Effects of Mobilization among Critically Ill Patients in the Intensive Care Unit: A Single-center Retrospective Study

Abstract

Objectives: This study investigated the effect of early mobilization [EM; physical rehabilitation with the intensity needed to sit on the edge of the bed started within 5 days of intensive care unit (ICU) admission] in relation to improvements in gait independence and other clinical outcomes. Methods: This retrospective single-center study evaluated patients aged at least 18 years who stayed in the ICU for at least 48 h and were categorized into EM and late mobilization (LM; physical rehabilitation started more than 5 days after ICU admission) groups. Outcomes were compared after adjusting for 20 background factors by propensity score matching and inverse probability of treatment weighting. The primary outcome was independent gait at discharge. The secondary outcomes were medical costs, 90-day survival, and durations of ICU and hospital stays. Results: Of 177 patients, 85 and 92 were enrolled in the EM and LM groups, respectively. Propensity score matching created 37 patient pairs. There was no significant difference in the 90-day survival rate (P=0.308) or medical costs (P=0.054), whereas independent gait at discharge (P=0.025) and duration of hospital stay (P=0.013) differed significantly. Multivariate logistic regression analysis showed that EM was independently associated with independent gait at discharge (P=0.011) and duration of hospital stay (P=0.010) but was not associated with 90-day survival (odds ratio: 2.64, 95% confidence interval: 0.67–13.12, P=0.169). Conclusions: Early mobilization in the ICU did not affect 90-day survival and did not lower medical costs but was associated with independent gait at discharge and shorter hospital stays.

Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge

“…Perceived barriers included predefined barriers described in prior studies 21,22,24,25,31 . Barrier assessment was routinely used at each institution prior to this study's initiation.…”

“…Barrier assessment was routinely used at each institution prior to this study's initiation. These included consciousness; subjective symptoms; and respiratory, circulatory, device, subject, and medical staff factors 25 . Details of these factors are shown in Fig.…”

“…1. The priority of this list was based on previous studies investigating barriers to mobilization, the consensus of early rehabilitation experts created in Japan, and our clinical experience 24,25,32,33 .…”

“…whereas categorical variables are presented as numbers and percentages. When appropriate, all patient outcomes were categorized as dichotomous data using median values 16 . We performed multiple logistic regression analysis to evaluate the effect of EM on patient outcomes.…”

“…Early mobilization protocol. This study's early goal-directed rehabilitation protocol 3,10,13,15,16,25 was developed > 6 months prior to study initiation, and the details of the protocol were specifically arranged according to the participating hospital. This protocol has been used in routine practice in multiple centers, and validation of the protocol's safety has already been reported 27 .…”