BACKGROUND
STUDY 1 STUDY 2 STUDY 3 STUDY 4
Effects of early postoperative mobilisation following
gastrointestinal (GI) surgery: systematic review and
meta-analysis (Willner et al., 2023)
Design/Objective: Systematic review and meta-analysis of
controlled trials to evaluate the effect of early post operative
mobilisation after GI surgery on recovery, mobility, morbidity,
and hospital stay.
Participants/Groups: Participants included 3,538 patients across
15 studies (8 RCTs) undergoing various gastrointestinal surgeries,
such as gastrointestinal, hepatopancreatobiliary, and colorectal
resections. The intervention groups followed early mobilisation
protocols - which varied in methods, techniques, and outcome
measures across studies - while control groups followed
standard care or less intensive mobilisation.
Outcome Measures: The primary outcomes were
gastrointestinal recovery, measured in time to first to experience
bowel movement, and postoperative mobility, measured by step
count on post operative day (POD) 3. Morbidity rate and hospital
stay duration were secondary measures.
Findings: Patients who mobilised early experienced a
significantly faster return of bowel function, with a mean
reduction of 11.53 hours. However, it did not significantly
increase mobility or reduce overall morbidity rates or hospital
length of stay.
Early mobilization after pancreatic surgery: A randomized
controlled trial (Li et al., 2024)
Design/Objective: RCT to find out whether early enforced
mobilisation reduces postoperative complications and
improves recovery in pancreatic surgery patients
Participants/Groups: The study included 135 patients post
pancreatic surgery at a Chinese hospital, randomised into an
intervention group receiving an early enforced mobilisation
protocol (involving professionally assisted first ambulation on
POD 1 and family-involved supervision to achieve daily walking
goals) and a control group receiving usual care.
Outcome Measures: The primary outcome was 30-day
postoperative complications (measured by the Comprehensive
Complication Index), while secondary outcomes included
mobilisation metrics (first ambulation time and walking
distance on postoperative days 1-7), gastrointestinal recovery
(time to first defecation), patient-reported outcomes (Quality
of Recovery-15 and QLQ-C30 scores), as well as
pulmonary/pancreatic-specific complications and 30-day
readmission/mortality rates.
Findings: Early mobilisation did not reduce postoperative
complications but improved postoperative mobility, GI
recovery, and patient-perceived recovery quality.
Early mobilization programme improves functional capacity after major
abdominal cancer surgery: a randomized controlled trial
(de Almeida et al., 2017)
Design/Objective: RCT (single-blind) study evaluating the efficacy, safety and
feasibility of an early mobilisation programme for patients recovering from
major abdominal cancer surgery - with a focus on the ability to walk
independently by POD 5.
Participants/Groups: The study included 108 patients who underwent major
abdominal oncology surgery, randomised equally into an intervention group
(n=54) receiving a supervised postoperative exercise program (focusing on
aerobic, resistance, and flexibility training twice daily) and a control group
(n=54) receiving standard care.
Outcome Measures: The primary measure was the inability to walk without
assistance at POD 5. Secondary outcomes included the 6-minute walk test at
POD 5, incidence of postoperative fatigue, health-related quality of life
(measured by EuroQoL-5D-5L) and postoperative complications.
Findings: The intervention group had fewer patients unable to ambulate
independently by POD 5 (16.7%) compared to the control group (38.9%),
walked significantly further (212m vs 66m), had less incidence fatigue at
POD 5, and had better QoL at POD 5. While the study did not find significant
statistical differences between the groups in complications and hospital
length of stay, additional analysis suggested that early mobilisation may help
early discharge, with 33.3% of the intervention group discharged within POD
7 compared to the 14.8% in the control group (P=0.024).
Early mobilisation after internal pudendal artery perforator (iPAP)
flap reconstruction: A RCT assessing safety and recovery outcomes
(Lima de Araujo et al., 2025)
Design/Objective: A prospective randomised, controlled,
non-inferiority clinical trial that assess the effectiveness, feasibility,
and safety of early mobilisation compared with standard bed rest in
patients who underwent iPAP flap reconstruction.
Participants/Groups: The study included 51 patients who underwent
iPAP flap reconstruction, with the intervention group (n=25) receiving
an early mobilisation program consisting of core exercises,
orthostasis training, gait training, muscle strengthening, and aerobic
exercises postoperatively, while the control group (n=26) followed a
standard bed-rest protocol.
