The effectiveness of early mobilization program to improve pain level, intestinal

peristaltic and physiologic paramaters on post-surgery patients

Dewi Prabawati 1, * and Farel Tania 2
1 Nursing Program, Nursing Faculty, STIK Sint Carolus, Jakarta, Indonesia.
2 Department of Nursing, Mitra Keluarga Hospital, Bekasi, Indonesia.

GSC Biological and Pharmaceutical Sciences, 2024, 28(03), 001–006

Publication history: Received on 02 July 2024; revised on 14 August 2024; accepted on 17 August 2024

Article DOI: https://doi.org/10.30574/gscbps.2024.28.3.0299

Abstract
Introduction: Surgery is an invasive medical procedure which performed to diagnose or treat illness, injury, or
disability. The decrease of intestinal peristaltic and incidence of pain may occur as a result of these actions; moreover,
it affects blood pressure and other physiologic parameters; thus, will make prolong the healing period because it will
interfere with the patient activity and become one of the reasons for the patient unwilling to perform early mobilization.

Objective: The purpose of this study was to determine the effectiveness of early mobilization program to improve pain
level, intestinal peristaltic and physiologic parameters on Post Surgery Patients.

Method: This study used quasi experimental design with One – Group Pretest-Posttest, and there were 33 patients
which chosen using total sampling technique. Pain level, intestinal peristaltic, blood pressure, heart rate and body
temperature were measured at before and after 3 days intervention of early mobilization program.

Result: Wilcoxon statistical analysis revealed significant difference in decreasing levels on pain, increasing intestinal
peristaltic, decreasing systolic blood pressure and decreasing heart rate (p<0.05) at before compared to after
intervention of early mobilization on post-surgery patients. Multivariate analysis showed that intervention of early
mobilization, age and type of surgery simultaneously affect dependent variables ((p<0.05; moreover, the r-squared is
0.727 which indicates that early mobilization intervention contributed 72.7% to changes in pain level, intestinal
peristaltic and physiologic parameters.

Conclusion: It is suggested that nurses should perform and apply early mobilization program to post surgery patients,
because of its positive impact to patient will faster patient’s recovery process .

Keywords: Early mobilization; Intestinal Peristaltic; Level of Pain; Physiologic parameter; Surgery

1. Introduction
Surgery is an invasive procedure that involves opening a part of the body, which is generally carried out by making an
incision to prevent disability and complications; this action is the therapy of choice for various conditions that are
difficult and impossible to cure with simple medicines (1). The impact of this action can vary, such as changes in
peristalsis, which results in nausea and vomiting, and complaints of post-operative pain, which also impact changes in
the body's physiological parameters.

* Corresponding author: Dewi Prabawati

Copyright © 2024 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0.
 GSC Biological and Pharmaceutical Sciences, 2024, 28(03), 001–006

Experts and hospitals have widely recommended early mobilization intervention because this intervention is thought
to speed up the healing process and reduce post-surgical complications. Intestinal function works more quickly after
surgery because early mobilization can help increase the tone of the gastrointestinal tract and abdominal wall,
stimulating peristalsis. On the other hand, recovery from abdominal wounds occurs more quickly if mobilization is
carried out early.

However, several gaps remain regarding implementing early mobilization interventions in Indonesia. Previous research
found that most respondents, namely 57.1% of patients, had poor early mobilization behavior (2), and 40% had
insufficient patient knowledge about early mobilization (3) .This happened because the nurse only gave leaflets about
early mobilization and advised the patients to do so with their families.

Some hospitals also experience obstacles in implementing early mobilization interventions for post-operative patients,
such as problems with patients with various complications, service arrangements, and human resource problems (4)
Furthermore, previous study (5) found obstacles for ICU nurses, namely the lack of trained nurses (76%), lack of staff
during shift work (72%), limited time (58%), and difficulty in mobilizing obese patients (82%) as a barrier to early
mobilization actions. Furthermore, nurses' understanding regarding early mobilization interventions is still mixed
where one study only carried out left and right oblique interventions to increase intestinal peristalsis in post-operative
patients (13). Due to this situation, this study aimed to determine the effectiveness of an early mobilization program in
decreasing pain levels and increasing intestinal peristaltic in post-surgery patients.

