperative period. Acta Orthop Belg 2015; 3: 485-92
- Dehghan, N., McKee, M. D., Jenkinson, R. J., Schemitsch, E. H., Stas, V., Nauth, A., Hall, J. A., Stephen, D. J., Kreder, H. J. Early Weightbearing and Range of Motion Versus Non-Weightbearing and Immobilization After Open Reduction and Internal Fixation of Unstable Ankle Fractures: A Randomized Controlled Trial. J Orthop Trauma 2016; 7: 345-52
- Gross, S. C., Galos, D. K., Taormina, D. P., Crespo, A., Egol, K. A., Tejwani, N. C. Can Tibial Shaft Fractures Bear Weight After Intramedullary Nailing? A Randomized Controlled Trial. J Orthop Trauma 2016; 7: 370-5
- Hagen, M. S., Allahabadi, S., Zhang, A. L., Feeley, B. T., Grace, T., Ma, C. B. A randomized single-blinded trial of early rehabilitation versus immobilization after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 3: 442-450
- Iwakiri, K., Ohta, Y., Shibata, Y., Minoda, Y., Kobayashi, A., Nakamura, H. Initiating range of motion exercises within 24Â hours following total knee arthroplasty affects the reduction of postoperative pain: A randomized controlled trial. 2020; 0: 11-16
- Jenssen, K. K., Lundgreen, K., Madsen, J. E., Kvakestad, R., Pripp, A. H., Dimmen, S. No Functional Difference Between Three and Six Weeks of Immobilization After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Non-Inferiority Trial. Arthroscopy 2018; 10: 2765-2774
- Johnson, R. L., Amundson, A. W., Abdel, M. P., Sviggum, H. P., Mabry, T. M., Mantilla, C. B., Schroeder, D. R., Pagnano, M. W., Kopp, S. L. Continuous Posterior Lumbar Plexus Nerve Block Versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Total Hip Arthroplasty: A Three-Arm Randomized Clinical Trial. J Bone Joint Surg Am 2017; 21: 1836-1845
- Keener, J. D., Galatz, L. M., Stobbs-Cucchi, G., Patton, R., Yamaguchi, K. Rehabilitation following arthroscopic rotator cuff repair: a prospective randomized trial of immobilization compared with early motion. J Bone Joint Surg Am 2014; 1: 11-9
- Kimmel, L. A., Edwards, E. R., Liew, S. M., Oldmeadow, L. B., Webb, M. J., Holland, A. E. Rest easy? Is bed rest really necessary after surgical repair of an ankle fracture?. Injury 2012; 6: 766-71
- Kumar, P. J., McPherson, E. J., Dorr, L. D., Wan, Z., Baldwin, K. Rehabilitation after total knee arthroplasty: a comparison of 2 rehabilitation techniques. Clin Orthop Relat Res 1996; 331: 93-101
- Lee, D. H., Lee, K. B., Jung, S. T., Seon, J. K., Kim, M. S., Sung, I. H. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med 2012; 9: 2023-8
- Lehtonen, H., Jarvinen, T. L., Honkonen, S., Nyman, M., Vihtonen, K., Jarvinen, M. Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study. J Bone Joint Surg Am 2003; 2: 205-11
- Liow, R. Y., Cregan, A., Nanda, R., Montgomery, R. J. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. Injury 2002; 9: 801-6
- MacDonald, S. J., Bourne, R. B., Rorabeck, C. H., McCalden, R. W., Kramer, J., Vaz, M. Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty. Clin Orthop Relat Res 2000; 380: 30-5
- Mazzocca, A. D., Arciero, R. A., Shea, K. P., Apostolakos, J. M., Solovyova, O., Gomlinski, G., Wojcik, K. E., Tafuto, V., Stock, H., Cote, M. P. The Effect of Early Range of Motion on Quality of Life, Clinical Outcome, and Repair Integrity After Arthroscopic Rotator Cuff Repair. Arthroscopy 2017; 6: 1138-1148
- Mortensen, H. M., Skov, O., Jensen, P. E. Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study. J Bone Joint Surg Am 1999; 7: 983-90
- Okamoto, T., Ridley, R. J., Edmondston, S. J., Visser, M., Headford, J., Yates, P. J. Day-of-Surgery Mobilization Reduces the Length of Stay After Elective Hip Arthroplasty. J Arthroplasty 2016; 10: 2227-30
- Paschos, N. K., Mitsionis, G. I., Vasiliadis, H. S., Georgoulis, A. D. Comparison of early mobilization protocols in radial head fractures. J Orthop Trauma 2013; 3: 134-9
- Schroter, S., Ateschrang, A., Lowe, W., Nakayama, H., Stockle, U., Ihle, C. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 2017; 1: 325-332
- Sheps, D. M., Bouliane, M., Styles-Tripp, F., Beaupre, L. A., Saraswat, M. K., Luciak-Corea, C., Silveira, A., Glasgow, R., Balyk, R. Early mobilisation following mini-open rotator cuff repair: a randomised control trial. Bone Joint J 2015; 9: 1257-63
- Sheps, D. M., Silveira, A., Beaupre, L., Styles-Tripp, F., Balyk, R., Lalani, A., Glasgow, R., Bergman, J., Bouliane, M. Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Arthroscopy 2019; 3: 749-760.e2
- Sherrington, C., Lord, S. R., Herbert, R. D. A randomised trial of weight-bearing versus non-weight-bearing exercise for improving physical ability in inpatients after hip fracture. Aust J Physiother 2003; 1: 15-22
- Smeeing, D. P. J., Houwert, R. M., Briet, J. P., Groenwold, R. H. H., Lansink, K. W. W., Leenen, L. P. H., van der Zwaal, P., Hoogendoorn, J. M., van Heijl, M., Verleisdonk, E. J., Segers, M. J. M., Hietbrink, F. Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial. Eur J Trauma Emerg Surg 2018; 0:
- Suchak, A. A., Bostick, G. P., Beaupre, L. A., Durand, D. C., Jomha, N. M. The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am 2008; 9: 1876-83
- Yashar, A. A., Venn-Watson, E., Welsh, T., Colwell, C. W., Jr., Lotke, P. Continuous passive motion with accelerated flexion after total knee arthroplasty. Clin Orthop Relat Res 1997; 345: 38-43
- Zhang, J. L., Bai, D. Y., Yang, J. W., Luan, Y. J., Zhao, C. J. Early motion versus immobilization for arthroscopic repair in the treatment of large size rotator cuff tears. Biomedical Research (India) 2017; 15: 6818-6822