Outcome Measures: Independent ambulation for 3 metres on POD 5
was the primary measure and 6-minute walk test (6MWT) on days 5
and 30, hospital length of stay, wound healing time, postoperative
complication rate, fatigue prevalence, and quality of life were
secondary outcomes.
Findings: The intervention group showed higher rates of
independent ambulation by day 5 (68% vs. 38.5%, P = 0.035), greater
6-minute walk test distances (day 5: 108.78m vs. 47.73m, P = 0.041;
day 30: 243.8m vs. 166.29m, P = 0.018), and earlier discharge (66.7%
vs. 33.3%, P = 0.043). Complication rates, healing times, fatigue, and
quality of life did not differ significantly between groups (P > 0.05).
The selected studies (RCTs and a systematic review with meta-analysis) provide strong evidence for the
impact of early mobilisation on abdominal postoperative outcomes. According to the "pyramid of
evidence", systematic reviews and meta-analyses of RCTs sit at the very top, followed by RCTs. This
positioning shows their strength in providing high-level, reliable evidence due to strong methodologies.
Synthesising high-quality evidence from different studies allows meta-analysis studies to reduce bias,
minimise inconsistencies in individual trials and enhance the generalisability of findings (Polit & Beck,
2018). By combining data from multiple RCTs, the systematic review and meta-analysis by Willner et al.
(2023) thus increases statistical power and provides a stronger estimate of the efficacy of early mobilisation
post abdominal surgery.
RCTs are considered the gold standard in clinical studies because randomisation reduces the risk of
selection bias and helps balance confounding variables across groups, increasing internal validity (Polit &
Beck, 2018). This means the RCTs by Li et al. (2024), de Almeida et al. (2017), and Lima de Araujo et al.
(2025) offer robust, high-quality evidence. Despite the high reliability of RCTs, limitations in sample size,
blinding, or intervention standardisation may impact outcomes (Polit & Beck, 2018). For example,
double-blinding was not feasible for the selected RCTs due to the nature of the intervention, which may
introduce some performance bias. In conclusion, using top-quality evidence strengthens the validity
of this evaluation assessing the efficacy of early mobilisation post surgery.
Based on the findings from multiple RCTs and a systematic review, I support continuing the current nursing
practice of early mobilisation after abdominal surgery. Although early mobilisation has long been promoted
as a significant practice of reducing postoperative complications, recent evidence highlights that its
greatest benefits lie in improving functional recovery rather than significantly lowering the risk of
complications such as DVT or PE. Several studies, including those by Willner et al. (2023) and Li et al.
(2024), have shown that early mobilisation interventions can improve gastrointestinal recovery, functional
mobility, and perceived quality of recovery without significantly increasing postoperative complications. De
Almeida et al. (2017) also reported reduced fatigue and improved walking independence, while Lima de
Araujo et al. (2025) highlighted earlier hospital discharges. Although the strength of the evidence is slightly
limited (i.e. some studies had small sample sizes or variability in mobilisation), the consistent positive
outcomes suggest early mobilisation is a safe and beneficial practice.
Considering these benefits, coupled with the low-risk nature of the intervention, I would support the
continuation of early mobilisation as a core postoperative practice in improving recovery. Current
evidence is not strong enough to confirm that early mobilisation reduces complications; therefore,
further research is required on this specific outcome.
HIERARCHY OF EVIDENCE CONTINUATION OF EVIDENCE
EARLY MOBILISATION POST ABDOMINAL SURGERY
Early mobilisation post-abdominal surgery is commonly believed to reduce postoperative complications and improve recovery (Tazreean et al., 2022). During my
clinical placement in the gastroenterology/general medicine ward, I observed that postoperative patients were regularly encouraged to sit upright and mobilise
within 12 hours, such as a 58-year-old male patient recovering from a laparoscopic cholecystectomy. A study by Dharap et al. (2022) found that 31.5% of general
surgery patients developed complications within 30 days. Postoperative complications, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), are a
detrimental clinical challenge that contributes to increased morbidity, mortality and a burdened healthcare system (Jandhyala et al., 2024; Saleh et al., 2017).
Early mobilisation is strongly endorsed by Enhanced Recovery After Surgery (ERAS) protocols as it
is believed to promote circulation, lung expansion, gastrointestinal functional recovery and shorter
hospital stays (Tazreean et al., 2022). Typically, early mobilisation involves sitting upright, standing,
mobilising from bed to chair, or walking with assistance within the first 24 hours (Tazreean et al.,
2022). However, the true impact of early mobilisation on abdominal postoperative outcomes is an
area that requires further investigation through evidence-based research.
