Description

Groups will present their findings to their classmates andfaculty in a PowerPoint presentation highlighting the following:

1.    Clinical problem and PICOquestion

2.    Summary of threeresearch articles

3.    Synthesis andappraised value to nursing practice

 

Guidelines

1.              The order of slides in the PowerPoint presentation andthe content for each slide is:

 

      Title Slide: Presentation title and names of allgroup members (1 slide)

      Clinical problem and PICO question: (1-2 slides)

o   Identifyclinical problem

Youare a certified neuroscience nurse and you just attended the AmericanAssociation of Neuroscience Nurses annual conference. While there, you attendeda presentation of a quality improvement project about very early mobilizationand the potential for it to improve functional outcomes of patients after anacute stroke, such as level of disability post stroke. Your units protocolincludes early ambulation/mobilization post stroke rather than very earlymobilization. Your team decides to investigate this further to see whetherthere is empirical evidence to support very early mobilization post stroke as amethod of improving functional outcomes such as level of disability poststroke.

o   Stateyour PICO question

Inadult patients after an acute stroke how does very early mobilization comparedto early mobilization post stroke affect functional outcomes post stroke?

      Review of Research Evidence: 1-2 slides perstudy. You can copy/paste your work formPICO project parts 2.

o   Purposeof the study

o   Overviewof research methods

  Studydesign (randomized controlled trial, quasi-experimental, mixed methods,observational/descriptive, cross-sectional, longitudinal, etc.)

  Sample(sampling method, sample size, setting, inclusion/exclusion criteria, how assignedto groups)

  Datacollection method (survey, sphygmomanometer, observation, etc.)

  Majorstatistical results (with p-value) related to the effectiveness of proposedintervention

  1-2Strengths/1-2 Weaknesses of study

Thepurpose of this study was to determine if early mobilization in post-acutestroke help improved recovery compared to delayed mobilization. The study was arandomized controlled trial (RCT) based on patients with acute stroke. Thestudy compared an intervention group that started out of bed mobilizationwithin 48 hours after stroke ( Langhorne, P., Collier, J. M., Bate,P. J., Thuy, M. N., & Bernhardt, J., 2018) There were nine RCTs that included 2958 participants but only one trialthat included 2104 participants gave the most accurate information. The median delayto start mobilization after stroke was 18.5 (13.1 to 43) hours in a very earlymobilization (VEM) and 33.3 (22.5 to 71.5) hours in a usual care group. Themedian difference within trials was 12.7 (4 to 45.6) hours. VEM group receivedmore time in mobility and primary outcome data were available for 2542 of 2618(97.1%) randomized participants who followed up for a median of three months. Accordingto the study VEM probably led to or slightly more deaths and poor outcomecompared with delayed mobility (51% versus 49%; odds ratio (OR) 1.08, 95% Cl)0.92 to 1.26; P=0.36; 8 trials; moderate-quality evidence) (Langhorne, et al.,2018). The death rate for patients who received VEM was 8.5% compared to 7% forpatients who received delayed mobilization. The effects of experiencing anycomplications were unclear. (Langhorne, et al., 2018) Based on the study theanalysis using outcomes collected only at three-month follow up did not alterthe conclusion. Even though the death percent was higher for patients whoreceived VEM there were some benefits that contributed to other factors.  The average ADL (activities of living) score(measured at the end of follow-up, with the 20-point Barthel Index) was higherin patients who received VEM compared to the patients who did not. The meanlength of stay was shorter for those who received VEM (MD -1.44, 95% Cl -2.28to -0.60, P=0.0008; 8 trials, 2532/2618 participants (96%.7); low quality evidence)(Langhorne, et al., 2018). Results of the answers were limited by the variabledefinition of length of stay and other secondary outcome analyses (quality oflife, ADL, walking ability, and patient mood) were limited by lack of data.  Based on the authors conclusion VEM within 24hours of stroke did not increase the number of people who survived or made agood recovery. VEM did reduce the length of stay in the hospital by about a day,but results related to this was low quality evidence. There was also concernthat VEM commencing within 24 hours may carry an increased risk, at least somepeople with stroke (Langhorne, et al., 2018). Based off limited informationmore detailed research is still required.

Conclusion:

            Based on the information given VEM in patient led tohigher death percentage which was a poorer outcome for theses patient. It did shortenthe length of stay in the hospital but this was an indirect outcome regardingstroke recovery which was easily affected by patient motivation and clinicaldecision. VEM had no significant benefit in any of the functional outcomes.Convincing evidence to support VEM patients with acute stroke is lacking evidence.Therefore VEM is not recommended as a component of a stroke unit treatment.

 

 Chippala,P., & Sharma, R. (2016). Effect of very early mobilisation on functionalstatus in

patients with acute stroke: a single-blind, randomized controlled trail.Clinical Rehabilitation, 30(7), 669675.https://doi-org.echo.louisville.edu/10.1177/0269215515596054

Langhorne,P., Collier, J. M., Bate, P. J., Thuy, M. N., & Bernhardt, J. (2018). Veryearly versus delayed mobilisation after stroke. The Cochrane database ofsystematic reviews, 10(10), CD006187. https://doi-org.echo.louisville.edu/10.1002/14651858

McGlinchey,M. P., James, J., McKevitt, C., Douiri, A., & Sackley, C. (2020). Theeffect of rehabilitation interventions on physical function andimmobility-related complications in severe stroke: a systematic review. BMJopen, 10(2), e033642.https://doi-org.echo.louisville.edu/10.1136/bmjopen-2019-033642

o   Everyslide should include an in-text citation for the article described, using APAformat and located in the bottom right hand corner of the slide.

      Synthesis & Appraised Value: (3 slides)

o   (1)Evidence of hierarchy table: interpret as weak, moderate, or strong evidence insupport of this intervention

o   (2)Describe the usefulness of findings as supportive evidence for proposedintervention

o   (3)Make clinical recommendation in support of (or not) the intervention to addressthe clinical problem

      Reference List in APA format: (2 slides)