early ambulation


Summary: Procedure to accelerate the ability of a patient to walk or move about by reducing the time to AMBULATION. It is characterized by a shorter period of hospitalization or recumbency than is normally practiced.

Top Publications

  1. Bailey P, Thomsen G, Spuhler V, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35:139-45 pubmed
    ..A majority of survivors (69%) were able to ambulate >100 feet at RICU discharge. Early activity is a candidate therapy to prevent or treat the neuromuscular complications of critical illness. ..
  2. Chhatriwalla A, Bhatt D. Walk this way: early ambulation after cardiac catheterization--good for the patient and the health care system. Mayo Clin Proc. 2006;81:1535-6 pubmed
  3. Larsen K, Sørensen O, Hansen T, Thomsen P, Søballe K. Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop. 2008;79:149-59 pubmed publisher
  4. Reilly K, Beard D, Barker K, Dodd C, Price A, Murray D. Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty--a randomised controlled trial. Knee. 2005;12:351-7 pubmed
    ..The strict inclusion criteria meant that 75% of eligible patients were excluded. However, a large percentage of these were due to the distances patients lived from the hospital. ..
  5. Dorr L, Gendelman V, Maheshwari A, Boutary M, Wan Z, Long W. Multimodal thromboprophylaxis for total hip and knee arthroplasty based on risk assessment. J Bone Joint Surg Am. 2007;89:2648-57 pubmed
    ..0001). A multimodal thromboembolic prophylactic regimen is consistent with protecting patients while limiting adverse clinical outcomes secondary to thromboembolic, vascular, and bleeding complications. ..
  6. Rath S, Schreuders T, Selles R. Early postoperative active mobilisation versus immobilisation following tibialis posterior tendon transfer for foot-drop correction in patients with Hansen's disease. J Plast Reconstr Aesthet Surg. 2010;63:554-60 pubmed publisher
  7. Garzon Serrano J, Ryan C, Waak K, Hirschberg R, Tully S, Bittner E, et al. Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession. PM R. 2011;3:307-13 pubmed publisher
    ..Nurse and physical therapists identify different barriers for mobilization. Routine involvement of physical therapists in directing mobilization treatment may promote early mobilization of critically ill patients. ..
  8. Kerr D, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop. 2008;79:174-83 pubmed publisher
    ..230 (71%) of the 325 patients were discharged directly home after a single overnight stay in hospital. Local infiltration analgesia is simple, practical, safe, and effective for pain management after knee and hip surgery. ..
  9. Bundgaard Nielsen M, Jørgensen C, Jørgensen T, Ruhnau B, Secher N, Kehlet H. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization. Br J Anaesth. 2009;102:756-62 pubmed publisher
    ..The pathogenic mechanisms include both impaired TPR and CO responses. ..

More Information


  1. Hanekom S, Gosselink R, Dean E, van Aswegen H, Roos R, Ambrosino N, et al. The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice. Clin Rehabil. 2011;25:771-87 pubmed publisher
    ..This framework can be used to facilitate clinical decision making within the context of a given patient. The next step is to determine the clinical utility of this working algorithm. ..
  2. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008;79:168-73 pubmed publisher
  3. Lord R, Mayhew C, Korupolu R, Mantheiy E, Friedman M, Palmer J, et al. ICU early physical rehabilitation programs: financial modeling of cost savings. Crit Care Med. 2013;41:717-24 pubmed publisher
    ..S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs. ..
  4. Engel H, Needham D, Morris P, Gropper M. ICU early mobilization: from recommendation to implementation at three medical centers. Crit Care Med. 2013;41:S69-80 pubmed publisher
    ..Instituting a planned, structured ICU early mobility quality improvement project can result in improved outcomes and reduced costs for ICU patients across healthcare systems. ..
  5. Clements R, Yellumahanthi K, Ballem N, Wesley M, Bland K. Pharmacologic prophylaxis against venous thromboembolic complications is not mandatory for all laparoscopic Roux-en-Y gastric bypass procedures. J Am Coll Surg. 2009;208:917-21; discussion 921-3 pubmed publisher
    ..Adequate VTE prophylaxis is achieved using calf-length pneumatic compression devices, early ambulation, and relatively short operative times...
  6. Bourdin G, Barbier J, Burle J, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55:400-7 pubmed
    ..The chair-sitting intervention was associated with nonsignificant oxygenation improvement. The tilting-up intervention was an effort as intense as walking. ..
  7. Needham D. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008;300:1685-90 pubmed publisher
    ..Emerging research in this field provides preliminary evidence supporting the safety, feasibility, and potential benefits of early mobilization in critical care medicine. ..
  8. Husted H, Otte K, Kristensen B, Ørsnes T, Wong C, Kehlet H. Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop. 2010;81:599-605 pubmed publisher
    ..This calls for a reconsideration of optimal duration of chemical thromboprophylaxis. ..
