Effects of the Level and Duration of Mobilization Therapy in the Surgical ICU on the Loss of the Ability to Live Independently: An International Prospective Cohort Study

Abstract

OBJECTIVES: It is unclear whether early mobilization in the surgical ICU helps improve patients’ functional recovery to a level that enables independent living. We assessed dose of mobilization (level + duration). We tested the research hypotheses that dose of mobilization predicts adverse discharge and that both duration of mobilization and maximum mobilization level predict adverse discharge. DESIGN: International, prospective cohort study. SETTING: Study conducted in five surgical ICUs at four different institutions. PATIENTS: One hundred fifty patients who were functionally independent before admission (Barthel Index ≥ 70) and who were expected to stay in the ICU for greater than or equal to 72 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mobilization was quantified daily, and treatments from all healthcare providers were included. We developed and used the Mobilization Quantification Score that quantifies both level and duration of mobilization. We assessed the association between the dose of mobilization (level + duration; exposure) and adverse discharge disposition (loss of the ability to live independently; primary outcome). There was wide variability in the dose of mobilization across centers and patients, which could not be explained by patients’ comorbidity or disease severity. Dose of mobilization was associated with reduced risk of adverse discharge (adjusted odds ratio, 0.21; 95%CI, 0.09–0.50; p < 0.001). Both level and duration explained variance of adverse discharge (adjusted odds ratio, 0.28; 95% CI, 0.12–0.65; p = 0.003; adjusted odds ratio, 0.14; 95% CI, 0.06–0.36; p < 0.001, respectively). Duration compared with the level of mobilization tended to explain more variance in adverse discharge (area under the curve duration 0.73; 95% CI, 0.64–0.82; area under the curve mobilization level 0.68; 95% CI, 0.58–0.77; p = 0.10). CONCLUSIONS: We observed wide variability in dose of mobilization treatment applied, which could not be explained by patients’ comorbidity or disease severity. High dose of mobilization is an independent predictor of patients’ ability to live independently after discharge. Duration of mobilization sessions should be taken into account in future quality improvement and research projects.

Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients

“…Based on previous studies, and after discussions with two intensivists, two ICU physiotherapists, and two ICU nurses, the RATs system was created to quantify the intensity and activity time of rehabilitation (i.e., the activity “dose”). 8 , 12 , 14 , 20 , 21 ) Rehabilitation levels were quantified based on the ICU rehabilitation protocol (i.e., levels 1–5). To calculate the dose of rehabilitation (intensity × activity time), each rehabilitation level was assigned a duration to define 1 unit of RATs ( Table 2 ).…”

“…Even if the activity time was less than the specified time for 1 unit of that level, the calculation was performed by rounding up the activity time to 1 unit. 12) Data regarding rehabilitation provided by nurses or physiotherapists were obtained using billing information or electronic medical records. The primary exposure of interest was the average daily RATs.…”

“… 8 ) In a previous study, Scheffenbichler et al created a new tool for assessing the mobilization dose based on the level and duration of rehabilitation (the mobilization quantification score; MQS). 12 ) The MQS was developed based on expert opinion and has been validated for reproducibility in multiple health centers. 12 ) However, although previous studies have reported an association between the MQS in surgical ICUs and ADL dependence at discharge, they have not explored the association between the timing of the targeted increase in MQS and the ADL dependence.…”

“… 12 ) The MQS was developed based on expert opinion and has been validated for reproducibility in multiple health centers. 12 ) However, although previous studies have reported an association between the MQS in surgical ICUs and ADL dependence at discharge, they have not explored the association between the timing of the targeted increase in MQS and the ADL dependence. Against this background, we developed an evaluation scale that rationalizes the setting of 1 unit of activity time and rehabilitation level and simplifies the method of dose calculation so that it can be assessed at multiple hospitals even by staff who have not received special training.…”

Mobilisation auf Intensivstationen: Intensivpflegezimmer und Medizintechnik können helfen

“…Die Verbesserung der körperlichen Funktion bei Entlassung von der Intensivstation wurde durch verschiedene weitere Arbeiten bestätigt [17]. Es gibt Hinweise, dass Patient*innen vermehrt von der Mobilisierung profitieren, wenn sie eine mittlere Krankheitsschwere aufweisen [18] und einen längeren Intensivaufenthalt haben [19].…”