Clinical Nurse SpecialistA Copyright B 2012
Wolters Kluwer Health | Lippincott Williams & Wilkins
Feature Article
Impact of Early Mobilization Protocol on the
Medical-Surgical Inpatient Population
An Integrated Review of Literature
Lavanya Pashikanti, MSN, RN n Diane Von Ah, PhD, RN
Purpose/Objectives:
The purpose of this review article was to examine the efficacy of
an early mobilization protocol in hospitalized medical-surgical
inpatient population.
Background/Rationale:
Prolonged immobilization can result in functional decline
and heighten the risk for hospital-associated complications
such as falls and pressure ulcers. Early mobilization, on the
other hand, has been shown to prevent functional decline
and hospital-associated complications. However, currently
no evidence-based guidelines exist with regard to an early
mobilization protocol for the medical-surgical inpatient population.
Therefore, the purpose of this review was to provide a thorough
analysis of current evidence pertaining to an early mobilization
protocol for the medical-surgical inpatient population.
Methods:
A comprehensive search of the literature was conducted
using Ovid, MEDLINE, and PubMed databases using
the following search terms: early ambulation, postoperative
care, and length of stay.
Outcome:
We found a total of 9 empirical studies that met the inclusion
criteria. Studies revealed that using the basic tenets of an early
mobilization protocol was associated with improved outcomes
for patients with deep vein thrombosis, reduced length of
Author Affiliations: Medical-Surgical Clinical Nurse Specialist, Indiana
University Health Bloomington (Ms Pashikanti), and Assistant Professor
and Robert Wood Johnson Nurse Faculty Scholar, School of Nursing,
Indiana University (Dr Von Ah), Indianapolis, Indiana.
Support for this publication was provided in part by a grant from the
Robert Wood Johnson Foundation (Nurse Faculty Scholar Award [prin-
cipal investigator Dr Von Ah 64194]).
The authors report no conflicts of interest.
Correspondence: Lavanya Pashikanti, MSN, RN, 1063 S Colchester
Ct, Bloomington, IN 47401 (lpashikanti@iuhealth.org).
DOI: 10.1097/NUR.0b013e31824590e6
Clinical Nurse Specialist A
Copyright @ 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
stay in patients with community-acquired pneumonia, and
maintained or improved functional status from admission to
discharge of hospitalized older adults and patients recovering
from major surgery.
Interpretation/Conclusion:
Overall, our review found that early mobilization (especially
early ambulation) of the medical-surgical inpatient population
may improve patient outcomes.
Implications:
Our review indicated that the greatest impact of early
mobilization is through standardized mobility protocols or
programs. Clinical nurse specialists are experts in leading
and sustaining standardized protocols or programs
pertaining to a nurse-sensitive outcome such as mobility.
KEY WORDS:
early mobilization, medical-surgical patients, outcomes
H
ospitalization, especially among the elderly, can
result in decreased mobility and functional de-
cline. Decreased mobility during hospitalization,
in turn, can lead to accelerated bone loss, dehydration,
malnutrition, delirium, sensory deprivation, isolation, sheer-
ing forces on the skin, and incontinence.1 Functional
decline (defined as the inability to perform usual activities
of daily living due to weakness, reduced muscle strength,
and reduced exercise capacity) can also significantly im-
pact nurse-sensitive outcomes.1 This is especially true for
the elderly population, which constitutes nearly half of
the medical-surgical inpatient population. In fact, func-
tional decline has been identified as the leading com-
plication of hospitalization for the elderly.1 Functional
decline and deconditioning from a patients baseline mo-
bility status can occur as early as day 2 of hospitalization
of elderly patients.1 Without adequate mobilization, an in-
dividual can lose up to 5% of muscle mass daily.2 This loss
in muscle mass and strength can have a significant impact
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 Feature Article
on nurse-sensitive outcomes such as hospital-acquired
pressure ulcers and falls. Falls and hospital-acquired pres-
sure ulcers can lead to further debilitation for the patient,
as well as increase the length of stay of the patient and
increase healthcare costs, as much as $17 483 per case3
and $43 180 per case,4 respectively. Research also sug-
gests that approximately 34% to 50% of the elderly popu-
lation who are hospitalized experience functional decline
that affects the length of stay, mortality, nursing home
placement, healthcare costs, and readmission rates.5,6
Therefore, clinical nurse specialists (CNSs) must focus their
efforts to develop intervention protocols that promote
mobility and prevent functional decline to optimize nurse-
sensitive outcomes in the hospitalized patient.
Early mobilization has been suggested as one effective
nursing intervention to prevent immobility-related compli-
cations and promote positive patient outcomes.6Y8 Early
mobilization includes the movement of the patient ranging
from passive range-of-motion exercises to active ambula-
tion, depending on the physical capabilities of the patient,
and is initiated within 24 hours of admission into an acute
care setting. Current research has documented the positive
effects of early mobilization in critical care patients,9Y11
stroke patients,12Y14 and patients who have undergone
cardiovascular15Y17 and orthopedic surgeries.18Y20 However,
these patients make up a limited number of all potential pa-
tients cared for in a hospital setting. In fact, critical care units
comprise only 10% of all acute care hospital beds.21 Thus,
what is not well known is: What impact does early mobi-
lization have on nurse-sensitive outcomes in the hos-
pitalized medical-surgical inpatient population? Therefore,
the purpose of this review and synthesis of the literature
was to examine the efficacy of early mobilization in hos-
pitalized medical-surgical inpatient population. Findings
from this review may be used by CNSs to improve care
guidelines and subsequently promote positive outcomes
for the medical-surgical inpatient population.
SEARCH STRATEGY
A comprehensive search of the literature was conducted
using Ovid, MEDLINE, and PubMed databases. Key terms
used in this search included early ambulation, postopera-
tive care, and length of stay. A total of 9 empirical studies
met the inclusion criteria including having been published
between the years of 2000 and 2011, empirical quantita-
tive studies, and in the English language (Table). Of the
9 empirical studies, 4 studies included surgical popula-
tions,2,24,28,29 and 5 studies included participants with
medical diagnoses.22,23,25Y27
SYNTHESIS OF FINDINGS
The (Table) comprehensively presents the study de-
sign, sample population, a detailed description of the
type of early mobilization intervention protocol, out-
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comes measured, and findings of each empirical study.
Overall, our review found that early mobilization (espe-
cially early ambulation) of the medical-surgical inpatient
population may improve patient outcomes. Specifically,
we found that early mobilization was associated with im-
proved outcomes for patients with deep vein thrombo-
sis (DVT), community-acquired pneumonia (CAP), older
adults, and patients recovering from major surgery. We
will summarize these findings in the following sections.
Improved Outcomes of Patients With DVT
One of the earliest studies found to address the basic te-
nets of an early mobilization protocol in the medical
population included patients with DVT. Partsch and
Blattler22 in 2000 and Partsch et al25 in 2004 revealed that
early ambulation can improve outcomes for patients diag-
nosed with DVT. Partsch and Blattler22 conducted a
randomized controlled trial in which 45 patients diag-
nosed with DVT received low-molecular-weight heparin
and compression but differed in whether they performed
early ambulation. These researchers found that participants
who performed early ambulation exercises had lower over-
all pain scores and a significant reduction in leg swelling
(lower leg circumference). The early ambulation group re-
ported significantly improved clinical symptoms including
less pain during walking, reduce pain associated with the
sole of the foot, and the palpation of the foot. In addition,
this group had less subfascial edema, prefascial edema, a
lower skin temperature, and reduced redness/cyanosis of
the affected limb compared to participants who did not
perform early ambulation. In 2004, Partsch and col-
leagues25 conducted a long-term follow-up study of 37 of
the 45 original medical patients. In this follow-up study,
although not statically significant, a lower percentage of
patients in the early ambulation group had swelling (in-
creased leg circumference) in the affected limb (16/26
early ambulation group vs 9/11 in the bed-rest group)
than those patients in the usual care unit. In addition, a
significantly lower percentage of patients in the early am-
bulation group (18/26 vs 2/11 in the bed-rest group) had
symptoms associated with postthrombotic syndrome (a
significant complication of DVT) than those patients in
the control group. Consequently, these 2 medical studies
revealed that implementing the basic tenets of an early
mobilization protocol for DVT patients assisted in symp-
tom control, in turn maintaining functional well-being.
Reduction in Length of Stay for Patients With CAP
In 2003, Mundy and colleagues23 conducted a study in
which they evaluated the effect of an early mobilization
protocol on length of stay of patients with CAP admitted
to 3 hospitals in Midwestern United States. These re-
searchers conducted a randomized controlled trial in
which medical units (within each of these 3 hospitals)
March/April 2012
Table. Comprehensive Review of the Literature Regarding Early Mobilization on
Outcomes in Medical-Surgical Patients
Study Design, Early Mobilization Outcome
Authors/Year Study Purpose Sample/Setting Protocol Variables Findings