2. Material and methods

2.1. Participants
This was quasi-experimental, one group pretest-posttest without control group design. Sample size was calculated using
Slovin formula. In this study, non-probability method, purposive sampling technique was applied and there were 33
laparotomy post operation patients met the inclusion and exclusion criteria. All patients given an early mobilization
program, adopted from previous study (6). The intervention was developed for days, namely 1st day: passive ROM and
positioning every 2 hours; 2nd day: sitting position in bed with or without back supported; 3 rd day: sitting on edge of
bed. The study was approved by Sint Carolus School of Health Sciences ethics committee (No.
005/KEPPKSTIKSC/II/2021).

2.2. Measures and Analysis

Research data were collected over three days using datasheet for profile of the participants. Numbering Pain Rating
Scale was utilized to measure pain level; Littmann stethoscope to measure intestinal peristaltic; Omron
sphygmomanometer to measure blood pressure and axillary thermometer to measure body temperature. Wilcoxon
signed rank test was used to determine whether there are statistically significant differences before and after
intervention of pain level, intestinal peristaltic and physiologic parameters of blood pressure, heart rate and body
temperature. Multivariate analysis of Ancova was applied to determine the effect of early mobilization program and
confounding variables of age, gender, type of surgery to dependent variables.

3. Results
Table 1 Frequency and percentage distribution of the participants

Characteristics N %
Age
12-25 4 12.1
26-45 23 69.7
46-55 4 12.1
>56 2 6.1
Gender
Male 11 33.3

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Female 22 66.7
Type of surgery
Appendectomy 11 33.3
Sectio Caesarea 12 36.4
Herniorrhaphy 3 9.1
Others 7 21.2
Total 33 100

Table 1 showed the frequency and percentage distribution of the participant. Most of the participants were age between
26-45 years old (69.7%) female (66.7%), and underwent for laparotomy surgery on indication of Sectio Caesarea
(36.4%).

Table 2 Mean and significant difference within the group

Variables Pre Post P value

N % N %
Level of Pain 0.000
Mild 0 0 33 100
Moderate 24 72.7 0 0
Severe 9 27.3 0 0
Intestinal Peristaltic 0.000
Weak 20 60.6 0 0
Normal 12 39.4 33 100
Systolic blood pressure 0.02
Normal 5 15.2 14 42.4
Prehypertension 19 57.6 15 45.5
Stage 1 8 24.2 3 9.1
Stage 2 1 3.0 1 3.0
Diastolic blood pressure 0.13
Normal 12 36.4 11 33.3
Prehypertension 14 42.4 16 48.5
Stage 1 6 18.2 6 18.2
Stage 2 1 3.0 0 0
Heart Rate 0.000
Normal 18 54.5 33 100
Tachycardia 15 45.5 0 0
Body Temperature 0.256
Hypothermia 19 57.6 21 63.6
Normal 14 42.2 12 36.4

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Table 2 presents the difference in the mean score level of pain, intestinal peristaltic and physiologic parameters namely
systolic and diastolic blood pressure, heart rate and body temperature. There were a significant within the group
differences in level of pain, intestinal peristaltic, systolic blood pressure and heart rate before and after intervention of
early mobilization program (p<0.05). Moreover, there were a significant decrease in level of pain and systolic blood
pressure, while 100% patients develop normal for intestinal peristaltic and heart rate after receiving an early
mobilization program for 3 days.

Table 3 Simultaneous Multivariate test of the effect of early mobilization program

Effect value F Hypothesis df Sig

Intercept 1226.948 6134.739b 4.000 0.000
Age 1.788 8.941b 4.000 0.000
Gender .205 1.023b 4.000 0.420
Type of surgery 2.775 1.8333 28.000 0.020
R Squared = ,727 (Adjusted R Squared = ,620)

Table 3 revealed Simultaneous Multivariate test of the effect of early mobilization program on pain level, intestinal
peristaltic and physiological parameters and confounding variables using Ancova Statistical test. It declared that early
mobilization intervention, together with variables of age, gender bring effect to dependent variable simultaneously,
with p value <0.05. In addition, the table shows r-square = 0.727, which indicated that early mobilization intervention
give contribution of 72.7% decreased level of pain, intestinal peristatic and physiologic parameters, such as systolic and
diastolic blood pressure, heart rate and body temperature on post-surgery patients; while 37.3% is provided by other
variables which is in not examined in this study.

