Abstract B051: Implementation of an Early Mobility Initiative in a Pediatric Bone Marrow Transplant Unit

Abstract Purpose/Objectives : Children who have undergone hematopoietic cell transplant (HCT) often have prolonged hospitalizations and complex clinical courses that increase risk of delirium and functional impairment. Because of these risks, pediatric HCT patients stand to benefit from early mobilization interventions designed to mitigate long-term functional morbidity. However, these patients’ clinical complexity may hinder successful implementation of an early ambulation intervention. Some HCT patients are under contact restrictions due to colonization with bacteria producing Extended Spectrum Beta-Lactamase (ESBL). Our goal was to assess the safety and feasibility of an early mobilization initiative in pediatric HCT patients. Design/Methods: This Quality Improvement project was implemented in the Bone Marrow Transplant and Cellular Therapy Unit (Transplant Unit) of a quaternary care center specializing in the care of children with hematologic and oncologic disorders. During the study period (Jan-Oct 2022), mobilization data was obtained from nursing and physical therapy (PT) documentation in the electronic health records. The intervention was performed in June 2022, during which nurses and staff received education on safely mobilizing patients under contact precautions for ESBL-colonization outside their rooms while wearing personal protective equipment (PPE). We also collected aggregate Rectal Surveillance Culture (RSC) data, patient demographics, and clinical characterizations of patients. Descriptive statistics were performed. Results: 85 patients were included in the study, 11 patients with admission periods before and after the intervention, 39 patients with admissions before the intervention, and 35 with admissions after the intervention. There were no statistically significant differences in the demographic variables between patients admitted pre-intervention compared to patients admitted post-intervention. Patients with admissions spanning both pre- and post-intervention had higher ambulation rates (p = 0.0015) and walked farther distances with PT (p < 0.0001) before the intervention than they did after the intervention. Patients admitted pre-intervention had higher ambulation rates and ambulated longer distances with PT than those admitted post-intervention (p < 0.0001). During the period before the intervention, there were 3 patients who became colonized with ESBL-producing bacteria, compared to 4 new patients who became colonized after the intervention. Conclusion/Discussion: The intervention was unsuccessful at increasing ambulation in the target population. This may be due to pediatric HCT patients’ complex clinical courses and frequent complications, which were not assessed in this study. There was no significant increase in the rate of ESBL-producing bacterial colonization for patients on the Transplant Unit after the intervention took place. Further research should continue to address the feasibility of early rehabilitation initiatives in pediatric HCT patients, who have many risk factors for long-term functional morbidity. Citation Format: Anne Swanson, Saad Ghafoor, Kimberly Fan, Kylie James, Akshay Sharma, Xiaomeng Yuan, Haitao Pan. Implementation of an Early Mobility Initiative in a Pediatric Bone Marrow Transplant Unit [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Discovery and Innovation in Pediatric Cancer— From Biology to Breakthrough Therapies; 2025 Sep 25-28; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2025;85(18_Suppl_2):Abstract nr B051.