Partsch and To evaluate the Randomized controlled 2 Ambulatory Pain: The daily walking
Blattler22 benefits of trial (RCT) groups; 1 with distance was between
(2000) compression and inelastic Unna boot 600 and 12 000 m
(medical early walking Sample: n = 45 patients bandages, 1 with -Overall pain in the ambulatory
study) exercises, in with DVT (15 per group) elastic compression groups and averaged
comparison Setting: Vienna, Austria stockings vs bed -During walking 66 m in the bed-rest
with bed rest rest, no compression group
in acute stage -Sole of foot
of proximal -Calf with palpation Lower overall pain
deep venous scores in ambulatory
thrombosis (DVT) Edema groups (starting
-Leg circumference 2nd day) compared
with bed-rest group
-Subfascial Decreased overall leg
circumference in
-Prefascial ambulatory groups
Skin temperature compared with
bed-rest group
Redness/cyanosis Improvements noted
in specific pain scores
Length of stay (LOS) (during walking, sole
of foot, and calf),
reduced edema
(subfascial and
prefascial), decreased
skin temperature,
and redness/cyanosis
No significant
difference in
progression of
thrombi noted
between groups
Mundy et al23 To determine Group randomized trial EM: Sitting out LOS Reduced LOS
(2003) if early of bed or ambulating (decreased by 1.1 d;
(medical mobilization Sample: for at least 20 min 95% confidence
study) (EM) reduces Total n = 458 during the first 24 h interval, 0.0Y2.2 d)
hospital length
of stay in Intervention: n = 227 Progressive
patients mobilization
Control: 231 occurred each
with CAP
Setting: Midwestern US subsequent day
24
Raue et al To compare Nonrandomized Multimodal Pulmonary function FAC pulmonary
(2004) outcomes of comparative cohort intervention (forced vital capacity function significantly
(surgical patients study with enforced [FAC]) improved on the 1st
study) receiving mobilization (early day for intervention
a multimodal Sample: ambulation) epidural Duration of group
fast-track analgesia and early postoperative ileus
rehabilitation Total: n = 52 oral feeding Pain Oral feeding and
program vs defecation occurred
usual care Intervention: Fatigue earlier in the
of patients n = 23 (post-AMP) Morbidity and mortality intervention group
undergoing
laparoscopic Control: LOS No changes in pain
sigmoidectomy scores
n = 29

