Improving Inpatient Ambulation Remains a Critical Issue in Supporting Patients Posttransplant


Sarah Low RN, MSN, OCN, CMSRN; and Claudia Maldonado-Howell, RN, MSN, FNP, BS, CMSRN, highlight the importance of improving inpatient ambulation for transplant patients.

Improving Inpatient Ambulation Remains a Critical Issue in Supporting Patients Posttransplant

Improving Inpatient Ambulation Remains a Critical Issue in Supporting Patients Posttransplant

For oncology nurses supporting patients undergoing autologous stem cell transplant (ASCT), improving inpatient ambulation is a key area of focus, according to Sarah Low RN, MSN, OCN, CMSRN; and Claudia Maldonado-Howell, RN, MSN, FNP, BS, CMSRN.

The pair presented data in an abstract during the 48th Annual Oncology Nursing Society (ONS) Congress that demonstrated that patients who undergo ASCT experienced a 24.4% average drop in physical ability between admission and discharge. The patients (n = 23) had been randomly assigned 1:1 to receive either verbal encouragement thrice daily from their nurses, along with visual feedback of their daily step data, as part of the intervention group vs no verbal or visual feedback, as part of the control group. Yet, the loss in ambulation was consistent in both arms.

In an interview with Oncology Nursing News®, the nurse investigators, both of whom practice at Cedars-Sinai Medical Center, discussed the implications of their research, and future directions in this space.

Oncology Nursing News: How did this study come about?

Maldonado: The study came about because we have an MD [working] in collaboration with our unit. We meet and troubleshoot anything going on in the unit.

We were discussing how to encourage our patients to ambulate more. One of the things that we had noticed was that the surgical units had done a study using mobility devices and Fitbits. We said, ‘Why don’t we do that for our patients?’ Our patients are here for long periods of time; it would be fun to get something going on our unit, and our patients would really enjoy it.

One of our doctors is very active, and he wanted to create a little competition with his patients. He usually gives them stickers. Instead of doing the sticker reward program, we said we are going to [use] the Fitbit instead [and] track how much patients are walking.

Could you elaborate on the design of the study?

Low: Our study was a randomized controlled trial. All the patients who were enrolled received activity monitors that measured their ambulation, but only a subset of [individuals] got the intervention, which was [encouragement from] our nursing staff and access to their real-time step counts. [This] was a way to motivate our patients, and to show them how they have been doing [step wise].

What were the findings from the study? Did anything surprise you?

Low: We really saw just how much more we need to be doing to help control symptoms. We were very surprised that our patients lost 24% of their mobility. We tend to consider our [ASCT] patients as our healthier population, they tend to have [fewer] comorbidities, [yet] they still lost 24%. It demonstrated the need for [ambulation] programs [such as] this.

With that, we saw huge gains in ambulation for our patients [in the intervention arm] in days 1 to 5 after transplant—right until pancytopenia kicked in. Until then, our patients [who were able] to see their step counts were walking like crazy. It was really amazing. Then it plummeted. From that point on, the [intervention] group was trending higher, but it wasn’t in a statistically significant way.

[However,] we did see that every time a patient engaged with a step count monitor, they would walk an extra 137 steps a day [on average]. [This] suggests that maybe if we’re able to improve the application of the intervention, this could make a bigger impact.

What are the overall implications from this project?

Low: Oncology nurses are asked to do more with less every single day. We know what our patients need, and we are hit with the reality of what we can actually provide. I think if technology can help us, we should use it. Our study suggests that activity monitors might be able to help our patients in a relatively inexpensive way.

Maldonado: I think everyone enjoyed [this project]—including our patients. The nurses were very happy to contribute to the work. It was very easy, and it is something that we hope we can continue doing for our patients in the future because it is very important to get them up and moving so that they can leave healthy and [be] able to walk better than when they came in.

Are there any next steps for this research?

Low: One of the challenges we had when it came to ambulation was that there really is no way to accurately track what our patients are doing. For most institutions, there is no good way to document how much our patients are ambulating. This is a big barrier because we do not know the baseline of what our patients are doing. There is a need for that data so that we can better support our patients.


Low S, Maldonado-Howeel C, Flores J, Daskivich T, Paquette R. Stepping up: improving inpatient ambulation for autologous stem cell transplant patients. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed June 28, 2023.

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