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Careplan

Mobility Impairment, Adult

Jul.10.2018

Mobility Impairment (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient experiencing limitation in ability to independently and safely move self from one position or place to another.

Key Information

  • Mobility impairment may hinder the patient’s ability to perform daily activities and may lead to negative health outcomes and the need for greater physical assistance.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Optimal Mobility

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Mobility Impairment

Signs/Symptoms/Presentation

  • difficulty with transfers
  • motor skill limitation
  • muscle strength decreased
  • range of motion limitation
  • reluctance to attempt mobility
  • requires assistance with ambulation
  • shortness of breath during or after activity
  • unable to reposition self independently

Problem Intervention

Optimize Mobility

  • Assess mobility skills (e.g., bed, transfers, ambulation, gait, stair climbing, wheelchair) and factors influencing mobility, such as balance, safety, range of motion, strength, muscle tone, cognition and sensory processing.
  • Instruct in transfer and mobility techniques supporting highest level of independence while ensuring safety.
  • Consider any contraindications or precautions to individualize treatment plan (e.g., joint or ligament instability, weight-bearing restrictions).
  • Encourage early mobilization and performance of daily activities, if able, while providing level of assistance needed for safety.
  • Schedule mobility activities when pain and fatigue are at a minimum to encourage optimal performance.
  • Pace activity; allow adequate time and rest periods to conserve energy.
  • Provide frequent encouragement, along with prompting and assistance as needed.
  • Individualize instructions and prompts to patient’s cognitive status to promote effective communication; simplify verbal directions, give encouragement and provide demonstrated cues as needed.
  • Design and implement therapeutic interventions to address impairments (e.g., functional mobility training, mat and standing balance activities, strengthening).
  • Train in and reinforce use of adaptive equipment and assistive devices, such as a walker or transfer board.
  • Utilize appropriate modalities, devices or techniques to facilitate mobility (e.g., ankle foot orthosis, electrical stimulation, sit-to-stand lift, treadmill-training).
  • Assess fall risk using standardized tool; implement appropriate interventions, such as behavioral or environmental modifications.
  • Use proper body mechanics and patient alignment during mobility to ensure safety.

Associated Documentation

  • Adaptive Equipment Use
  • Positioning/Transfer Devices
  • Self-Care Promotion

Education

CPG-Specific Education Topics

Overview

  • risk factors

  • signs/symptoms

Self Management

  • assistive/adaptive devices

  • energy conservation

  • home safety

  • joint mobility/strength

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

  • Bolding, D.; Adler, C.; Tipton-Burton, M.; Verran, A. (2013). In Pedretti's occupational therapy: Practice skills for physical dysfunction. Chapter 11: Mobility. (pp.233-294). St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Bulechek, G. M.; Butcher, H. K.; McCloskey-Dochterman, J. M.; Wagner, C. (2013). Nursing Interventions Classification (NIC). St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Degelau, J.; Belz, M.; Bungum, L.; Flavin, P. L.; Harper, C.; Leys, K.; Lundquist, L.; Webb, B. (2012). Prevention of falls (Acute Care) protocol. Bloomington, MN: Institute for Clinical Systems Improvement. [Quality Measures,Clinical Practice Guidelines]
  • Handoll, H. H.; Sherrington, C.; Mak, J. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database of Systematic Reviews. 2011, March;(3) doi:10.1002/14651858.CD001704.pub4 [Metasynthesis,Meta-analysis,Systematic Review]
  • Harvey, L. A.; Glinsky, J. V.; Bowden, J. L. The effectiveness of 22 commonly administered physiotherapy interventions for people with spinal cord injury: A systematic review. Spinal Cord. 2016;54(11), 914-923. [Metasynthesis,Meta-analysis,Systematic Review]
  • Hoeman, S. P. (2008). Rehabilitation nursing prevention, intervention, and outcomes. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Hollands, K. L.; Pelton, T. A.; Tyson, S. F.; Hollands, M. A.; van Vliet, P. M. Interventions for coordination of walking following stroke: Systematic review. Gait & Posture. 2012;35(3), 349-359. [Metasynthesis,Meta-analysis,Systematic Review]
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  • Martínez-Velilla, N.; Cadore, E. L.; Casas-Herrero, Á.; Idoate-Saralegui, F.; Izquierdo, M. Physical activity and early rehabilitation in hospitalized elderly medical patients:  Systematic review of randomized clinical trials. Journal of Nutrition, Health and Aging. 2016;20(7), 738-751. doi:10.1007/s12603-016-0683-4 [Metasynthesis,Meta-analysis,Systematic Review]
  • Morawietz, C.; Moffat, F. Effects of locomotor training after incomplete spinal cord injury: A systematic review. Archives of Physical Medicine and Rehabilitation. 2013;94(11), 2297-2308. [Metasynthesis,Meta-analysis,Systematic Review]
  • National Guideline Clearinghouse (NGC). (2013, March). Guideline summary: Brain injury rehabilitation in adults. A national clinical guideline. (Summary of a guideline from the Scottish Intercollegiate Guidelines Network) In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). [Quality Measures,Clinical Practice Guidelines]
  • National Guideline Clearinghouse (NGC). (2015, January). Guideline summary: Occupational therapy practice guidelines for adults with stroke. (Summary of a guideline from the American Occupational Therapy Association, Inc.) In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). [Quality Measures,Clinical Practice Guidelines]
  • National Guideline Clearinghouse (NGC). (2016). Guideline summary:  Motor neurone disease:  Assessment and management. (Summary of a guideline by the National Guideline Centre) In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). [Quality Measures,Clinical Practice Guidelines]
  • Pollock, A.; Baer, G.; Campbell, P.; Choo, P. L.; Forster, A.; Morris, J.; Pomeroy, V. M.; Langhorne, P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database of Systematic Reviews. 2014;(4) doi:10.1002/14651858.CD001920.pub3 [Metasynthesis,Meta-analysis,Systematic Review]
  • Prenton, S.; Hollands, K. L.; Kenney, L. P. Functional electrical stimulation verus ankle foot orthoses for foot-drop: A meta-analysis of orthotic effects. Journal of Rehabilitation Medicine. 2016;48(8), 646-656. [Metasynthesis,Meta-analysis,Systematic Review]
  • Rocha, P. A.; Porfírio, G. M.; Ferraz, H. B.; Trevisani, V. F. Effects of external cues on gait parameters of Parkinson's disease patients: A systematic review. Clinical Neurology and Neurosurgery. 2014;124, 127-134. [Metasynthesis,Meta-analysis,Systematic Review]
  • Umphred, D. A.; Lazaro, R. T.; Roller, M. L.; Burton, G. U. (2013). Umphred's neurological rehabilitation. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.