BMJ  2004;328 (17 January), doi:10.1136/bmj.328.7432.0-f

Filler

POEM^*

Earlier mobilisation improves pneumonia outcomes

Question Does early mobilisation improve outcomes in patients with community-acquired pneumonia?

Synopsis Everyone looks healthier sitting up, don't they? Previous studies of myocardial infarction and orthopaedic procedures have shown improved outcomes with early mobilisation. These researchers applied that thinking to hospitalised patients with community acquired pneumonia. Patients (n = 458) admitted to 17 general medical units were randomised by medical unit to early mobilisation (encouraged to get into an upright position for at least 20 minutes during the first 24 hours of hospitalisation, with progressively increased mobilisation thereafter) or usual care. A large variety of variables and outcomes were measured, but the primary outcome was length of stay. Groups were similar at baseline; approximately 25% were younger than 50 years and 25% were older than 80 years. Most received their antibiotics within eight hours. The mean length of stay was lower for the early mobilisation group (5.8 v 6.9 days; 95% confidence interval 0 to 2.2). The results were stratified by the pneumonia severity index (PSI) score, where I is the lowest severity (what were they doing in the hospital in the first place?) and V is the highest severity. The greatest difference in length of stay occurred among the 86 patients with an intermediate PSI score of III (4.9 v 7.4 days; 0.2 to 5.0), and the authors speculate that patients who were less sick were going to get better quickly whether they were lying down, sitting up, or standing on their head, while those who were most sick were less likely to benefit from this simple intervention. There was no difference between groups in the risk of death or readmission.

Bottom line Early mobilisation, beginning by having patients sit up for at least 20 minutes in the first 24 hours after admission, reduces the length of stay for patients with community acquired pneumonia.

Level of evidence 1b (see www.infopoems.com/resources/levels.html). Individual randomised controlled trials (with narrow confidence intervals).

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Mundy LM, Leet TL, Darst K, et al. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest 2003;124: 883-9[Abstract/Free Full Text].

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^* Patient-Oriented Evidence that Matters. See editorial ( BMJ 2002;325: 983[Free Full Text])

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