Practices and Barriers to Early Mobilization in Intensive Care Unit Post Head and Neck Cancer Surgeries: An Observational Study.

Q2 Medicine

Asian Pacific Journal of Cancer Prevention Pub Date : 2026-09-01 DOI:10.31557/APJCP.2026.27.9.3169

Vaishnavi Puranik, Cherishma Dsilva, Aishwarya Gatty, Rohanchandra Gatty

{"title":"Practices and Barriers to Early Mobilization in Intensive Care Unit Post Head and Neck Cancer Surgeries: An Observational Study.","authors":"Vaishnavi Puranik, Cherishma Dsilva, Aishwarya Gatty, Rohanchandra Gatty","doi":"10.31557/APJCP.2026.27.9.3169","DOIUrl":null,"url":null,"abstract":"Background: Head and neck cancer (HNC) is a growing global health concern, with rising incidence in India. Patients undergoing HNC surgery experience postoperative challenges due to altered airway anatomy and complex reconstruction. Enhanced Recovery After Surgery (ERAS) protocols recommend early mobilization (EM) to improve postoperative outcomes; however, its implementation remains inconsistent. Evidence regarding EM practices in this population is limited. This study aimed to evaluate EM practices and their barriers in post HNC surgery patients in a tertiary care setting.Methods: A prospective observational study was conducted among adults undergoing HNC surgery. Patients with neurological deficits or preoperative non-ambulatory status were excluded. Mobilization was assessed daily until postoperative day (POD) 5 using the ICU Mobility Scale (IMS). Barriers to EM were documented using a validated checklist and categorized into three domains. Logistic regression analyses were performed to identify factors associated with non-ambulatory status (IMS<5). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. A p<0.05 was considered statistically significant.Results: Among the 69 patients included, 69.6% patients received in-bed exercises, while 27.5% had not been mobilized on POD 1. On POD 3, 23.1% were ambulated with assistance. More than 75% of the patients were ambulated and shifted to the wards by POD 5. Major functional and clinical barrier domains included nasotracheal intubation (75.4%), respiratory distress (53.6%) and free flap reconstruction (28.9%). The system-provider domain included low prioritization of EM (46.4%) and communication gaps among healthcare professionals (7.26%). This domain was independently associated with non-ambulatory status (aOR 0.402, 95% CI 0.172-0.817, p=0.020).Conclusion: EM practices showed a consistent but gradual improvement over the five postoperative days. Though patient related barriers were common, the overall mobility outcomes were mainly determined by the system-provider domain of barriers. Addressing barriers to EM is crucial for enhancing its practice and ensuring adherence to EM protocols.","PeriodicalId":55451,"journal":{"name":"Asian Pacific Journal of Cancer Prevention","volume":"27 9","pages":"3169-3178"},"PeriodicalIF":0.0000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Pacific Journal of Cancer Prevention","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31557/APJCP.2026.27.9.3169","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Head and neck cancer (HNC) is a growing global health concern, with rising incidence in India. Patients undergoing HNC surgery experience postoperative challenges due to altered airway anatomy and complex reconstruction. Enhanced Recovery After Surgery (ERAS) protocols recommend early mobilization (EM) to improve postoperative outcomes; however, its implementation remains inconsistent. Evidence regarding EM practices in this population is limited. This study aimed to evaluate EM practices and their barriers in post HNC surgery patients in a tertiary care setting.

Methods: A prospective observational study was conducted among adults undergoing HNC surgery. Patients with neurological deficits or preoperative non-ambulatory status were excluded. Mobilization was assessed daily until postoperative day (POD) 5 using the ICU Mobility Scale (IMS). Barriers to EM were documented using a validated checklist and categorized into three domains. Logistic regression analyses were performed to identify factors associated with non-ambulatory status (IMS<5). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. A p<0.05 was considered statistically significant.

