Acute Crit Care.  2022 Aug;37(3):286-294. 10.4266/acc.2021.01564.

Improving mobility in the intensive care unit with a protocolized, early mobilization program: observations of a single center before-and-after the implementation of a multidisciplinary program

• Ho L
• Tsang JHC
• Cheung E
• Chan WY
• Lee KW
• Lui SR
• Lee CY
• Lee ALH
• Lam PKN

• KMID: 2535291
• DOI: http://doi.org/10.4266/acc.2021.01564

Abstract

Background
Early intensive care unit (ICU) protocolized rehabilitative programs have been described previously, yet with differing starting time points and mostly on mechanically ventilated patients. We extended the concept to all admitted ICU patients and investigate the efficacy of early mobilization in improving mobility of the critically ill, address issues surrounding the timing and intensity of an early rehabilitative program.
Methods
Prospective cohorts of patients admitted consecutively before-and-after (control, n=92; intervention, n=90) the introduction of an early mobilization program in a single center, general hospital ICU. Improvement in mobility as assessed by ICU mobility score, on ICU admission and upon ICU discharge, was measured as a primary outcome.
Results
Those receiving early mobilization in the intensive care unit had higher ICU mobility score (2.63; 95% confidence interval, 0.65–4.61; P<0.001) upon discharge from the intensive care, with earlier out of bed mobilization on day 5 compared to the control group of day 21 (P<0.001). No differences were found in terms of mortality, intensive care hospitalization and subsequent hospitalization duration after discharge from ICU.
Conclusions
Here, we report that improvement in mobility score earlier in the course of intensive care hospitalization with the introduction of a protocolized early rehabilitative program.

Keyword

critically ill; intensive care; mobilization; physical rehabilitation

Figure

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  Figure 1. Flowchart showing an overview of the study protocol and description of each incremental steps of the early mobilization program offered to the interventional group. Patients are recruited within 24 hours of admission to the intensive care unit. Assessment for mobilization after initial recruitment is performed daily according to the listed steps. MRC: Medical Research Council.

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  Figure 2. Summary of results. (A) The length of hospitalization in the intensive care unit (ICU) of the control group (n=92; median, 6; interquartile range [IQR], 4–9) and the early mobilization group (n=90; median, 6; IQR, 4–10) show no differences (P=0.89; 95% confidence interval [CI], –6.86 to 6.00; R2=0.95). (B) The length of hospitalization in general ward after discharge from the intensive care. The control group (n=92; median, 11; IQR, 4.25–24) and the early mobilization group (n=90; median, 11; IQR, 4–19) show no differences (P=0.72; 95% CI, –134 to 94; R2=0.31). (C) Survival analysis of the control group and the early mobilization group shows no significance at 30 and 60 days after ICU admission (P=0.27). Shaded areas within the dotted lines represent the 95% CI. (D) ICU Mobility Scale on admission of the control cohort (mean, 0.8; standard deviation [SD], 0.4; blue) and early mobilization cohort (mean, 1.2; SD, 1.5); and upon discharge in control group (mean, 1.8, SD, 1.8) and early mobilization group (mean, 4.9; SD, 2.9). There is a significant improvement in the mobilization scores (2.63, P<0.0001; 95% CI, 0.65–4.61). (E) Time taken to achieve the selected mobilization targets. All data, censored and events, are marked.

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