Continued

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 Feature Article

Table. Comprehensive Review of the Literature Regarding Early Mobilization on

Outcomes in Medical-Surgical Patients, continued
Study Design, Early Mobilization Outcome
Authors/Year Study Purpose Sample/Setting Protocol Variables Findings

Significantly lower fatigue

reported by participants in
the intervention vs control
group
Morbidity same for both
groups
Intervention group
participants were discharged
significantly earlier than
those in usual care (4th vs 7th
day postoperatively)
Partsch et al25 To investigate Observational cohort See protocol in Clinical and No significant differences
(2004) the long-term study Partsch and venous duplex venous duplex
(medical benefits of Blattler22 investigation and pain
study) compression and Sample: Pain
early walking Total: n = 37 Leg
exercises in circumference,
comparison clinical
vs bed rest
in patients Intervention: n = 26 PTS: 5 symptoms Smaller proportion of
with DVT and 6 objective mobile patients
Control: n = 11 indicators (16/26) had increased
leg circumference
(in diseased leg) vs bed-rest
patients (9/11)
Setting: Vienna, Austria Larger proportion of mobile
patients (18/26) had no
postthrombotic syndrome
(PTS) symptoms compared
with bed-rest patients (2/11)
Marzen-Groller To examine the Comparative pre-post AMP, which includes Functional Researchers found that the
et al2 (2008) relationship of study observational study early and progressive mobility AMP protocol increased the
prolonged LOS mobilization functional mobility of the
and functional Sample: LOS participants
mobility Total: n = 44
status after
lower-extremity Intervention: No difference in LOS was
amputation, and noted.
n = 14 (post-AMP)
the impact of
the Amputee Control:
Mobility
n = 30 (pre-AMP)
Protocol (AMP)
Setting: United States
Padula and To determine the Nonequivalent control Nurse-driven mobility Functional status Functional status (ability to
Baumhover26 impact of a group design protocol included perform activities of daily
(2009) nurse-driven (controlled trial) promotion of mobility living) scores improved
(medical mobility protocol (question orders for significantly from admission
study) on functional Sample: n = 50 older bed rest); reduction of LOS to discharge in the
decline in adults, variety of medical barriers to mobility intervention group vs control
hospitalized diagnoses (remove catheters);
older patients Setting: United States ambulation 3Y4 Intervention group had
times per day; and up significantly lower LOS
for meals than control (4.96 d
treatment vs 8.72 d,
respectively, P G .001)

