After Gyn Surgery Patients Don't Walk Despite Goal Setting

Jenni Laidman

February 06, 2013

Setting a goal to encourage walking among patients after major gynecologic surgery did not induce them to walk more in the 24 hours before discharge, even with reinforcement, according to a randomized control trial published online February 6 in Obstetrics & Gynecology.

Patients report that indwelling catheters, poles for intravenous therapy, and pain were the major barriers to walking, the study shows.

Maike Lieberman, MD, instructor, Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, and colleagues randomly assigned 146 surgical inpatients at Loyola into 2 groups: 77 would receive usual care and 69 would be encouraged to take 500 steps before discharge. The women, aged 18 years and older, were supplied pedometers. Researchers tallied the number of pedometer-recorded steps in the 24 hours before discharge.

Bedside signs and signs on patient doors were used to reinforce the walking goal for patients in the treatment group. In addition, physicians and nurses were instructed to remind the patients to walk during every encounter.

Of 129 patients for whom data were available at discharge, 12% (8 in each group) took no steps. The median number of steps for the encouragement group was 80 (range, 0 - 2353 steps), which was not significantly different from the median number of steps for the usual treatment group (87 steps; range, 0 - 3576 steps; P = .70).

"Although we did not detect improvements in ambulation with specific ambulation goals, we believe that this may be the result of an insufficient intervention, lack of attention to patient-identified barriers, or other factors," the authors write.

The researchers found that those with minimally invasive procedures had a higher median number of steps, at 143 (range, 0 - 3576 steps), compared with patients with open abdominal procedures, who took a median 27 steps (range, 0 - 2275 steps; P = .035).

Eighty percent of the study participants completed an ambulation barrier survey that found that urinary catheters (38.5%), intravenous poles (28%), and pain (12.5%) were the most common barriers to walking after surgery. There was no significant difference in barrier perception between the 2 groups.

There also was no significant difference between the 2 groups for age, body mass index, race, discharge day, surgery type, preoperative difficulty score, or postoperative difficulty score.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2013;121:533-537.