TY - JOUR
T1 - Extended mobility scale (AMEXO) for assessing mobilization and setting goals after gastrointestinal and oncological surgery
T2 - a before-after study
AU - Boerrigter, José L.
AU - Geelen, Sven J. G.
AU - van Berge Henegouwen, Mark I.
AU - Bemelman, Willem A.
AU - van Dieren, Susan
AU - de Man-van Ginkel, Janneke M.
AU - van der Schaaf, Marike
AU - Eskes, Anne M.
AU - Besselink, Marc G.
N1 - Funding Information: The research team would like to thank Kiki Kablau RN MSc for her contribution to this research since she provided the approval of the Medical Ethical Review Committee, was involved by the design of the study, and requested a part of the database. Publisher Copyright: © 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - BACKGROUND: Early structured mobilization has become a key element of Enhanced Recovery After Surgery programs to improve patient outcomes and decrease length of hospital stay. With the intention to assess and improve early mobilization levels, the 8-point ordinal John Hopkins Highest Level of Mobility (JH-HLM) scale was implemented at two gastrointestinal and oncological surgery wards in the Netherlands. After the implementation, however, healthcare professionals perceived a ceiling effect in assessing mobilization after gastrointestinal and oncological surgery. This study aimed to quantify this perceived ceiling effect, and aimed to determine if extending the JH-HLM scale with four additional response categories into the AMsterdam UMC EXtension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale reduced this ceiling effect. METHODS: All patients who underwent gastrointestinal and oncological surgery and had a mobility score on the first postoperative day before (July-December 2018) or after (July-December 2019) extending the JH-HLM into the AMEXO scale were included. The primary outcome was the before-after difference in the percentage of ceiling effects on the first three postoperative days. Furthermore, the before-after changes and distributions in mobility scores were evaluated. Univariable and multivariable logistic regression analysis were used to assess these differences. RESULTS: Overall, 373 patients were included (JH-HLM n = 135; AMEXO n = 238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score before extending the JH-HLM into the AMEXO as compared to 4 (1.7%) patients after (OR = 0.021, CI = 0.007-0.059, p < 0.001). During the first three postoperative days, 118 (87.4%) patients scored the highest possible mobility score before compared to 40 (16.8%) patients after (OR = 0.028, CI = 0.013-0.060, p < 0.001). A change in mobility was observed in 88 (65.2%) patients before as compared to 225 (94.5%) patients after (OR = 9.101, CI = 4.046-20.476, p < 0.001). Of these 225 patients, the four additional response categories were used in 165 (73.3%) patients. CONCLUSIONS: A substantial ceiling effect was present in assessing early mobilization in patients after gastrointestinal and oncological surgery using the JH-HLM. Extending the JH-HLM into the AMEXO scale decreased the ceiling effect significantly, making the tool more appropriate to assess early mobilization and set daily mobilization goals after gastrointestinal and oncological surgery.
AB - BACKGROUND: Early structured mobilization has become a key element of Enhanced Recovery After Surgery programs to improve patient outcomes and decrease length of hospital stay. With the intention to assess and improve early mobilization levels, the 8-point ordinal John Hopkins Highest Level of Mobility (JH-HLM) scale was implemented at two gastrointestinal and oncological surgery wards in the Netherlands. After the implementation, however, healthcare professionals perceived a ceiling effect in assessing mobilization after gastrointestinal and oncological surgery. This study aimed to quantify this perceived ceiling effect, and aimed to determine if extending the JH-HLM scale with four additional response categories into the AMsterdam UMC EXtension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale reduced this ceiling effect. METHODS: All patients who underwent gastrointestinal and oncological surgery and had a mobility score on the first postoperative day before (July-December 2018) or after (July-December 2019) extending the JH-HLM into the AMEXO scale were included. The primary outcome was the before-after difference in the percentage of ceiling effects on the first three postoperative days. Furthermore, the before-after changes and distributions in mobility scores were evaluated. Univariable and multivariable logistic regression analysis were used to assess these differences. RESULTS: Overall, 373 patients were included (JH-HLM n = 135; AMEXO n = 238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score before extending the JH-HLM into the AMEXO as compared to 4 (1.7%) patients after (OR = 0.021, CI = 0.007-0.059, p < 0.001). During the first three postoperative days, 118 (87.4%) patients scored the highest possible mobility score before compared to 40 (16.8%) patients after (OR = 0.028, CI = 0.013-0.060, p < 0.001). A change in mobility was observed in 88 (65.2%) patients before as compared to 225 (94.5%) patients after (OR = 9.101, CI = 4.046-20.476, p < 0.001). Of these 225 patients, the four additional response categories were used in 165 (73.3%) patients. CONCLUSIONS: A substantial ceiling effect was present in assessing early mobilization in patients after gastrointestinal and oncological surgery using the JH-HLM. Extending the JH-HLM into the AMEXO scale decreased the ceiling effect significantly, making the tool more appropriate to assess early mobilization and set daily mobilization goals after gastrointestinal and oncological surgery.
KW - Early ambulation [MESH]
KW - Mobility limitation [MESH]
KW - Patient outcome assessment [MESH]
KW - Postoperative period [MESH]
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85124110853&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/35109840
UR - http://www.scopus.com/inward/record.url?scp=85124110853&partnerID=8YFLogxK
UR - https://pure.hva.nl/ws/files/26442830/Additional_file_1.pdf
UR - https://pure.hva.nl/ws/files/26442832/Additional_file_2.pdf
UR - https://pure.hva.nl/ws/files/26442834/Additional_file_3.pdf
U2 - https://doi.org/10.1186/s12893-021-01445-3
DO - https://doi.org/10.1186/s12893-021-01445-3
M3 - Article
C2 - 35109840
SN - 1471-2482
VL - 22
SP - 38
JO - BMC Surgery
JF - BMC Surgery
IS - 1
M1 - 38
ER -