Continued

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Table. Comprehensive Review of the Literature Regarding Early Mobilization on
Outcomes in Medical-Surgical Patients, continued
Study Design, Early Mobilization Outcome
Authors/Year Study Purpose Sample/Setting Protocol Variables Findings
27
Baird et al To examine the Retrospective, 2-group Multimodal program: LOS Lower length of stay
(2010) impact of a comparison design preoperative for intervention
(surgical fast-track education, early group vs usual care
study) intervention Sample: ambulation, early 30-d hospital (4.66 d compared
program return to diet, new readmission with 5.87 d for usual
Total n = 200
(education, early anesthetic, analgesic, care patients
ambulation, early Intervention n = 100 and surgical
diet, etc) on Usual care (retrospective techniques; and best Readmission rates
length of stay and chart review) n = 100 practice (use of drains, between the 2 groups
30-d hospital tubes, and urinary were not statistically
readmission in Setting: Midwestern US catheters significantly different
laparoscopic postoperatively)
colorectal surgery
Gustafsson To examine the Prospective cohort Multimodal Adherence to the Postoperative
et al28 (2011) impact of different design program: ERAS ERAS protocol symptoms declined
(published adherence levels protocol including: significantly for
online) to the enhanced Sample: thoracic epidural Incidence of patients on the ERAS
(surgical study) recovery after analgesia; postoperative symptoms protocol
Total: 953 and complications
surgery (ERAS) preoperative oral
protocol and the Treated 2002Y2004: carbohydrates until LOS The proportion of
effect of various n = 464 2 h prior to surgery, adverse postoperative
ERAS elements and avoidance of outcomes (30-d
on outcomes Treated 2005Y2007; preoperative oral morbidity, symptoms,
following major n = 489 bowel preparation; and readmissions) was
colorectal surgery Setting: Stockholm, perioperative fluid significantly reduced
Sweden overloading; early with increasing
oral diet (4 h after adherence to the ERAS
surgery); and EM protocol
(2 h out of bed on the
day of surgery and Median LOS reduced
then 6 h daily) from 7 to 6 d for all
patient groups (not
statistically significant);
proportion of patients
with LOS within the
clinical target for
abdominoperineal
resections (7 d)
increased significantly
from 35.4% to 46.8%
Lee et al29 To evaluate the RCT Multimodal Recovery time Recovery time was
(2011) efficacy of a intervention: early (tolerate diet; safe shorter in the
(surgical study) rehabilitation Sample: oral feeding, early ambulation, rehabilitation program
program after Total n = 100 ambulation, and analgesic-free, and group than in the usual
laparoscopic regular laxative afebrile and free of care group (median
colon surgery Intervention: major complications) time 4 vs 6 d,
n = 46 respectively; P = .0001)

Usual care: Secondary outcomes: No difference in

postoperative LOS,
n = 54 LOS complication rates
Setting: Korea Complications, quality between groups
of life Quality of life and
pain were similar in
both groups
There were no
readmissions or
mortality