  9. Schweickert W, Pohlman M, Pohlman A, Nigos C, Pawlik A, Esbrook C, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874-82 pubmed publisher
    ..None. ..
  10. Schweickert W, Kress J. Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest. 2011;140:1612-1617 pubmed publisher
    ..Future research to address the benefits of early mobilization in other patient populations is needed. In addition, the potential for early mobilization to impact long-term outcomes in ICU survivors requires further study. ..
  11. Diserens K, Moreira T, Hirt L, Faouzi M, Grujic J, Bieler G, et al. Early mobilization out of bed after ischaemic stroke reduces severe complications but not cerebral blood flow: a randomized controlled pilot trial. Clin Rehabil. 2012;26:451-9 pubmed publisher
    ..No influence on neurological three-month outcomes or on cerebral blood flow was seen. These results justify larger trials comparing mobilization protocols with possibly even faster mobilization out of bed than explored here. ..
  12. Giannoukas A, Labropoulos N, Michaels J. Compression with or without early ambulation in the prevention of post-thrombotic syndrome: a systematic review. Eur J Vasc Endovasc Surg. 2006;32:217-21 pubmed
    ..aim of this study was to assess whether there is enough evidence to suggest that compression with or without early ambulation after proximal DVT reduces the risk of post-thrombotic syndrome (PTS)...
  13. Cotter S, Cantrell W, Fisher B, Shopnick R. Efficacy of venous thromboembolism prophylaxis in morbidly obese patients undergoing gastric bypass surgery. Obes Surg. 2005;15:1316-20 pubmed
    ..Combination of medical management, early ambulation, and external compression devices adequately prevented the development of VTE in patients after gastric ..
  14. Pearse E, Caldwell B, Lockwood R, Hollard J. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br. 2007;89:316-22 pubmed
    ..However, multiple logistic regression analysis showed that the institution of an early mobilisation protocol resulted in a 30-fold reduction in the risk of post-operative deep-vein thrombosis when we adjusted for other risk factors. ..
  15. Hopkins R, Spuhler V, Thomsen G. Transforming ICU culture to facilitate early mobility. Crit Care Clin. 2007;23:81-96 pubmed
    ..Involvement of front-line staff in early mobility and other components of the care process model resulted in the development of a culture of safety and teamwork. ..
  16. Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007;23:35-53 pubmed
  17. Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, Nidhinandana S, Suwantamee J. Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study. J Med Assoc Thai. 2006;89:814-20 pubmed
    To compare the prevalence of Post Dural Puncture Headache (PDPH) between 6 hour- supine recumbence and early ambulation in Thai patients...
  18. Husted H, Hansen H, Holm G, Bach Dal C, Rud K, Andersen K, et al. [Accelerated versus conventional hospital stay in total hip and knee arthroplasty III: patient satisfaction]. Ugeskr Laeger. 2006;168:2148-51 pubmed
    ..These results support the implementation of fast-track total hip- and knee arthroplasty. ..
  19. Rath S. Immediate active mobilization versus immobilization for opposition tendon transfer in the hand. J Hand Surg Am. 2006;31:754-9 pubmed
    ..To test the hypothesis that immediate postoperative active mobilization of the hand after opposition tendon transfer will achieve outcomes similar to those of the standard practice of cast immobilization...
  20. Winkelman C, Higgins P, Chen Y. Activity in the chronically critically ill. Dimens Crit Care Nurs. 2005;24:281-90 pubmed
    ..This study provides information for investigators and practitioners who are interested in measuring or implementing therapeutic activity in selected critically ill adults. ..
  21. Zutshi M, Delaney C, Senagore A, Mekhail N, Lewis B, Connor J, et al. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestin. Am J Surg. 2005;189:268-72 pubmed
    ..TE offers no advantage over PCA for patients undergoing major intestinal resections who are on a fast-track postoperative care plan using PCA. ..
  22. Cantor J, Lebwohl N, Garvey T, Eismont F. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine (Phila Pa 1976). 1993;18:971-6 pubmed
    Eighteen neurologically intact patients with burst fractures at the thoracolumbar junction were treated with early ambulation in a total contact orthosis. No attempt was made to reduce the associated deformity...
  23. Delaney C, Zutshi M, Senagore A, Remzi F, Hammel J, Fazio V. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003;46:851-9 pubmed
    ..and intestinal or rectal resection were randomly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care...
  24. Siu A, Penrod J, Boockvar K, Koval K, Strauss E, Morrison R. Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med. 2006;166:766-71 pubmed
    ..2% [P = .38] for patients independent in locomotion at baseline). In patients with hip fracture, delay in getting the patient out of bed is associated with poor function at 2 months and worsened 6-month survival. ..