Results: Among the 69 patients included, 69.6% patients received in-bed exercises, while 27.5% had not been mobilized on POD 1. On POD 3, 23.1% were ambulated with assistance. More than 75% of the patients were ambulated and shifted to the wards by POD 5. Major functional and clinical barrier domains included nasotracheal intubation (75.4%), respiratory distress (53.6%) and free flap reconstruction (28.9%). The system-provider domain included low prioritization of EM (46.4%) and communication gaps among healthcare professionals (7.26%). This domain was independently associated with non-ambulatory status (aOR 0.402, 95% CI 0.172-0.817, p=0.020).

Conclusion: EM practices showed a consistent but gradual improvement over the five postoperative days. Though patient related barriers were common, the overall mobility outcomes were mainly determined by the system-provider domain of barriers. Addressing barriers to EM is crucial for enhancing its practice and ensuring adherence to EM protocols.

查看原文本刊更多论文

头颈癌手术后重症监护病房早期动员的实践和障碍：一项观察性研究。

背景：头颈癌（HNC）是一个日益严重的全球健康问题，印度的发病率不断上升。接受HNC手术的患者由于气道解剖改变和复杂的重建而面临术后挑战。增强术后恢复（ERAS）方案推荐早期活动（EM）以改善术后结果；然而，它的执行仍然不一致。关于这一人群的EM实践的证据是有限的。本研究旨在评估三级医疗机构HNC手术后患者的EM实践及其障碍。方法：对接受HNC手术的成人进行前瞻性观察研究。排除有神经功能缺损或术前非活动状态的患者。使用ICU活动能力量表（IMS）每天评估活动能力，直至术后第5天（POD）。使用经过验证的检查表记录了EM的障碍，并将其分为三个领域。进行Logistic回归分析以确定与非活动状态（ims）相关的因素。结果：在纳入的69例患者中，69.6%的患者接受了床上运动，而27.5%的患者没有在POD 1上活动。在第三阶段，有23.1%的人在协助下走动。超过75%的患者通过POD 5走动并转移到病房。主要功能和临床障碍领域包括鼻气管插管（75.4%）、呼吸窘迫（53.6%）和游离皮瓣重建（28.9%）。系统供应商领域包括低优先级EM（46.4%）和卫生保健专业人员之间的沟通差距（7.26%）。该区域与非运动状态独立相关（aOR 0.402, 95% CI 0.172-0.817, p=0.020）。结论：EM实践在术后5天内显示出一致但逐渐的改善。虽然患者相关障碍很常见，但总体移动性结果主要取决于障碍的系统提供者领域。解决EM的障碍对于加强其实践和确保遵守EM协议至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Asian Pacific Journal of Cancer Prevention 医学-肿瘤学

CiteScore

2.80

自引率

0.00%

发文量

779

审稿时长

3 months

期刊介绍： Cancer is a very complex disease. While many aspects of carcinoge-nesis and oncogenesis are known, cancer control and prevention at the community level is however still in its infancy. Much more work needs to be done and many more steps need to be taken before effective strategies are developed. The multidisciplinary approaches and efforts to understand and control cancer in an effective and efficient manner, require highly trained scientists in all branches of the cancer sciences, from cellular and molecular aspects to patient care and palliation. The Asia Pacific Organization for Cancer Prevention (APOCP) and its official publication, the Asia Pacific Journal of Cancer Prevention (APJCP), have served the community of cancer scientists very well and intends to continue to serve in this capacity to the best of its abilities. One of the objectives of the APOCP is to provide all relevant and current scientific information on the whole spectrum of cancer sciences. They aim to do this by providing a forum for communication and propagation of original and innovative research findings that have relevance to understanding the etiology, progression, treatment, and survival of patients, through their journal. The APJCP with its distinguished, diverse, and Asia-wide team of editors, reviewers, and readers, ensure the highest standards of research communication within the cancer sciences community across Asia as well as globally. The APJCP publishes original research results under the following categories: -Epidemiology, detection and screening. -Cellular research and bio-markers. -Identification of bio-targets and agents with novel mechanisms of action. -Optimal clinical use of existing anti-cancer agents, including combination therapies. -Radiation and surgery. -Palliative care. -Patient adherence, quality of life, satisfaction. -Health economic evaluations.