Student Number: 9602675T Master of Science in Physiotherapy. Faculty of Health Sciences / The purpose of the study was to compare the outcome in patients following primary total hip arthroplasty, between those receiving a mobility programme alone, as compared to bed exercises and a mobility programme, at discharge from hospital. Thirty-six patients were randomly allocated to either the control or experimental group using a concealed allocation process. The control group received a programme of supervised bed exercises and were mobilised according to the standard postoperative mobility protocol. The experimental group were mobilised according to standard protocol. On the third/fourth and sixth/seventh day postoperatively, patients were assessed by a blinded assessor on functional ability, pain at rest, and active range of hip flexion and abduction. The results indicated no difference in functional ability (p=0.99), pain at rest (p=0.83) and active range of hip flexion (p=0.19) or abduction (p=0.12), on the seventh/eight day postoperatively, between the control and experimental groups. In conclusion bed exercises appear to offer no additional benefit to patients post THA, during the acute hospitalisation phase. However this should not be extrapolated to THA patients who have prolonged bed rest periods postoperatively.

Critically ill patients can be prescribed bed rest as a therapeutic intervention. Immobility from bed rest can cause neuromuscular deconditioning and weakness. Preventing immobility by implementing mobilization activities may prevent these complications from occurring. Currently, mobility protocols are lacking. The purpose of this literature review is to analyze the evidence related to mobilizing patients in the Intensive Care Unit (ICU). In the future, a standard mobility protocol should be instituted for critically ill patients indicating when and how to begin mobilization. The efficacy of mobility protocols relies on an interdisciplinary team for positive outcomes to prevent complications of inactivity and promote patient safety. Future implementation of mobilization can decrease patients' lengths of stay and extensive rehabilitation from inactivity. Nursing education, practice and research should focus on interventions to prevent complications of immobility by identifying mobilization techniques, safety approaches and the use of protocols.

Deconditioning occurs in critically ill patients as early as 4 days after entering the intensive care unit (ICU) resulting in a loss of up to 25% peripheral muscle tone and 18% body weight by the time the patient is discharged. Early mobility (EM) has been shown to reduce complications such as neuromuscular weakness, muscle wasting, pneumonia, and the effects of prolonged periods of time on the ventilator. No formal education on EM had been provided to nurses at the clinical site. The purpose of this project was to develop an educational program on EM to promote early ambulation of critically ill ICU patients. The theory of knowledge to action was used to guide the development of the educational program. The practice-focused question addressed whether an educational program would improve nurses' perceptions of their knowledge of EM and if they would promote the use of EM among ICU patients. After a literature review to identify evidence-based practices and a protocol on EM, an educational program was developed that included a 25-item Likert-style pretest and posttest to measure percent agreement with perceptions of knowledge gained and likelihood of behavior change related to the practice of EM. Participants included 60 ICU nurses. Results demonstrated improvement in perceptions of knowledge of EM (from 74% before education to 88% after) and in likelihood of behavior change related to EM (from 69% before education to 91% after). Findings may be used to integrate EM into the ICU setting to reduce complications such as neuromuscular weakness, muscle wasting, and pneumonia. Results may also include improved patient outcomes, reduced length of stay, and increased quality of life for patients and their families, and thereby promote positive social change.