Department of Anesthesiology and Pain Medicine, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), 93017 Bobigny, France.
J Clin Anesth. 2023 Jun;86:111048. doi: 10.1016/j.jclinane.2022.111048. Epub 2023 Jan 28.
Postoperative physical therapy and early mobilization are major elements for enhanced recovery after surgery. In contrast with supervised physical therapy sessions that can be monitored, self-mobilization is not easily quantifiable and has so far been estimated mainly through patient auto-reports. This study aimed to perform a comprehensive and objective evaluation of postoperative mobility.
Prospective observational study.
Postoperative setting.
Patients undergoing mini-invasive lung surgery.
Measurement of postoperative mobility during the first five postoperative days using an accelerometer (ActiGraph GT3X).
The primary outcome was the number of daily steps. Secondary outcomes included physical activity duration and intensity, sedentary time, number of breaks in sedentary time, sedentary patterns, daily evaluation by physiotherapists, postoperative complications, and acceptability of wearing the accelerometer.
Sixty patients were included in the study, of whom 56 provided at least one day of valid accelerometry data. There was no significant change during the first four PODs concerning the number of daily steps nor the mean cadence. One-minute cadence peak, total activity counts, and duration of light-intensity physical activity increased over time (p = 0.032, p = 0.001 and p = 0.001, respectively). Sedentary patterns changed favorably over time, with a decrease in prolonged sedentary bouts (≥ 60 consecutive min) (p < 0.001), and an increase in shorter bouts (< 10 min) (p = 0.001). Similar results were observed when analysis was adjusted for the day of the week when the surgery took place. The median acceptability of wearing the accelerometer was excellent (median 10 [9-10] on a 10-point Likert scale). Three patients had major complications.
Our findings suggest that daily steps may not be the only relevant indicator of early mobility following thoracic surgery and that accelerometry is suitable to follow patients' early postoperative activity.
术后物理治疗和早期活动是促进手术后康复的主要因素。与可监测的监督性物理治疗相比，自我活动不易量化，迄今为止主要通过患者的自我报告来估计。本研究旨在对术后活动进行全面和客观的评估。
前瞻性观察性研究。
术后环境。
接受微创肺手术的患者。
在术后的前 5 天，使用加速度计（ActiGraph GT3X）测量术后活动度。
主要结果是每日步数。次要结果包括体力活动持续时间和强度、久坐时间、久坐时间中断次数、久坐模式、理疗师每日评估、术后并发症以及佩戴加速度计的可接受性。
共有 60 例患者入组，其中 56 例至少提供了一天有效的加速度计数据。在最初的 4 个术后日，每日步数和平均步频均无显著变化。1 分钟步频峰值、总活动计数和轻强度体力活动持续时间随时间增加（p=0.032、p=0.001 和 p=0.001）。久坐模式随时间改善，长时间久坐（≥60 分钟）的时间减少（p<0.001），短时间久坐（<10 分钟）的时间增加（p=0.001）。当分析调整为手术发生的日期时，也观察到类似的结果。佩戴加速度计的中位可接受性为优秀（10 分制中得分为 10 [9-10]）。3 例患者发生重大并发症。
我们的研究结果表明，每日步数可能不是胸部手术后早期活动的唯一相关指标，而加速度计适合随访患者的术后早期活动。
