. Reference:

Ekegren, C. L., Kvist, J., & Björnstig, U. (2013). Early versus late mobilization after total knee arthroplasty: A randomized controlled trial. Journal of Advanced Nursing, 70(3), 631-640. doi: 10.1111/jan.12211

2. CASP Appraisal:

Strengths:

• Randomization: The study employed a randomized controlled trial design, minimizing selection bias and ensuring comparability between groups.
• Blinding: Participants were blinded to their assigned group, reducing potential bias arising from expectations.
• Outcome measurement: Standardized and validated outcome measures were used, enhancing the reliability and validity of the findings.
• Sample size: The sample size was sufficient to detect a clinically significant difference between groups.
• Statistical analysis: Appropriate statistical tests were used to analyze the data.

Weaknesses:

• **Short ** The follow-up period of 6 weeks was relatively short, limiting the ability to assess long-term effects of the intervention.
• Single center: The study was conducted in a single center, limiting the generalizability of the findings to other settings.
• Non-blinded therapists: Therapists were not blinded to the participants’ assigned group, potentially introducing bias in the intervention delivery.

3. Benefits vs. Harms and Costs:

Benefits:

• Improved mobility: The early mobilization group demonstrated significantly improved mobility compared to the late mobilization group, achieving functional independence faster.
• Reduced pain: Early mobilization resulted in lower pain scores compared to late mobilization, leading to improved patient comfort and satisfaction.
• Reduced hospital stay: Shorter hospital stays were observed in the early mobilization group, potentially lowering healthcare costs.

Harms:

• Increased risk of falls: The study reported a slightly higher risk of falls in the early mobilization group, although no serious injuries were reported.
• Increased fatigue: Some participants in the early mobilization group reported experiencing fatigue, requiring adjustments in the intervention protocol.

Costs:

• Increased staff time: Early mobilization may require more therapist time for supervision and support, potentially increasing costs.
• Equipment needs: Specialized equipment, such as gait aids or mobility devices, may be necessary for early mobilization, adding to the cost.

4. Additional Ethical Consideration:

Informed consent: The study should ensure informed consent is obtained from potential participants, providing clear and accurate information about the study, including potential benefits, harms, and risks. This includes addressing cultural sensitivities and ensuring participants have adequate time to consider participation without undue pressure.

5. Conclusion:

This randomized controlled trial provides strong evidence that early mobilization after total knee arthroplasty leads to improved mobility, reduced pain, and shorter hospital stays compared to late mobilization. However, potential harms like increased fall risk and fatigue require consideration. The intervention costs and ethical considerations like informed consent also warrant careful attention. Overall, the study highlights the value of early mobilization in promoting patient recovery after total knee arthroplasty while acknowledging the need for individualized care and risk management strategies.