Comprehensive assessment of postoperative mobility during the first days after mini-invasive lung surgery: A prospective observational study

Study Objective: Postoperative physical therapy and early mobilization are
major elements of enhanced recovery after surgery. In contrast with
supervised physical therapy sessions that can be monitored,
self-mobilization is not easily quantifiable and has so far been estimated
mainly through patient auto-reports. This study aimed to perform a
comprehensive and objective evaluation of postoperative mobility. Design:
Prospective observational study. Setting: Postoperative setting. Patients:
Patients undergoing mini-invasive lung surgery. Interventions: Measurement
of postoperative mobility during the five first postoperative days using
an accelerometer (ActiGraph GT3X). Measurements: The primary outcome was
the number of daily steps. Secondary outcomes included physical activity
duration and intensity, sedentary time, number of breaks in sedentary
time, sedentary patterns, daily evaluation by physiotherapists,
postoperative complications, and acceptability of wearing the
accelerometer. Main Results: Sixty patients were included in the study, of
whom 56 provided at least one day of valid accelerometry data. There was
no significant change during the first four PODs concerning the number of
daily steps nor the mean cadence. One-minute cadence peak, total activity
counts, and duration of light-intensity physical activity increased over
time (P = 0.032, P = 0.001 and P = 0.001, respectively). Sedentary
patterns changed favorably over time, with a decrease in prolonged
sedentary bouts (≥ 60 consecutive min), and an increase in shorter bouts
(< 10 min) (P < 0.001). Similar results were observed when
analysis was adjusted for the day of the week when the surgery took place
except for daily sedentary time (P = 0.055). The median acceptability of
wearing the accelerometer was excellent (median 10 [9-10] on a 10-point
Likert scale). Three patients had major complications. Conclusions: Our
findings suggest that daily steps may not be the most relevant indicator
of early mobility following thoracic surgery and that accelerometry is
suitable to follow patient's early postoperative activity.