The researchers followed the “6S” evidence model, beginning with high-level systems and summaries and extending to individual studies. They searched international and Chinese-language websites and databases, including the National Institute for Health and Care Excellence, Joanna Briggs Institute resources, the Cochrane Library, PubMed, Embase, Web of Science, CNKI, Wanfang, VIP and SinoMed. Searches ran from the inception of each database through December 19, 2025, using terms for colorectal cancer, laparoscopic or minimally invasive surgery, enhanced recovery, ambulation, mobilization, physiotherapy and early exercise. The initial search retrieved 2,130 records; 1,885 remained after duplicates were removed, and 19 publications ultimately met the inclusion criteria.

Two researchers independently appraised the literature and extracted data, resolving disagreements by group discussion. AGREE II was used for guidelines, adapted Joanna Briggs Institute criteria for expert consensus statements and systematic reviews, the Critical Appraisal for Summaries of Evidence tool for the evidence summary, and corresponding critical-appraisal criteria for randomized controlled trials. The evidence was then converted into recommendations through the Joanna Briggs Institute grading system, with strength also informed by feasibility, appropriateness, meaningfulness, effectiveness, clinical applicability and safety. Secondary sources were treated as summaries of their underlying primary studies to avoid counting the same evidence more than once.

The resulting pathway treats early mobilization as a progressive, measurable part of enhanced recovery after surgery rather than a single intervention. Its recommended sequence runs from structured exercises in bed to sitting upright, standing at the bedside, assisted walking and independent walking, with activity duration and distance increasing according to recovery. In-bed exercises—including deep breathing, elbow flexion, ankle pumping, knee flexion, hip elevation and turning—should begin within 24 hours after regaining consciousness from anesthesia. Patients should be encouraged to attempt standing or walking within 24 hours of surgery, and from the first postoperative day the pathway calls for at least three hours of activity each day.

Before any activity begins, nurses should assess consciousness, vital signs, pain, muscle strength and the condition of the surgical incision. The synthesized criteria call for activity to be suspended when pain measured on the visual analogue scale exceeds 4, oxygen saturation falls below 90%, heart rate is above 100 or below 40 beats per minute, systolic blood pressure is below 90 mmHg or diastolic pressure below 50 mmHg, or dizziness, marked weakness or orthostatic intolerance develops. These thresholds are explicitly provisional rather than universal safety standards: they largely derive from one randomized trial, and the review assigned the stop criteria a weak recommendation pending validation in larger, multicenter studies.

Preoperative work is presented as a foundation for postoperative participation. Patients and families should receive education about the importance, components and goals of early mobilization, with additional strategies and success stories proposed for people who may have difficulty retaining verbal information. Exercise-based prehabilitation combining aerobic activity, cardiorespiratory exercise and resistance training may improve functional reserve and exercise endurance, although no standardized protocol is supported by the available evidence. Grip strength and the six-minute walk test can describe functional status before surgery, but the review cautions that they should not be presented as established predictors of surgical risk.

The postoperative plan also depends on removing barriers to movement. For patients without high-risk factors, urinary catheters should be removed within 24 hours; for those without risk of urinary retention, removal is recommended within 48 hours. Other drainage tubes should be reviewed promptly and removed when appropriate. Postoperative nausea and vomiting should be prevented, and excessive intravenous fluid should be limited because fluid overload can reduce a patient’s willingness and ability to get out of bed. Nutritional screening before surgery, daily monitoring afterward and early enteral nutrition within 24 hours, together with oral supplements, are recommended to support gastrointestinal recovery and shorten hospital stay.

