Implementation of an Early Mobility Initiative in a Pediatric Bone Marrow Transplant Unit

Area of Science:

• Pediatric Hematology
• Oncology
• Infectious Disease Control
• Rehabilitation Medicine

Background:

• Pediatric hematopoietic cell transplant (HCT) recipients face functional impairments due to complex clinical courses.
• Early mobilization is crucial for reducing long-term functional issues in these patients.
• Infectious transmission concerns, particularly with extended-spectrum beta-lactamase (ESBL) colonization, can limit early ambulation.

Purpose of the Study:

• To significantly increase ambulation in pediatric HCT recipients within three months.
• To enhance daily ambulation events, physical therapy (PT) visits per week, and walking distance per PT session.

Main Methods:

• Retrospective data collection from electronic health records (January-October 2022).
• Implementation of a quality improvement initiative allowing ESBL-colonized patients to ambulate with personal protective equipment (PPE).
• Clinical staff training on updated protocols for mobilizing ESBL-colonized patients.

Main Results:

• Ambulation rates were higher before the intervention compared to after (Group 1: 1.36x increase, p=0.004; Group 2 vs. Group 3: 1.33x increase, p=0.016).
• Effect sizes for ambulation changes were modest (0.3042 and 0.2856).
• The intervention did not achieve its primary goal of increasing ambulation.

Conclusions:

• The quality improvement initiative failed to increase ambulation in pediatric HCT recipients.
• Observed ambulation trends favored the pre-intervention period, though statistical power was limited.
• Factors such as short monitoring, retrospective design, PPE challenges, and unmeasured variables may explain the lack of success.