***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Amputations of the lower extremity are still a common problem in diabetic feet and peripheral vasculopathies . The presented paper introduces a new device for an easier and faster mobilization of below-the-knee amputees . It is based on a new modular prostheses with individual inflatable air bladders . The compliance rate is higher with this device and it could be used from the day of surgery until the definitive prostheses is made . A biomechanical cadaver study with the prostheses will also be presented BACKGROUND Perioperative treatment of patients with colorectal cancer according to the Enhanced Recovery After Surgery ( ERAS ) protocol has proven to reduce complications and duration of stay . However , strict adherence remains a challenge and the benefits may decrease with lower adherence . In this study , we report on 8 years of adherence to the ERAS protocol and its effect on postoperative outcome in patients with colon cancer . METHODS In 2006 , the ERAS protocol was introduced for treatment of colon cancer patients in the Medical Center Alkmaar , a large teaching hospital . Patients scheduled for elective colon cancer resection were included in this study . Adherence to ERAS items was monitored and along with clinical data prospect ively gathered in a data base . In 2011 , several measures to improve adherence were implemented . RESULTS In total , 816 patients were included .  Mean adherence rate was 73 % in 2006 and 2007 , 66 % in 2008 and 2009 , 63 % in 2010 and 2011 , and 82 % in 2012 and 2013 . There was a shorter duration of stay in the years with high adherence ( 5.7 days ) compared with the years with low adherence ( 7.3 days ; P < .001 ) . The ERAS items that were the strongest predictors for a shorter duration of stay were no nasogastric tube , early mobilization , early oral nutrition , early removal of epidural , early removal of catheter , and nonopioid oral analgesia . CONCLUSION It is possible to improve adherence to the ERAS protocol and related outcomes with specific measures . Adherence to the ERAS protocol was related inversely to duration of stay . Only postoperative items of the ERAS protocol were predictive for a shorter duration of stay . Keeping adherence optimal remains an ongoing challenge that requires repeated training and dedicated personnel To evaluate the use of an  immediate postoperative prosthesis ( IPOP )  for transtibial amputees , we compared patient outcomes from a prospect i ve clinical study of 19 patients managed with an IPOP  with those of a retrospective review of a matched historic control group of 23 patients managed with st and ard soft dressings .  Data were analyzed with the Student 's t-test , and significance was set at P=0.05 . The IPOP patients had no surgical revisions , whereas the patients with st and ard soft dressings had 11 . This was a significant difference . IPOP patients also had significantly fewer postoperative complications and shorter times to custom prosthesis than did controls Eighty lower-extremity amputation patients were r and omly divided into two groups : one that ambulated ( A ) early ( 48 to 72 hours ) and one that did not ( NA ) . Group A patients used an immediate , post-operative , pneumatic splinting device . The two groups were compared as to the incidence of wound and constitutional post-operative complications , with the A group showing significantly fewer . As in previous studies , the A group continued toward quicker and more successful rehabilitation OBJECTIVES To estimate the prevalence of different levels of mobility in a hospitalized older cohort , to measure the degree and rate of adverse outcomes associated with different mobility levels , and to examine the physician activity orders and documented reasons for bedrest in the lowest mobility group . DESIGN A prospect i ve cohort study . SETTING An 800-bed university teaching hospital . PARTICIPANTS Four hundred ninety-eight hospitalized medical patients , aged 70 and older . MEASUREMENTS Using average mobility level , scored from 0 to 12 , the low-mobility group was defined as having a score of 4 or less , intermediate as a score of higher than 4 to 8 , and high as higher than 8 . Outcomes were functional decline , new institutionalization , death , and death or new institutionalization . RESULTS Low and intermediate levels of mobility were common , accounting for 80 ( 16 % ) and 157 ( 32 % ) study patients , respectively . Overall , any activity of daily living ( ADL ) decline occurred in 29 % , new institutionalization in 13 % , death in 7 % , and death or new institutionalization in 22 % of patients in this cohort . When compared with the high mobility group , the low and intermediate groups were associated with the adverse outcomes in a grade d fashion , even after controlling for multiple confounders . The low-mobility group had an adjusted odds ratio ( OR ) of 5.6 ( 95 % confidence interval (CI)=2.9 - 11.0 ) for ADL decline , 6.0 ( 95 % CI=2.5 - 14.8 ) for new institutionalization , 34.3 ( 95 % CI=6.3 - 185.9 ) for death , and 7.2 ( 95 % CI=3.6 - 14.4 ) for death or new institutionalization . The intermediate group had adjusted ORs of 2.5 ( 95 % CI=1.5 - 4.1 ) , 2.9 ( 95 % CI=1.4 - 6.0 ) , 10.1 ( 95 % CI=1.9 - 52.9 ) , and 3.3 ( 95 % CI=1.8 - 5.9 ) for ADL decline , new institutionalization , death , and death or new institutionalization , respectively . Bedrest was ordered at some point during hospitalization in 165 ( 33 % ) patients . For most patients , mobility was limited involuntarily ( bedrest orders ) , and almost 60 % of bedrest episodes in the lowest mobility group had no documented medical indication . CONCLUSION Low mobility and bedrest are common in hospitalized older patients and are important predictors of adverse outcomes . This study demonstrated that the adverse outcomes associated with low mobility and bedrest may be viewed as iatrogenic events leading to complications , such as functional decline It is common practice to keep those patients with lower extremity autografts  immobile until post-operative day ( POD ) 5 . There is however inherent risks associated with even short periods of immobility . As of now there are no r and omized controlled trials looking at early ambulation of patients with lower extremity autografts in the burn community . The objective of this study was to show that patients who begin ambulation within 24 hours of lower extremity autografting will have no increased risk of graft failure than those patients who remain immobile until POD 5 . Thirty-one subjects who received autografts to the lower extremity were r and omized after surgery into either the early ambulation group ( EAG;17 subjects ) or the st and ard treatment group ( STG;14 subjects ) . Those subjects r and omized to the EAG began ambulating with physical therapy on POD 1 . Subjects in the STG maintained bed rest until POD 5 . There was no difference in the number of patients with graft loss in either the EAG or STG on POD 5 , and during any of the follow-up visits . No subjects required regrafting . There was a significant difference in the mean minutes of ambulation , with the EAG ambulating longer than the STG ( EAG 23.4 minutes [ SD 12.03 ] , STG 14.1 [ SD 9.00 ] , P=.0235 ) on POD 5 . Burn patients with lower extremity autografts can safely ambulate on POD 1 without fear of graft failure compared with those patients that remain on bed rest for 5 days 
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CONCLUSIONS This systematic review reveals a lack of evidence to determine whether early mobilisation interventions are beneficial to this vulnerable patient group .
Nevertheless , ambulation from the first postoperative day with temporary prosthesis is possible among the heterogeneous population of dysvascular lower limb-amputated patients if the necessary interdisciplinary team is dedicated to the task .