Pain control is a central enabler of activity, and the review adjusts earlier evidence to reflect the laparoscopic population. Its recommended strategy is multimodal analgesia centered on acetaminophen combined with bilateral transversus abdominis plane blocks. For colon surgery, selective cyclooxygenase-2 inhibitors may be added, whereas nonsteroidal anti-inflammatory drugs should be avoided in rectal surgery; intrathecal morphine may be used as needed for visceral analgesia. The authors also recommend chewing gum three or four times daily for 10 to 15 minutes after surgery. Assessment should combine patient reports with objective measures such as time to first flatus, time to first bowel movement, time to mobilization, daily steps, walking distance, sleep duration, pain, fatigue, complications and quality of life.

The evidence supports a structured approach, but it does not establish that one mobilization dose independently improves every clinical outcome. The included trials were heterogeneous and generally small, and a colorectal trial in which staff facilitated mobilization found substantially greater in-hospital activity without better walking capacity at four weeks or other measured outcomes. The 2025 ERAS Society guidance likewise characterizes evidence for specific mobilization interventions as limited and finds no demonstrated improvement in functional capacity or complications from mobilization on the day of surgery. The review therefore distinguishes between encouraging movement to avoid prolonged immobility and claiming that a particular number of active hours independently produces better outcomes.

Implementation remains a substantial challenge. Age, beliefs about recovery, catheter use, duration of anesthesia, wound pain, preoperative hemoglobin and family support can affect adherence, while staffing shortages and heavy clinical workloads can prevent patients from getting out of bed. A colorectal cohort of 1,170 patients found that 58% did not meet a first-day target of at least six hours out of bed; emergency surgery, older age and intraoperative fluid overload were associated with delayed mobilization, which was in turn linked to more complications and longer hospitalization. Multidisciplinary quality-improvement work in other major abdominal surgery raised mobilization rates substantially and reduced length of stay, but that evidence is indirect. The review’s 23-item framework therefore calls for tailored goals, explicit safety criteria, adequate staffing, patient education and continued measurement rather than reliance on a uniform routine.

Subject of Research: Evidence-based early postoperative mobilization after laparoscopic radical colorectal cancer resection

Article Title: Summary of the best evidence for early mobilization following laparoscopic radical resection for colorectal cancer

Article References: She, R., Jin, X., Shi, Z., Wei, H., Wei, X., & Wu, Z. (2026). Summary of the best evidence for early mobilization following laparoscopic radical resection for colorectal cancer. Frontiers in Medicine, 13, Article 1967502. https://doi.org/10.3389/fmed.2026.1967502

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1967502

Keywords: colorectal cancer, laparoscopic surgery, early mobilization, enhanced recovery, postoperative care, evidence synthesis, nursing protocols, clinical safety, Summary, best, evidence, early

A team of Chinese nursing researchers has now tackled that definitional vacuum head-on. In a concept analysis published in BMC Nursing, Yingying Wang of the First Affiliated Hospital of Wannan Medical University and colleagues applied Walker and Avant’s classic eight-step method of concept analysis to the phrase intelligent robot-assisted care in critical care nursing. The approach, a staple of nursing science since the 1980s, forces researchers to dissect a fuzzy concept into its essential attributes, the conditions that must precede it, its consequences, and the concrete empirical measures that would tell a bedside observer the concept is actually present. The result is not a gadget review but a conceptual architecture for one of the fastest-moving corners of digital health.

The methodological backbone of the study was a structured literature search spanning nine English- and Chinese-language databases from their inception to 3 June 2026, supplemented by reference list searching. The identification and screening process was reported in a PRISMA 2020-style flow diagram, the same transparency standard used for systematic reviews of clinical trials. From this harvest, fourteen topic-related reports fed directly into the concept development, while methodological, ethical, and background literature supported the authors’ interpretation. That bilingual scope matters: much of the world’s ICU robotics research emerges from Chinese and East Asian hospitals, and restricting the search to English would have silently skewed the resulting definition toward Western engineering priorities.