  25. Kirkeby Garstad I, Wisløff U, Skogvoll E, Stølen T, Tjønna A, Stenseth R, et al. The marked reduction in mixed venous oxygen saturation during early mobilization after cardiac surgery: the effect of posture or exercise?. Anesth Analg. 2006;102:1609-16 pubmed
    ..The response to postural change and exercise was altered after surgery and may both contribute to the reduction in Svo2 during postoperative mobilization. ..
  26. Malik M, Black E. Fast-track video-assisted bullectomy and pleurectomy for pneumothorax: initial experience and description of technique. Eur J Cardiothorac Surg. 2009;36:906-9; discussion 909 pubmed publisher
    ..b>Early ambulation and discharge should be a reasonable goal...
  27. Jan A, Crean P, Büllesfeld L, Coleman J, Grube E, Mulvihill N. First clinical experience with Celt ACD(®) : a femoral arterial puncture closure device. J Interv Cardiol. 2013;26:417-24 pubmed publisher
    ..The device may be effective in early ambulation and discharge of patients postcoronary intervention procedures.
  28. Rath S, Schreuders T, Stam H, Hovius S, Selles R. Early active motion versus immobilization after tendon transfer for foot drop deformity: a randomized clinical trial. Clin Orthop Relat Res. 2010;468:2477-84 pubmed publisher
    ..Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout...
  29. Pawlik A, Kress J. Issues affecting the delivery of physical therapy services for individuals with critical illness. Phys Ther. 2013;93:256-65 pubmed publisher
    ..The purpose of this article is to explore the issues that the physical therapy profession needs to address as the rehabilitation management of the patient with critical illness evolves. ..
  30. Lin J, Whelan R, Sakellarios N, Cekic V, Forde K, Bank J, et al. Prospective study of ambulation after open and laparoscopic colorectal resection. Surg Innov. 2009;16:16-20 pubmed publisher
    ..9 days in the > or =8-cm group (P < .001). Patients undergoing minimal-access colorectal surgery ambulated significantly further than equivalent open patients in the early postoperative period and had a shorter LOS. ..
  31. Ratiu A, Motoc A, Pascut D, Crişan D, Anca T, Păscuţ M. Compression and walking compared with bed rest in the treatment of proximal deep venous thrombosis during pregnancy. Rev Med Chir Soc Med Nat Iasi. 2009;113:795-8 pubmed
  32. Martin C, Pugely A, Gao Y, Clark C. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty. 2013;28:849-54 pubmed publisher
    ..Overall, the anterior approach patients had earlier discharge and mobilization as compared to patients who received the posterior approach. Neuropraxia and fracture remain a concern, but the clinical significance was low in our cohort. ..
  33. Grade M, Quintel M, Ghadimi B. Standard perioperative management in gastrointestinal surgery. Langenbecks Arch Surg. 2011;396:591-606 pubmed publisher
    ..The aim of this review is to provide clinicians with practical recommendations for day-to-day decision-making from a joint surgical and anaesthesiological point of view. The discussion centres on gastrointestinal surgery specifically. ..
  34. Ross A, Morris P. Safety and barriers to care. Crit Care Nurse. 2010;30:S11-3 pubmed publisher
  35. Letton C, Cheung C, Nordin A. Does an enhanced recovery integrated care pathway (ICP) encourage adherence to prescribing guidelines, accelerate postoperative recovery and reduce the length of stay for gynaecological oncology patients?. J Obstet Gynaecol. 2013;33:296-7 pubmed publisher
    ..There was a modest reduction in the length of stay and an increase in prescribed thromboprophylaxis and sodium docusate ( Cheung et al. 2011 ). ..
  36. Coon T. [Quadriceps-sparing minimally invasive technique for total knee arthroplasty : a new classification]. Orthopade. 2007;36:1113-9 pubmed
    ..Technical factors, quality control, and training remain the main issues of concern for surgeons new to these demanding techniques. ..
  37. Resch H, Krappinger D, Moroder P, Auffarth A, Blauth M, Becker J. Treatment of acetabular fractures in older patients-introduction of a new implant for primary total hip arthroplasty. Arch Orthop Trauma Surg. 2017;137:549-556 pubmed publisher
    ..The presented cage provides the possibility of early mobilization with full weight bearing which represents a valuable addition to the treatment spectrum in this challenging patient group. ..
  38. Kreutzer L, Minami C, Yang A. JAMA PATIENT PAGE. Preventing Venous Thromboembolism After Surgery. JAMA. 2016;315:2136 pubmed publisher
  39. Khan A, Parker M. Minimally invasive sliding hip screw insertion technique. Hip Int. 2012;22:214-7 pubmed publisher
    ..Follow-up was at six weeks for radiographic review and then subsequently at one year. The commonest complications were superficial wound infection (1.7%), detachment of the plate (0.9%) and cut-out of the lag screw (0.5%)...