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 Feature Article
who cared for patients with CAP were randomly assigned
to provide the early mobilization intervention or usual
care. After the random assignment of units and careful re-
view of the exclusion criteria (hospitalization within the
prior 2 weeks, diagnosis with large-volume aspiration
pneumonia, admission or transfer to an intensive care unit
or assignment to a nonstudy hospital unit), 458 patients
were deemed eligible and enrolled in the study. Of the
458 participants, 227 were assigned to the early mobiliza-
tion intervention group, and 231 patients were assigned to
usual care. According to the study protocol, early mobili-
zation was defined as movement out of bed with change
from horizontal to upright position for at least 20 minutes
during the first 24 hours of the hospitalization with pro-
gressive mobilization on each subsequent day during
hospitalization. These researchers found that the partici-
pants in the early mobilization group had significantly
shorter length of stay (fewer inpatient days) compared
with the usual care group (Table). Importantly, patients
in these 2 groups (early mobilization and usual care) did
not differ demographically (age and gender) or in relation
to their disease severity and treatment, supporting the hy-
pothesis that an early mobilization protocol resulted in
decreased length of stay for patients with CAP. Based
on this large randomized controlled trial, an early mobili-
zation protocol can reduce clinical symptoms of CAP (as
seen by a faster recovery time Y a shorter length of stay)
and in effect also maintain functional well-being (as no
hospital-associated complications were noted). However,
further research is needed to replicate these findings.
Mobility Protocol (Based on Early Ambulation)
Decreased the Hospital Length of Stay of Older Adults
Researchers in Rhode Island conducted a study to evaluate
the effect of a nurse-driven mobility protocol (based on early
ambulation) on a convenience sample of hospitalized adults
60 years or older.26 Two nursing units were selected for this
study, and both were equal in size, cared for similar patient
populations, and were characterized by similar nursing
staff composition. The nursing unit that implemented the
mobility protocol found that participants either maintained
or improved their functional status from admission to dis-
charge. Furthermore, these participants had a reduced
length of stay compared with the control nursing unit that
did not implement the mobility protocol. Therefore, adop-
tion of the nurse-driven mobility protocol (based on early
mobilization) led to the decreased length of stay in hospital-
ized elderly patients and maintained or improved their func-
tional status from admission to discharge.
Use of a Mobility Protocol Improved the
Functional Mobility of Patients Who Underwent
Lower-Limb Amputations
In 2008, researchers in eastern Pennsylvania conducted
an observational study to examine the effect of a mobil-
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ity protocol on patients who underwent above-the-knee
or below-the-knee amputations.2 This study was con-
ducted in a medical-surgical vascular unit at a large aca-
demic community hospital. The protocol was specifically
designed to encourage and promote early and progressive
mobilization of postamputation patients. The researchers
examined the impact of the mobility protocol on the func-
tional mobility and the length of stay of these participants.
Functional mobility was defined by how much physical
assistance a participant needed to perform the following
actions: supine to sit and sit to supine, stand pivot, sliding
board transfer, sit to stand and stand to sit, and finally dis-
tance ambulated in feet. Researchers found that the proto-
col increased the functional mobility of the participants,
but it did not impact the length of stay. Overall, study find-
ings indicate that early ambulation may positively impact
functional mobility of patients who underwent lower-
limb amputations. More research is needed to understand
if it reduces hospital length of stay in these patients.
Multimodal Rehabilitation Program Can Contribute
to Positive Outcomes for Patients Recovering From
Surgical Procedures
Four studies examined the impact of multimodal interven-
tions on outcomes after surgery including laparoscopic
sigmoidectomy, laparoscopic colorectal or colon surgery,
and major colon surgery. In 2004, researchers from Berlin,
Germany, conducted a study to evaluate the effects of a
multimodal rehabilitation program on patients who under-
went an elective laparoscopic sigmoidectomy (Table).
In the multimodal or fast-task rehabilitation program,
patients were consistently encouraged to perform early
ambulation (beginning from the day of surgery until the
day of discharge) in combination with epidural analgesia
and early oral feeding. Two different surgical units in a
Berlin hospital were selected to provide either early am-
bulation or standard (usual care) treatment. Patients in
the early ambulation unit demonstrated significant clinical
improvement and were discharged earlier compared with
patients who received standard (usual care) treatment.
Similar results were noted by Lee and colleagues,29 who
found that recovery time was shorter for those receiving
a rehabilitation program that included early ambulation
in laparoscopic colon surgery. Baird et al27 also noted
lower length of stay for patients in a rehabilitation pro-
gram who were recovering from laparoscopic colorectal
surgery. In addition, Gustafsson et al28 noted that par-
ticipants who had greater adherence to the multimodal
rehabilitation program had fewer postoperative symp-
toms and complications than those who did not. Although
early ambulation was not the only intervention provided
in these studies, the results indicate that it may be an impor-
tant component to include within a multimodal reha-
bilitation program.
March/April 2012
Effects of Standardized Early Mobilization Protocols
In review of all studies, it was clear that those protocols
that utilized a more standardized and structured format