The analysis distilled the sprawling field into four defining attributes, each of which must be present for a practice to qualify as intelligent robot-assisted care in critical care nursing. The first is an embodied robotic system, meaning a physical machine occupying space in the clinical environment rather than an algorithm running invisibly on a server. The second is intelligent sensing and task execution, the capacity to perceive the patient or environment and act on that perception, whether by recognizing a patient’s movement attempts or adjusting assistance during early mobilization. The third attribute is integration into critical care nursing practice: the robot must slot into the actual workflows of intensive care, not operate as a standalone novelty. The fourth, and arguably most consequential, is clinician-governed augmentation of care, the principle that the machine extends rather than replaces nursing judgment.

That fourth attribute draws the sharpest boundary around the concept. The authors explicitly distinguish intelligent robot-assisted care from software-only artificial intelligence, from passive devices, and from robotic applications that lack either nursing-practice integration or clinician governance. A predictive deterioration algorithm, however sophisticated, is not robot-assisted care because it has no body. A passive pressure-redistributing mattress, however useful, senses and executes nothing intelligently. And a robot deployed by an engineering team without nursing oversight fails the governance test. In an era when the words artificial intelligence are stamped on nearly every hospital purchase, this definitional discipline functions as a kind of quality control for the entire field.

The researchers also mapped the antecedents, the conditions that must exist before such care can responsibly occur. These include genuine clinical need, task suitability, system compatibility with the existing ICU infrastructure, trained clinicians ready to work alongside the machine, organizational support from hospital leadership, and pre-established safeguards covering safety, ethics, and data protection. The list reads like a checklist for any hospital administrator contemplating a robotics pilot, and its emphasis on organizational and human factors reflects a hard-won lesson from decades of health technology implementation: the machine is rarely the limiting factor, the surrounding system is.

What has robot-assisted care actually delivered in the studies examined? The reported findings include task feasibility, an increased mobilization dose for patients, and a signal of functional improvement in a selected neurocritical-care population. Early mobilization is a particularly telling application, because intensive care unit-acquired weakness remains one of the most feared complications of prolonged critical illness. Getting an ICU patient standing within days of waking, when each session demands two to four clinicians and considerable physical risk, is precisely the kind of labor-intensive, high-stakes task where an embodied robot with intelligent sensing could change the arithmetic of care. The Chelsea Critical Care Physical Assessment Tool, one of the measures used in this literature, provides a standardized way to track whether that promise translates into measurable functional gain.

The authors are careful not to oversell the evidence. Preparation and coordination demands remained substantial across studies, and effects on patients and staffing varied from one report to another. This candor matters in a field prone to demonstration-project enthusiasm, where a robot that dazzles in a promotional video can falter when asked to navigate a crowded ICU at 3 a.m. during a code. The concept analysis deliberately frames robot-assisted care as augmentation under retained clinician authority, a framing that keeps accountability where clinical law and ethics already place it, with the human care team.

Perhaps the most practically useful output of the analysis is its set of empirical referents, the observable phenomena that would confirm the concept in action. The authors describe four attribute-linked empirical referent domains that identify a specified application, while patient, clinician, workflow, technical, safety, ethical, and relational measures separately evaluate consequences and implementation quality. In plain terms, proving that a robot belongs in the ICU requires more than showing the device works. It requires evidence across at least seven distinct measurement domains, from patient outcomes and clinician workload to workflow disruption, technical reliability, safety events, ethical acceptability, and the quality of the human-robot relationship at the bedside.

The study arrives at a moment when intensive care is under simultaneous pressure from workforce shortages, aging populations, and the rising acuity of surviving patients. By fixing the meaning of intelligent robot-assisted care, the researchers have given the field something it has conspicuously lacked: a common language for identifying, reporting, and evaluating these systems task by task. The definition supports consistent communication across disciplines and countries, and it embeds safety, ethical, and relational safeguards directly into the concept rather than treating them as afterthoughts. Whether robots ultimately become as unremarkable a presence in the ICU as the ventilator or the infusion pump will depend on many trials and many years. But now, at least, the question of what is being tested has a rigorous answer, and that clarity may prove to be the most important piece of infrastructure the robotics revolution in critical care receives.

