Patient-Level Barriers and Facilitators to Early Mobilization and the Relationship With Physical Disability Post–Intensive Care

Abstract

Background: Early mobilization (EM) is associated with reduced physical disability post-intensive care (PD PIC). Yet, contextual factors facilitate or impede delivery of EM in the intensive care unit (ICU). Only 45% of 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 personal (patient-level) factors, using the theoretical lens of the World Health Organization'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 World Health Organization 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 delivery was influenced by personal factors. Deeper sedation level, the presence of delirium, higher patient acuity, the presence of medical devices, and patient weight were identified barriers to EM delivery. Patient engagement in EM was associated with improved delivery. Patients who enjoyed

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

“…Consistent with our observations, in a 2020 study at a safety-net hospital in Texas, speaking a language other than English or Spanish was associated with fewer minutes of therapy delivered to older adults hospitalized with prolonged acute illness . Among patients who are critically ill, the reduced amount of rehabilitation services delivered to those with LEP could be due to differential prescription of rehabilitation services by physicians because of perceived barriers to engagement or differences in management of sedation and delirium that might influence a patient’s ability to participate in rehabilitation …”

“…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.…”

Redundancy, quality appraisal, and discordance in the results of systematic reviews of early mobilization of critically ill adults. A meta-research protocol

“…Critically ill adult patients may present with various complications from hospitalization in an intensive care unit (ICU) stay [1,2]. Being on mechanical ventilation, sedation, neuromuscular blockade, and the mobility restrictions imposed by the context of critical illness, as well as barriers derived from invasive devices in critically ill patients [3][4][5], create an environment that can facilitate cognitive [6] and neuromusculoskeletal complications [7], among others.…”

Assessment of redundancy, methodological and reporting quality, and potential discrepancies of results of systematic reviews of early mobilisation of critically ill adults: a meta-research protocol

“…Critically ill adult patients may present with complications from hospitalisation in an intensive care unit (ICU) stay 1 2. Mechanical ventilation, sedation, neuromuscular blockade and the mobility restrictions imposed by the context of critical illness, as well as barriers derived from invasive devices in critically ill patients,3–5 create an environment that can facilitate cognitive6 and neuromusculoskeletal complications,7 among others.…”