Environmental Factors Affecting Early Mobilization and Physical Disability Post–Intensive Care

Abstract

Background Early mobilization (EM) is one of few potential protective factors associated with reduced physical disability post–intensive care (PD PIC). However, only 45% of intensive care units (ICUs) in the United States routinely practice EM despite its recognized benefits. Objectives To analyze the evidence on the relationship between critical care EM, PD PIC, and environmental factors, using the theoretical lens of the World Health Organization's (WHO's) International Classification of Functioning, Disability, and Health (ICF). Method The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the WHO ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized. Results Early mobilization was related to improved functioning on the disability continuum of the WHO ICF. Early mobilization was influenced by several WHO ICF environmental factors. Dedicated physical and occupational therapy teams in the ICU, interdisciplinary rounds, and positive family and staff perception of EM facilitated intervention delivery. However, poor staffing levels, negative unit culture, perceived workload burden, and lack of equipment, education, and financial support impeded delivery of EM. Discussion Early mobilization is a promising intervention that may reduce PD PIC. However, environmental factors negatively influence delivery of EM in the ICU. Several gaps in EM research limit its acceptability in ICU practice. Existing EM research is challenged by poor methodological quality. Further study is necessary to better understand the role of EM on PD PIC and improve patient outcomes following critical illness.

Social Determinants of Health and Delivery of Rehabilitation to Older Adults During ICU Hospitalization

“…First, factors related to resources and organization of rehabilitation services at hospitals deserve consideration. Staffing by physical therapists and nurses is associated with rehabilitation among patients who are critically ill. 11 , 18 Hospitals serving more dually eligible patients and those located in rural areas are generally more underresourced and may not be adequately staffed by professionals essential to delivering rehabilitation. 40 Similar to our findings, dual Medicare and Medicaid eligibility was associated with a lower likelihood of skilled rehabilitation among patients with acute stroke.…”

“…However, these studies did not investigate associations between SDOH and delivery of in-hospital rehabilitation. Many patient- and hospital-level factors known to be associated with prescription of skilled rehabilitation to patients who are critically ill can be affected by SDOH . For example, limited English proficiency (LEP) could be associated with lower rehabilitation delivery due to perceived barriers to engagement with therapy services or differences in management of sedation and delirium by clinicians .…”

“…Many patient- and hospital-level factors known to be associated with prescription of skilled rehabilitation to patients who are critically ill can be affected by SDOH. 11 , 17 , 18 , 19 For example, limited English proficiency (LEP) could be associated with lower rehabilitation delivery due to perceived barriers to engagement with therapy services or differences in management of sedation and delirium by clinicians. 20 Furthermore, variation in resources and practices at hospitals caring for a higher proportion of patients with socioeconomic disadvantage could lead to reduced delivery of skilled rehabilitation services, as has been observed for other care processes.…”

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

“…Using the World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF), early mobilization is identified as a potential protective factor that can reduce physical disability after intensive care (PD PIC). However, only a small portion of US ICUs regularly implement early mobilization due to a lack of staff, a bad unit culture, and the perception of increased workload [ 58 ]. In Germany, general practitioners are more relied upon for treating trauma in a medical setting compared to trauma induced by other factors, such as PTSD [ 59 ].…”

Factors Associated with Medication Adherence in Elderly Individuals with Tuberculosis: A Qualitative Study

“…Finally, 38 studies were analyzed. Te mixed methods appraisal tool (MMAT) (version 2018) was used to check the quality of the studies [45][46][47][48][49][50]. Based on the MMAT, all the studies had suitable quality to be included in the review.…”