Subject of Research: Concept analysis of intelligent robot-assisted care in critical care nursing

Article Title: Intelligent robot-assisted care in critical care nursing: a concept analysis using Walker and Avant’s method

Article References: Wang, Y., Li, J., Li, L., Zhu, L., Zhang, L., Gu, S., & Wang, Y. (2026). Intelligent robot-assisted care in critical care nursing: a concept analysis using Walker and Avant’s method. BMC Nursing. https://doi.org/10.1186/s12912-026-05471-5

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05471-5

Keywords: critical care nursing, intensive care units, robotics, artificial intelligence, concept analysis, human-robot interaction, patient safety, nursing care, early mobilization, ICU-acquired weakness, clinician governance, Walker and Avant method

The trial, known as APPAHOCA-2, is described in BMC Geriatrics by Heidi Solem-Laviec of the Centre François Baclesse in Caen and her colleagues across two French centers. It is designed as a prospective, multicenter, open-label phase II study that will enroll 60 patients aged 65 and older who are scheduled for elective major cancer surgery or operations expected to carry high morbidity. Rather than waiting until complications appear, the investigators intend to measure whether daily supervised treadmill sessions can preserve or restore what geriatricians call functional fitness, using a well-established clinical yardstick: the six-minute walk test, or 6MWT. The distance a patient can cover in six minutes reflects the integrated performance of the heart, lungs, muscles, and nervous system, which is precisely why it has become a favored endpoint in studies of surgical recovery.

The logic of the design rests on a careful baseline. Before any operation takes place, each enrolled patient completes a comprehensive geriatric assessment during the month preceding surgery, and that visit includes a 6MWT measurement that captures the patient’s preoperative walking capacity. This pre-surgical value then becomes the reference point against which recovery is judged. The main endpoint of the trial is the proportion of patients who, at the time of discharge from the surgical ward, have regained their preoperative functional fitness as measured by the same test. In other words, the study does not ask whether patients simply improved over their hospital stay, but whether the intervention allowed them to climb back to their own personal starting line before going home.

The intervention itself is deliberately pragmatic. Unless a medical contraindication exists, patients in the trial will be offered one to two walking sessions per day on a treadmill, beginning the day after their operation. Each session is supervised by an Adapted Physical Activity Specialist, a professional trained to calibrate exercise intensity to fragile, recently operated patients, and the target duration ranges from six to thirty minutes. That flexibility matters. Early after abdominal, thoracic, or head and neck cancer surgery, a patient may manage only a few cautious minutes, while later in the admission the same person may tolerate a half hour of steady walking. The protocol’s designers have built that natural trajectory into the intervention rather than imposing a rigid dose that many frail patients could not achieve.

The scientific rationale comes in part from an earlier pilot study conducted by the same group, which showed that supervised treadmill walking in older cancer inpatients was feasible and could improve gait speed, with one important caveat: the benefit appeared in patients who were not malnourished. That finding highlights a biological reality that geriatric oncologists know well. Muscle recovery after surgery depends on an adequate supply of protein and energy, and in a patient whose nutrition is compromised, exercise can become a drain rather than a stimulus. The APPAHOCA-2 protocol therefore treats nutritional status as a critical variable, assessing it alongside sarcopenia, the age-related loss of skeletal muscle mass and strength that both cancer and major surgery can accelerate.

What makes the trial unusually comprehensive is the breadth of data it will collect. Assessments are scheduled at three points: before surgery, at hospital discharge, and at routine surgical follow-up visits 30 and 90 days after the operation. At each of these time points, the researchers will record levels of anxiety and depression, concerns about falling, cognitive function, nutritional and sarcopenia status, sleep complaints and changes in sleep-wake patterns, daytime activity, physical performance measures, and results from blood examinations. This multidimensional approach reflects a growing recognition in geriatric medicine that physical recovery cannot be separated from mental health, cognition, sleep, and metabolic state. A patient who walks farther but falls asleep poorly or becomes anxious about falling may not actually function better at home.

