Walkway Used in Postoperative Mobilization

Overview

Introduction Surgical operations are increasing globally, with abdominal surgeries accounting for approximately 70% of these procedures. Despite the prevalence, postoperative complications occur in 30-60% of cases, leading to prolonged hospital stays, increased mortality, and higher healthcare costs. Early mobilization is a critical component of Enhanced Recovery After Surgery (ERAS) protocols, known to reduce surgical stress, muscle atrophy, and pulmonary complications. However, implementation in pediatric care is often limited, as children may perceive mobilization as a "task" rather than a part of healing. Purpose The primary aim of this study is to investigate the effects of a low-cost, distraction-based Walkway (Mat Carpet) on pain levels, fear, and the time to initiate mobilization in children aged 4-10 who have undergone abdominal surgery.

Early mobilization is defined as the patient's ability to stand up and walk as soon as possible after surgery or after illness, depending on the type of operation performed and the course of the disease. Early mobilization is considered and recommended as one of the factors that accelerate recovery. One study indicated that initiating movement and mobilization early reduced surgical stress, muscle atrophy, complications, hospital stay, and care costs. Other studies have also reported that early mobilization accelerates the functioning of the Gastrointestinal System (GIS), prevents thromboembolic complications, and speeds up recovery. To minimize complications after surgery and optimize the child's health, the Enhanced Recovery After Surgery (ERAS) protocol can be applied. These protocols, also known as "Fast-Track," were first implemented in 2001. Early mobilization is one of the most important components of the ERAS approach. According to the ERAS protocol, the patient needs to be mobilized for two hours on the day of surgery and for a total of six hours on subsequent days until discharge. Although the benefits of early mobilization after surgery and its contribution to the recovery process are known, one study reported that early mobilization attempts were infrequent for patients after surgery (Rafeeqi and Pearson, 2021). Another study also indicated that patients need assistance with mobilization after surgical operations. At this point, nurses are key in initiating the early mobilization process to improve the quality of postoperative care. It is essential that early mobilization is initiated by the nurse, followed by encouraging the child to move independently. The surgical nurse should support the patient to achieve the highest possible level of independence and help improve their well-being. Randomized controlled trials that comprehensively assess both physical performance and psychological comfort (pain and fear) simultaneously during mobilization in postoperative children are limited. This study is designed as a randomized controlled trial to prove the effectiveness of low-cost, easy-to-implement, and concrete play materials such as "Walking Tracks" (Mat Mats), which are distraction-based and suitable for children's developmental characteristics, in contrast to expensive and technology-based mobilization initiatives in the literature. It aims to fill the evidence gap that holistically evaluates both physical and psychological recovery. This study aims to improve both physical and psychological recovery in a holistic way by transforming mobilization in children from a "task" into a "game". The population of the study, which is planned as a randomized controlled trial, will consist of 74 children aged 4-10 years who underwent abdominal surgery in the Pediatric Surgery Department of Mersin University Hospital. Methodology Study Design: A randomized controlled experimental design will be employed. Setting \& Sample: The study will be conducted at Mersin University Hospital Pediatric Surgery Service. A total of 74 children (37 experiment, 37 control) will be recruited based on power analysis. Randomization: Stratified block randomization will be used based on Surgical Technique (Open vs. Laparoscopic) and Developmental Stage (4-6 years vs. 7-10 years) to ensure group homogeneity. Intervention: The experimental group will use a "Walkway" mat featuring colorful figures and a target route placed in front of their beds. The control group will receive standard parent-supported mobilization. Data Collection Tools: \* Introductory Information Form Wong-Baker FACES Pain Rating Scale Children's Fear Scale Vital Signs Tracking Form Procedure: A pilot study with 10 children will precede the main study. Mobilization for all participants will begin 30-60 minutes after a standard dose of analgesic (paracetamol) to ensure comfort. Pain and fear will be assessed by the child, parent, and nurse simultaneously before and after mobilization. Statistical Analysis Data will be analyzed using SPSS, employing descriptive statistics, t-tests, or Mann-Whitney U tests for group comparisons. Consistency between child, parent, and nurse assessments will be measured using the Cohen's Kappa Test. Expected Outcomes It is hypothesized that turning mobilization into a game via the walkway will significantly reduce the children's fear and pain levels while shortening the time to initiate the first step. This study aims to provide nursing evidence for holistic, low-cost, and developmentally appropriate pediatric postoperative care.