Effects of Postoperative Video-assisted Early Mobilization on Recovery Outcomes

Laparoscopic cholecystectomy is among the most frequently performed surgical procedures worldwide and is associated with shorter recovery times and lower postoperative complication rates compared with open surgery. However, despite the advantages of minimally invasive techniques, postoperative physiological stress responses-characterized by elevations in cortisol and glucose levels-together with pain, nausea, delayed mobilization, and prolonged gastrointestinal recovery remain significant challenges to achieving optimal patient outcomes. Early mobilization is a key component of Enhanced Recovery After Surgery (ERAS) protocols and has been shown to reduce postoperative complications, accelerate functional recovery, and shorten hospital length of stay. Nevertheless, limited patient awareness and insufficient education continue to represent major barriers to effective adherence to mobilization recommendations.

This randomized controlled trial investigates whether video-assisted early mobilization education, combined with objective monitoring using wearable activity tracking systems, can improve postoperative outcomes in patients undergoing laparoscopic cholecystectomy. The intervention consists of two professionally produced educational videos developed in a university television studio: Part 1 of the video; a preoperative theoretical module that explains the physiological benefits of early mobilization using clear language supported by animations, and Part 2 of the video; a postoperative practical module recorded in an actual patient room, demonstrating safe and stepwise mobilization techniques based on evidence-based ERAS practices. The video content has been culturally adapted and will be pilot-tested to ensure comprehensibility across different levels of health literacy.

Participants will be randomly assigned in a 1:1 ratio to either the intervention group or the control group using a computer-generated block randomization method. Both groups will receive standard postoperative care; however, only the intervention group will receive the video-based mobilization education. To maintain objectivity, patients in both groups will wear passive pedometer devices during the first 24 hours after surgery. These devices will record step count, time to first mobilization, and total ambulation duration, while motivational feedback features will be disabled to ensure that any observed effects can be attributed solely to the video intervention.

Physiological stress responses will be assessed using salivary cortisol and capillary glucose measurements collected at four standardized time points: preoperative baseline (T0), postoperative hour 3 (T1), hour 6 (T2), and hour 24 (T3). These time points were selected based on the circadian rhythm of cortisol secretion and the temporal dynamics of the surgical stress response. Postoperative symptoms, including pain, nausea, and vomiting, will be evaluated using validated Visual Analogue Scales. Functional outcomes will include step count, walking duration, and time to first mobilization. Clinical outcomes, such as length of hospital stay, time to first flatus, oral intake, and defecation, as well as stability of vital signs (heart rate, blood pressure, respiratory rate, body temperature, and peripheral oxygen saturation [SpO₂]), will also be monitored. In addition, postoperative follow-up at 30 days will be conducted to assess emergency department visits, hospital readmissions, and complications.

This study aims to generate robust evidence regarding the effectiveness of digital, video-based patient education integrated with wearable technology in optimizing postoperative recovery. It is anticipated that video-assisted early mobilization education may reduce physiological stress markers, enhance mobilization performance, improve adherence to ERAS protocols, shorten recovery timelines, and increase patient satisfaction. Given that the intervention is easily scalable and adaptable to different surgical populations, the findings of this trial may contribute to clinical practice improvement, inform national health policy development, and support cost-effective, technology-assisted perioperative care strategies.

Inclusion criteria

• Adults aged 18 to 65 years.
• Scheduled for elective laparoscopic cholecystectomy.
• Classified as ASA I or ASA II according to the American Society of Anesthesiologists Physical Status Classification.
• Ability to read and understand Turkish.
• Adequate cognitive capacity to understand video education and operate the wearable activity tracker.
• Willingness to participate and signing the informed consent form

Exclusion criteria

• Chronic pain syndrome or severe chronic orthopedic/rheumatologic pain conditions.
• Pre-existing mobility limitations.
• Endocrine or metabolic diseases affecting cortisol or glucose (e.g., diabetes, thyroid disorders, Addison's disease, Cushing's syndrome).
• Use of medications affecting the HPA axis (e.g., systemic corticosteroids, chronic opioids, high-dose benzodiazepines).
• Diagnosed severe psychiatric or cognitive disorders (e.g., dementia, major depression).
• Skin allergies or medical device contraindications preventing use of the activity tracker.
• Conversion to open surgery or major intraoperative complications.