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Mobilization patterns of children on a hematology/oncology inpatient ward
Krista Johnston1,2, Robin Deliva2, Cathy Evans1
1Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Insights
Most pediatric cancer patients mobilize early in their hospital stay, but frequency can be improved. Isolation and fever significantly decrease mobilization, impacting recovery for children undergoing cancer treatment.
Area of Science:
- Pediatric Oncology
- Rehabilitation Medicine
- Hospital Medicine
Background:
- Hospitalized children with cancer face detrimental impairments from bed rest.
- Limited understanding exists regarding mobilization patterns in pediatric cancer patients during hospitalization.
- Therapeutic side effects and disease progression necessitate frequent assessment of mobility.
Purpose of the Study:
- To examine mobilization patterns in children on a pediatric hematology/oncology ward.
- To identify factors associated with delayed or infrequent mobilization in this population.
- To inform interventions aimed at optimizing mobility during cancer treatment.
Main Methods:
- Retrospective chart review of 228 pediatric patients.
- Analysis of documented mobilization, including timing, frequency, type, and nature.
- Inclusion of physiotherapy referral data to assess mobility support.
Main Results:
- 43% of children mobilized 3-5 days/week; median time to first mobilization was 2 days.
- Caregiver assistance was documented in 91% of mobilizations.
- Isolation and fever significantly decreased mobilization frequency and delayed onset (p<0.05).
Conclusions:
- Early mobilization is common in pediatric cancer patients, but frequency requires improvement.
- Isolation is a significant barrier to mobilization, negatively impacting frequency and timing.
- Further research and interventions are needed to enhance mobilization in hospitalized children with cancer.
Background:
Children being treated for cancer are admitted to the hospital for treatment of their disease or complications of therapy. Periods of bed rest during hospitalization can cause impairments detrimental to children with cancer who endure many side effects of therapy. Little is known about how these children mobilize while admitted to the hospital. The purpose of this study was to examine how children admitted to a hematology/oncology ward are mobilizing and analyze factors associated with delayed or infrequent mobility.
Procedure:
A retrospective chart review was conducted on 228 charts with data recorded on documented mobilization and referrals to physiotherapy. Primary outcome was related to mobility including timing, frequency, type, and nature of mobilization.
Results:
Almost half of children (43%) mobilized between 3 and 5 days per week, with median time to first mobilization being 2 days (interquartile range 1-3). Caregivers assisted with mobilization 91% of the time. Children isolated to their room and those reporting fever had a statistically significant decrease in the percent of admission days involving mobilization (mean difference 15 and 8%, respectively) than those not isolated and without fever. Children who were isolated also mobilized 1 day later (P = 0.016) than children who were not isolated. Percentage of time in isolation was positively correlated with timing (P = 0.04) and negatively correlated with frequency of mobilization (P < 0.001).
Conclusion:
Most children admitted to the hospital for treatment of oncologic or hematologic conditions were noted to mobilize early, but frequency of mobilization could be improved. Periods of time in isolation appear to negatively affect mobilization.