Clinical attitudes and perceived barriers to early mobilization of critically ill
            patients in adult intensive care units

Fontela, Paula Caitano; Forgiarini, Luiz Alberto; Friedman, Gilberto

doi:10.5935/0103-507x.20180037

Cited by 53 publications

(57 citation statements)

References 24 publications

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“…In agreement with other reports, we identified patient instability, deep sedation and lack of nurses as the top three barriers against advanced mobilization targets [ 15 , 29 ]. In contrast to some reports [ 16 , 18 , 21 , 34 ], however, there was a similar perception regarding mobilization barriers in our scenarios among the surveyed professions. Garzon-Serrano [ 16 ] reported that physical therapists indicate hemodynamic instability as an obstacle to mobilization, but not renal replacement procedures.…”

Section: Discussioncontrasting

confidence: 82%

“…Garzon-Serrano [ 16 ] reported that physical therapists indicate hemodynamic instability as an obstacle to mobilization, but not renal replacement procedures. Berney et al [ 34 ] and Fontela et al [ 21 ] reported similar results, with physicians and nurses rating ventilation status as decisive when setting mobilization targets, while physical therapists perceived sedation state as critical for the decision. Berney explains these differences with varying responsibilities in the ICU team.…”

Section: Discussionmentioning

confidence: 80%

“…Safety concerns limiting mobilization are common among nurses, as they tend to feel responsible for the integrity of the devices, in particular for the endotracheal tube and the catheters for the renal replacement therapy [ 35 ]. Interestingly, Fontela et al [ 21 ] and Jolley et al [ 18 ] found no knowledge differences between physical therapists and nurses according to mobilization. Local standards of education may influence interprofessional differences in knowledge and possibly performance.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of mobilization capacity in 10 different ICU scenarios by different professions

Hermes¹,

Nydahl

Blobner

et al. 2020

PLoS ONE

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Background Mobilization of intensive care patients is a multi-professional task. Aim of this study was to explore how different professions working at Intensive Care Units (ICU) estimate the mobility capacity using the ICU Mobility Score in 10 different scenarios. Methods T en fictitious patient-scenarios and guideline-related knowledge were assessed using an online survey. Critical care team members in German-speaking countries were invited to participate. All datasets including professional data and at least one scenario were analyzed. Kruskal Wallis test was used for the individual scenarios, while a linear mixed-model was used over all responses. Results In total, 515 of 788 (65%) participants could be evaluated. Physicians (p = 0.001) and nurses (p = 0.002) selected a lower ICU Mobility Score (-0.7 95% CI -1.1 to -0.3 and -0.4 95% CI -0.7 to -0.2, respectively) than physical therapists, while other specialists did not (p = 0.81). Participants who classified themselves as experts or could define early mobilization in accordance to the “S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders” correctly selected higher mobilization levels (0.2 95% CI 0.0 to 0.4, p = 0.049 and 0.3 95% CI 0.1 to 0.5, p = 0.002, respectively). Conclusion Different professions scored the mobilization capacity of patients differently, with nurses and physicians estimating significantly lower capacity than physical therapists. The exact knowledge of guidelines and recommendations, such as the definition of early mobilization, independently lead to a higher score. Interprofessional education, interprofessional rounds and mobilization activities could further enhance knowledge and practice of mobilization in the critical care team.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Assessment of mobilization capacity in 10 different ICU scenarios by different professions

Hermes¹,

Nydahl

Blobner

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

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“…Finally, due to our persistent follow-up with non-responders, we had a very high response rate (85%), which optimizes the external validity [22]. Our response rate is similar or better than other surveys of ICU PTs reporting response rates from 22 to 87% [7, 53, 54].…”

Section: Discussionmentioning

confidence: 88%

Therapist perceptions of a rehabilitation research study in the intensive care unit: a trinational survey assessing barriers and facilitators to implementing the CYCLE pilot randomized clinical trial

