Clinical Question: Does early mobilization improve outcomes in patients with community-acquired pneumonia?
Setting: Inpatient (ward only)
Study Design: Randomized controlled trial (nonblinded)
Synopsis: Previous studies of myocardial infarction and orthopedic procedures have demonstrated improved outcomes with early mobilization. Mundy and colleagues applied that thinking to hospitalized patients with community-acquired pneumonia. Patients (n = 458) admitted to 17 general medical units were randomized by medical unit to early mobilization (i.e., encouraged to get into an upright position for at least 20 minutes during the first 24 hours of hospitalization, with progressively increased mobilization thereafter) or usual care. Numerous variables and outcomes were measured, but the primary outcome was length of hospital stay.
Groups were similar at baseline; approximately 25 percent were younger than 50 years, and 25 percent were older than 80 years. Most received their antibiotics within eight hours. The mean length of stay was less for patients in the early mobilization group (5.8 versus 6.9 days for usual care; 95 percent confidence interval [CI], zero to 2.2). The results were stratified by the Pneumonia Severity Index (PSI) score, in which I is the lowest severity 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 versus 7.4 days for usual care; 95 percent CI, 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 or sitting up, while those who were most sick were less likely to benefit from this simple intervention. No difference was noted between groups in the risk of death or readmission.
Bottom Line: Early mobilization, which begins by having patients sit up for at least 20 minutes in the first 24 hours after admission, reduces the length of stay in patients with community-acquired pneumonia. (Level of Evidence: 1b)