Results of included studies rated “good” or “excellent” quality
| Study | Study size | Study population | Study quality* | Ambulation quantified? | Pharmacological VTE prophylaxis | Outcome (definition) | Results | Study conclusion | Notes | |
|---|---|---|---|---|---|---|---|---|---|---|
| Sorbello et al (42) | 71 | Medicine | Good | No | NR | VTE (NR) | Amb | 0% | No difference in complications after initiation of early mobilization | Physiotherapy-directed OR physiotherapist-directed ambulation early in admission did not change VTE rates compared with standard of care |
| Control | 0% | |||||||||
| Amin et al (46) | 1054 | Medicine | Good | Yes | Yes† | VTE (clinical) | Amb | 8.4%‡ | In the prevention of VTE, reaching ambulatory status may not be a reason for stopping chemical prophylaxis | The best study to quantify ambulation (> 10 m walking). Reinforces need for chemical VTE prophylaxis |
| Control | 16.2% | |||||||||
| Cassidy et al (37) | 2892 | Surgery | Good | No | Yes, according to risk assessment | VTE (NSQIP) | Amb | 3% | Postoperative mobilization program, risk stratification and electronic recommendations reduce VTE | Large study with definition of VTE used widely. Wide implementation of a 3 times/d regimen failed to show a reduction in VTE |
| Control | 0.8% | |||||||||
| de Almeida et al (44) | 108 | Surgery | Excellent | Yes | NR | DVT (clinical) | Amb | 1.8% | Primary outcome was ability to walk but no difference in DVT | VTE events were a secondary outcome. More ambulation (≥ 2 times/d compared with ≤ 1 time/d) did not reduce VTE events |
| Control | 0% | |||||||||
| Guo et al (45) | 115 | Surgery | Good | No | Yes | DVT (clinical or ultrasonography) | Amb | 1.6% | Because of the sample size limitation, the authors could not draw any conclusion about the effects of exercises on the prevention of VTE | Similar to other lower quality studies, ankle exercises do not seem to reduce risk of DVT |
| Control | 1.9% | |||||||||
Note: Amb = ambulation, NR = not reported, NSQIP = National Surgical Quality Improvement Program, VTE = venous thromboembolism (pulmonary embolism or deep vein thrombosis [DVT])
↵* Assessed using the Downs and Black tool. (28)
↵† Patients in both groups were randomly assigned to receive placebo or enoxaparin 40 mg or 20 mg once daily.
↵‡ Ambulation and enoxaparin 40 mg once daily had the lowest rate of VTE at 3.3%.