obtained the most significant results. The standardized
format was brought in by implementing a progressive
series of specific mobility interventions (as defined by
the hospital unit/organization/researcher) to help the
patient attain and/or maintain his/her baseline mobility
status. These specific mobility interventions began within
24 hours of admission and were sustained throughout
the inpatient stay.2,23,26 These studies demonstrated that
a more standardized early mobilization protocol can sig-
nificantly improve the functional status of hospitalized
older adults and reduce the length of stay for patients
with CAP and patients who underwent lower-limb ampu-
tations.2,26 In the case of surgical patients (laparoscopic
sigmoidectomy, laparoscopic colorectal or colon surgery,
and major colon surgery), only the basic tenets of an early
mobilization protocol were included in the structure of
a larger rehabilitation program24,27Y29 Patients who were
included in these rehabilitation programs experienced re-
duced length of stay, faster recovery time, and reduced
postoperative symptoms.
LIMITATIONS OF REVIEWED STUDIES
Findings in this review must be taken in consideration of
the limitations of the studies presented. One major limi-
tation of this work is that researchers defined and imple-
mented early mobilization protocol in a slightly different
manner in each of the studies reviewed. Some researchers22
defined and implemented early mobilization protocol as
specific walking exercises; some2,23,26 included a stan-
dardized form of a series of progressive mobility interven-
tions, and finally others24,27Y29 included early mobilization
as a part of a larger rehabilitation program with other in-
terventions. Although the overall definition of early mobi-
lization was similar in all these studies, the implementation
method could impact the clinical outcomes noted in each
of these patient populations. Overall, more work is needed
that consistently defines early mobilization across studies,
establishes the optimal dose of early mobilization, and
determines its impact on clinical outcomes for various
medical-surgical inpatient populations.
IMPLICATIONS FOR CNS PRACTICE
Maintaining functional well-being, management of symp-
toms associated with an acute clinical condition and
preventing hospital-associated complications are all nursing-
sensitive outcomes. An early mobilization protocol may
address each one of these nursing-sensitive outcomes.
The findings of this empirical literature review suggest that
an early mobilization protocol can maintain and/or im-
prove functional status from admission to discharge.2,6Y8,26
Clinical Nurse Specialist A
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Including the basic elements of an early mobilization
protocol helped to control clinical symptoms in DVT pa-
tients, laparoscopic sigmoidectomy patients, and patients
recovering from colorectal surgery.22,24,25,28 In addition,
we noted that an early mobilization protocol alone or in
combination with other rehabilitative strategies can reduce
length of stay and prevent complications known to be as-
sociated with functional decline.
Interestingly, the greatest and most direct impact on
functional status occurred through standardized early mo-
bilization protocols. These protocols include a series of
specific (as defined by the hospital unit/organization/
researcher) mobility interventions implemented in a pro-
gressive manner (throughout the inpatient stay) to help
promote or sustain the patients baseline mobility status.2,26
Nurses will play a primary role in implementing these stan-
dardized early mobilization protocols as they directly ad-
dress the functional status (a nursing-sensitive outcome)
of the medical-surgical inpatient population.
Clinical nurse specialists will serve as the experts in
leading project teams to implement these types of stan-
dardized protocols. Clinical nurse specialists are in a
prime position to collaborate with the bedside nurses,
as well as other healthcare team members (such as phys-
ical therapists, occupational therapists, and physicians),
to sustain an ongoing program of early mobilization of
medical-surgical inpatients. In addition, CNSs can be a
primary resource to explore the impact of early mobiliza-
tion on other outcomes for this population. For example,
research to explore how early mobilization may promote
functional status (from admission to discharge) and sub-
sequently prevent hospital-acquired conditions such as
falls and pressure ulcers within the medical-surgical inpa-
tient population is warranted. Measuring and document-
ing the impact of early mobilization programs on falls
and pressure ulcers would be an important contribution
to establishing best practices for caring for the hospitalized
medical-surgical patients.
CONCLUSION
In summary, prolonged immobility can be detrimental to
the health of all hospitalized patients. Early mobilization
is one nursing-amenable intervention that has previously
shown to provide positive outcomes for critical care, car-
diovascular, neurological (stroke patients), and orthopedic
patient populations. This review including synthesis of the
literature, to our knowledge, is the first to explore the impact
of an early mobilization protocol in the medical-surgical in-
patient population.
The results of this review indicate that early mobilization
leads to positive outcomes for patients with a variety of
medical diagnoses and surgical conditions. We found that
patients with DVT, older medical patients, and patients
with lower-limb amputations demonstrated improved
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 Feature Article
physical functioning (greater functional mobility), less pain,
enhanced well-being, and/or lower length of hospital stay.
Thus, this review supports the need to incorporate early
ambulation as a nurse-driven intervention for medical-
surgical inpatients. Clinical nurse specialists will serve
as the primary advocates to implement and sustain such
a nursing-amenable intervention for the entire medical-
surgical inpatient population.
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