The hospital environment itself is a central character in this story. Clinical guidelines on postoperative rehabilitation have long advocated early mobilization, yet hospital wards are rarely designed to make walking safe and appealing for frail older adults. Corridors are busy, floors may be slippery, IV poles and monitoring equipment tether patients to their rooms, and nursing workloads leave little time for escorted walks. A walking treadmill, paradoxically, can offer a more controlled and secure environment than the ward corridor itself: handrails provide support, speed is adjustable and precisely known, and a specialist stands by to intervene. The APPAHOCA-2 investigators are essentially testing whether a piece of equipment more often associated with gyms can be safely redeployed to the surgical ward in the service of older cancer patients.

The study has cleared the standard regulatory hurdles that govern clinical research in France. It received ethical approval from the Comité de Protection des Personnes Ile de France I in December 2023, and the French Health Regulatory Authority, the ANSM, validated the investigation’s compliance with the European Union Medical Device Regulation. The trial is registered on ClinicalTrials.gov under identifier NCT06201884, with registration dated 2 January 2024, and the protocol has reached version 4.1 as of December 2025. Funding comes from the French Ministry of Health through the interregional hospital clinical research program, and the protocol itself was peer-reviewed by the funding body before the trial was granted support. The funding agency, the authors note, played no role in the design, conduct, or analysis of the study. All participants will receive an information file from their surgeons or anesthesiologists and must provide written informed consent before any study-related assessment begins.

The trial’s phase II designation signals its purpose: this is an effectiveness and feasibility study intended to establish whether the intervention works well enough to justify a larger definitive trial. Beyond the primary endpoint, the investigators plan to explore how the level of effectiveness relates to the number and duration of walking sessions patients actually complete during their recovery, a dose-response question that could shape how such programs are prescribed in the future. If patients who accumulate more minutes on the treadmill recover their walking capacity more reliably, that would support structured, supervised early mobilization as a standard component of postoperative care for older adults. If the relationship is weak or absent, the field will need to look elsewhere, perhaps toward nutritional optimization or other rehabilitation strategies.

For now, the value of APPAHOCA-2 lies in its clarity of purpose. It takes a problem that is easy to overlook, the quiet physical decline of older surgical patients during hospital stays, and subjects a simple remedy to rigorous measurement. The six-minute walk test, the geriatric assessments, the 90-day follow-up, and the careful tracking of sleep, mood, cognition, and nutrition together form a portrait of recovery that is far richer than length of stay alone could provide. As populations age and cancer surgery is performed increasingly on patients in their seventies and eighties, the question the French team is asking will only grow more urgent: can the hospital stay itself become part of the cure rather than an obstacle to it? The answer, the researchers hope, may begin with a few supervised steps on a treadmill the day after surgery.

Subject of Research: Early supervised treadmill walking to restore physical fitness in older inpatients recovering from cancer surgery

Article Title: Effectiveness of early supervised walking sessions on a walking treadmill in older inpatients after cancer surgery: study protocol for the APPAHOCA-2 trial

Article References: Solem-Laviec, H., Beauplet, B., Leconte, A., Coquerel, A., Demeude, F., Thuard, O., Ruet, A., Bastit, V., Babin, E., Varatharajah, S., Guilloit, J.-M., Fauvet, R., Waeckel, T., Perrier, J., Lequesne, J., & Clarisse, B. (2026). Effectiveness of early supervised walking sessions on a walking treadmill in older inpatients after cancer surgery: study protocol for the APPAHOCA-2 trial. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08422-6

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08422-6

Keywords: geriatric oncology, cancer surgery, treadmill walking, early mobilization, six-minute walk test, rehabilitation, sarcopenia, gait speed, older inpatients, clinical trial, physical deconditioning, APPAHOCA-2