To Örebro University

Mobilization for up to 2 hours on the surgery day followed by 6 hours daily is advised in Enhanced Recovery After Surgery pathways for colorectal surgery, but this recommendation is often not met. Immediate mobilization (i.e. within 30 minutes of post-anesthesia care unit arrival) is considered safe, but its benefits and how patients and professionals view it remain unclear. This thesis is based on four studies using patients from the same cohort. Study I was a randomized controlled trial (RCT) of 144 patients assigned to immediate or standard ward mobilization. The primary outcome was physical activity measured as daily steps on postoperative days 1–3. Immediate mobilization did not improve physical activity compared to standard care, and no improvements were seen in any other physical or clinical outcomes. Study II was a qualitative interview study including patients (n=41) and healthcare professionals (n=5). Patients found immediate mobilization challenging but important and relied on support from staff. Professionals viewed it as a balance, stressing the need for resources and physiotherapist involvement. Study III was a secondary analysis of the RCT data in patients ≥65 years (frail n=32, non-frail n=64). Immediate mobilization appeared to help preserve functional ability in patients with mild frailty. Study IV included 107 patients who completed the World Health Organization Disability Assessment Score 2.0 questionnaire assessing functioning and participation before surgery, at 1 month, and by phone at 3, 6, and 12 months. Patients had more disability at 1 month but improved by 3 months after surgery. Older frail patients required up to 12 months to recover. In summary, immediate mobilization is safe but challenging after colorectal surgery with limited benefit; most patients recovered within 3 months, though frail elderly patients may need longer time.