4. Discussion
From the patient characteristics, it can be seen that most respondents were post-appendectomy and cesarean-section
patients. This is in accordance with the data that women and adults aged 26-45 dominate the sample. The incidence of
appendicitis can be found at all ages, with the highest peak in the 20-30-year age group. This is caused by the hyperplasia
factor of lymphoid tissue, where the tissue reaches its peak growth at that age, so if there is a blockage, it will cause an
increase in intraluminal pressure (7).

This study's results align with the theory, which states that the impact of an early mobilization program can speed up
the patient's healing process by reducing post-surgical pain, improving intestinal peristalsis, and stabilizing the body's
physiological parameters. The pain sensation after surgery occurs due to incision or trauma to the tissue, which is the
complaint most feared by patients undergoing surgery. The sensation of pain begins to be felt before the patient's
consciousness has fully recovered and will increase as the effect of the anesthesia wears off (8).

In this study, the initial pain assessment was carried out when the post-operative patient was fully conscious. The post-
test was carried out after early mobilization 6 hours after surgery. In this condition, the anesthetic effect disappears and
does not work, so the respondent begins to feel an acute pain sensation. The results indicate that early mobilization
promotes a positive experience in significantly reducing pain. The reduction in pain levels after early mobilization
occurs because early mobilization can reduce the patient's concentration on the location or area of surgery and reduce
the activity of chemical mediators such as histamine, bradykinin, prostaglandin, acetylcholine, leukotrienes, and
potassium in the inflammatory process and minimize pain nerve transmission to the central nerve (9).

Early mobilization can reduce the incidence of complications, including helping to increase the tone of the
gastrointestinal tract and abdominal wall and stimulating peristalsis to reduce the possibility of post-operative
abdominal distension. The recovery of abdominal wounds is faster if mobilization is carried out early. In this research,
the movements carried out through early mobilization intervention refer to Moris (2008) (6). The mobilization
movements carried out have four stages, namely ROM exercises and changes in left and right tilt positions, followed by
a sitting position for the first 24 hours. The movement continues with sitting next to the bed, and the last is standing up
to moving to a chair with assistance. In previous research (6) explains that this mobilization movement reduces the
length of stay for patients in the ICU, thereby reducing treatment costs.

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Another effect of this study is that the pain scale is significantly reduced if early mobilization occurs. This also impacts
physiological parameters, where the pulse rate and body temperature return to normal more quickly if the patient tries
to reach normal preoperative activity levels as quickly as possible.

In patients undergoing surgery, the anesthetic drug will cause peristaltic movements to stop temporarily, where the
anesthetic agent that enters the body inhibits parasympathetic nerve impulses to the intestinal muscles. The anesthetic
works to slow or stop peristaltic waves. If peristaltic movements stop for too long, around 24-48 hours, it will result in
peristaltic ileus, complicating the patient's healing process (9).

Early mobilization carried out on post-operative patients aims to increase physical activity. Skeletal muscle contractions
during mobilization will cause muscle tension by providing sudden electrical stimulation around the area of the
contracting muscle. If skeletal muscle contractions are carried out around the abdomen, then these contractions can
trigger contractions of the muscles in the abdomen, especially the gastrointestinal muscles. The movements carried out
also cause impulses in the spinal cord. These impulses will spread to the part of the spinal cord, which regulates the
parasympathetic nerves, which regulate the digestive nerves, namely the lumbar and sacral nerves (10).

The results of this research align with the results of research conducted (11). His research showed a significant influence
on respondents before and after early mobilization intervention (ROM) on the recovery of intestinal peristalsis in post-
operative patients with general anesthesia (p=0.0001). Early mobilization exercises can increase intestinal peristalsis
with an average increase of 4 times per minute. This will have a broad impact where the length of stay in hospital will
be shorter and cheaper, and the broad impact will provide benefits for hospitals and patients (12).

5. Conclusion
Early mobilization is an effective program for post-operative patients because it has been proven to significantly reduce
pain, increase intestinal peristalsis, and improve physiological parameters such as systolic blood pressure and heart
rate, statistically even providing an impact of 72.7%. It is recommended that nurses implement early mobilization by
implementing movements according to the procedures to shorten the patient's length of stay.

Compliance with ethical standards

Disclosure of conflict of interest

All authors declare that no competing interests were disclosed.

Statement of ethical approval

Ethical clearance was approved by Sint Carolus School of Health Sciences ethics committee (No.
005/KEPPKSTIKSC/II/2021).

Statement of informed consent

Informed consent was obtained from all individual participants included in the study.

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