BackgroundEarly structured mobilization has become a key element of Enhanced Recovery After Surgery programs to improve patient outcomes and decrease length of hospital stay. With the intention to assess and improve early mobilization levels, the 8-point ordinal John Hopkins Highest Level of Mobility (JH-HLM) scale was implemented at two gastrointestinal and oncological surgery wards in the Netherlands. After the implementation, however, healthcare professionals perceived a ceiling effect in assessing mobilization after gastrointestinal and oncological surgery. This study aimed to quantify this perceived ceiling effect, and aimed to determine if extending the JH-HLM scale with four additional response categories into the AMsterdam UMC EXtension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale reduced this ceiling effect.MethodsAll patients who underwent gastrointestinal and oncological surgery and had a mobility score on the first postoperative day before (July–December 2018) or after (July–December 2019) extending the JH-HLM into the AMEXO scale were included. The primary outcome was the before-after difference in the percentage of ceiling effects on the first three postoperative days. Furthermore, the before-after changes and distributions in mobility scores were evaluated. Univariable and multivariable logistic regression analysis were used to assess these differences.Results Overall, 373 patients were included (JH-HLM n = 135; AMEXO n = 238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score before extending the JH-HLM into the AMEXO as compared to 4 (1.7%) patients after (OR = 0.021, CI = 0.007–0.059, p ConclusionsA substantial ceiling effect was present in assessing early mobilization in patients after gastrointestinal and oncological surgery using the JH-HLM. Extending the JH-HLM into the AMEXO scale decreased the ceiling effect significantly, making the tool more appropriate to assess early mobilization and set daily mobilization goals after gastrointestinal and oncological surgery.
This project challenges traditional cognition-based research methods. While informative, they do not fully capture the complexity of economic transformation. This hinders our ability to support regenerative entrepreneurs in their journey toward a fair and sustainable economy. At AUAS Centre for Economic Transformation, our search for a more integrative approach to building new business models, led us to arts- and nature-based research. We are intrigued by art- and nature-based research as a tool to integrate cognitive, emotional and practical elements (head/ heart/ hands). Our curiosity led us to the following research question: how can innovative methodologies that focus on lessons from the arts (creativity) and nature (diversity) help to enrich the understanding of economic transformation among researchers and entrepreneurs engaged in regenerative practices. This study employs an action-oriented research approach, including progressive learning and reflective monitoring and evaluation. During workshops the researchers and entrepreneurs go outside and collect pieces of nature. With these materials they compose their own work of art. Participants, under guidance, step-by-step, 'engage in dialogue' with their artwork based on their own question, eventually experiencing (a direction to) an answer. This project brings together researchers with expertise in the diverse fields of entrepreneurship, craftsmanship, co-ownership and economic ecosystems and entrepreneurs of regenerative practices. They emerge themselves in innovative research methods aimed at integrating head, heart, and hands to enhance diversity and creativity and enrich their understanding of economic transformation. The presentation will be enriched by the works of Claudy Jongstra, a Dutch artist and regenerative entrepreneur.