  40. Gavaskar A, Tummala N, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. Injury. 2011;42:1495-8 pubmed publisher
    ..Open reduction increases the chances of achieving anatomical reduction and gives satisfactory functional results when coupled with aggressive rehabilitation. ..
  41. Blumenstein M. Early ambulation after acute deep vein thrombosis: is it safe?. J Pediatr Oncol Nurs. 2007;24:309-13 pubmed
    ..The majority of studies agree that early ambulation does not increase an anticoagulated patient's risk for pulmonary embolism...
  42. Chumbler N, Jia H, Phipps M, Li X, Ordin D, Vogel W, et al. Does inpatient quality of care differ by age among US veterans with ischemic stroke?. J Stroke Cerebrovasc Dis. 2012;21:844-51 pubmed publisher
    ..thrombolysis, deep venous thrombosis prophylaxis, antithrombotic therapy by hospital day 2 and at discharge, early ambulation, fall risk assessment, pressure ulcer risk assessment, rehabilitation needs assessment, atrial fibrillation ..
  43. Marrocco Trischitta M, Melissano G, Chiesa R. Letter to the editor regarding "Fast track open aortic surgery: reduced post operative stay with a goal directed pathway". M.A. Murphy, T. Richards, C. Atkinson, J. Perkins and L.J. Hands. Eur J Vasc Endovasc Surg 2007;34:274-278. Eur J Vasc Endovasc Surg. 2008;35:251 pubmed
  44. Rizio L, Jarmon N. Chronic quadriceps rupture: treatment with lengthening and early mobilization without cerclage augmentation and a report of three cases. J Knee Surg. 2008;21:34-8 pubmed
    ..The gap was < or = 2 cm following adequate surgical mobilization of the quadriceps tendon. Results of this technique are presented with a minimum of 1-year follow-up. ..
  45. Than K, Wang A, Etame A, La Marca F, Park P. Postoperative management of incidental durotomy in minimally invasive lumbar spinal surgery. Minim Invasive Neurosurg. 2008;51:263-6 pubmed publisher
    ..None of the patients developed symptoms related to durotomy. Although this represents a small series, early postoperative mobilization appears to be a reasonable option and results in shorter hospitalization. ..
  46. Hvelplund A, Jeger R, Osterwalder R, Bredahl M, Madsen J, Jensen J, et al. The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention. EuroIntervention. 2011;7:234-41 pubmed publisher
    ..With routine use of a femoral vascular closure device, approximately 87% of patients are suitable for immediate mobilisation. ..
  47. Müller I. [Applying kinesthetic basic principles at the Ludwigshaven Clinic gGmbH: assuring sustained continuing education]. Pflege Z. 2008;61:24-6 pubmed
  48. Arevalo Rodriguez I, Ciapponi A, Munoz L, Roqué I Figuls M, Bonfill Cosp X. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev. 2013;:CD009199 pubmed publisher
    ..There is no evidence from RCTs that suggests that routine bed rest after dural puncture is beneficial for the prevention of PDPH onset. The role of fluid supplementation in the prevention of PDPH remains unclear. ..
  49. Gottschalk A. [Regional anaesthesia and organ protection--the role of thoracic epidural anaesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2010;45:264-9; quiz 270 pubmed publisher
    ..Positive effects of epidural anaesthesia should be intensively used in terms of intensive physiotherapy and postoperative mobilisation as well as early enteral nutrition to further improve outcome of the patients. ..
  50. Needham D, Truong A, Fan E. Technology to enhance physical rehabilitation of critically ill patients. Crit Care Med. 2009;37:S436-41 pubmed publisher
    ..Future studies are needed to evaluate their efficacy in intensive care unit patients. ..
  51. Jørgensen C, Kehlet H. Early thromboembolic events ≤1week after fast-track total hip and knee arthroplasty. Thromb Res. 2016;138:37-42 pubmed publisher
    ..Further research is needed regarding interventions for prevention of "early" TEE in disposed patients. ..
  52. Custers I, Flierman P, Maas P, Cox T, van Dessel T, Gerards M, et al. Immobilisation versus immediate mobilisation after intrauterine insemination: randomised controlled trial. BMJ. 2009;339:b4080 pubmed publisher
    ..Immobilisation for 15 minutes should be offered to all women treated with intrauterine insemination. Current Controlled Trials ISRCTN53294431. ..
  53. de Maistre E, Terriat B, Lesne Padieu A, Abello N, Bouchot O, Steinmetz E. High incidence of venous thrombosis after surgery for abdominal aortic aneurysm. J Vasc Surg. 2009;49:596-601 pubmed publisher
    ..Even though this series is one of the largest ever published on this topic, the rarity of the events calls for confirmation with a larger prospective study. ..