Reid

McCaskell

Kho

2019

Pilot Feasibility Stud

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BackgroundRehabilitation interventions, including novel technologies such as in-bed cycling, could reduce critical illness-associated morbidity. Frontline intensive care unit (ICU) therapists often implement these interventions; however, little is known about their perceptions of engaging in clinical research evaluating these technologies.ObjectiveTo understand frontline therapist perceptions of barriers and facilitators to implementing a pilot randomized controlled trial (RCT) of early in-bed cycling with mechanically ventilated patients in the ICU and outcome measures (CYCLE Pilot RCT; NCT02377830).MethodsWe developed a 115-item, self-administered, electronic survey informed by 2 complementary knowledge translation (KT) models: the Capability-Opportunity-Motivation-Behaviour (COM-B) system and the Theoretical Domains Framework (TDF). We included demographics and 3 sections: Rehabilitation Practice and Research, Cycling, and Physical Outcome Measures. Each section contained items related to the COM-B system and TDF domains. Item formats included 7-point Likert-type scale questions (1 = strongly disagree, 7 = strongly agree) and free-text responses. We invited therapists (physiotherapists, occupational therapists, and therapy assistants) who participated in the international, multi-center, CYCLE Pilot RCT to complete this cross-sectional survey. We descriptively analyzed results by survey section, COM-B attribute, TDF domain, and individual question within and across sections. We identified barriers based on items with median scores < 4/7.ResultsOur response rate was 85% (45/53). Respondents were from Canada (67%), the USA (21%), and Australia (11%). The majority had a physiotherapy background (87%) and previous research experience (87%). By section, Rehabilitation Practice and Research (85%; 95% confidence interval (CI) [82%, 87%]) was higher than Cycling (77%; 95% CI [73%, 80%]) and Outcome Measures (78%; 95% CI [75%, 82%]). Across the 3 sections, Motivation was lower than Capability and Opportunity. The most common Motivation barrier was the emotion TDF domain, related to the time required to conduct cycling and outcome measures (median [1st, 3rd quartiles] 3/7 [2, 6]).ConclusionsFrontline ICU therapists had positive perceptions of research engagement. However, we identified barriers related to Motivation, and concerns regarding time to implement the research protocol. Our results can inform specific KT strategies to engage frontline ICU therapists and optimize protocol implementation in critical care rehabilitation research.

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“…Among the hypotheses are the organizational aspects of the units and the need for cooperation from the medical team, which are indispensable to the process. It is important to underscore that implementing initiatives to overcome the barriers to mobilization is a factor that still limits adherence by the multiprofessional team, highlighting the difference between evidence-based recommendations and what actually occurs in the ICU in terms of early mobilization [37,38].…”

Section: Discussionmentioning

confidence: 99%

Mobility and clinical outcome of patients admitted to an intensive care unit

et al. 2020

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Introduction: The hospital environment exacerbates the effects of immobility due to several exposure factors, and the functional assessment of individuals using reliable instruments is vital. Objective: To determine the relationship between functional mobility and the clinical outcome of patients admitted to an intensive care unit. Method: This is a prospective quantitative longitudinal study, approved by the institutional research ethics committee, carried out in the intensive care unit of a University Hospital. Clinical data and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were collected 24 hours after admission. The Perne Score was used to analyze patient mobility. Results: 33 patients participated, 63% female. With respect to mobility and transfers, 69.7% required total assistance from the supine to the sitting position and 70% to maintain balance, 9.1% needed minimum assistance from sitting to standing, and 100% total assistance for walking and endurance exercises. The main barriers to mobility were invasive ventilation (60%), assistive devices and intravenous infusion (100%). The following Perne Score domains were significantly associated with the outcome: mental status (p = 0.040), barriers to mobility (p = 0.016), strength (p = 0.010), mobility in bed (p = 0.024) and the total Perme Score ( p = 0.002). There were also significant associations between invasive ventilation and low Perme Scores (p = 0.000), and the Richmond Agitation-Sedation Scale (RASS) (-5 and -4) and death in 66.7% of patients (p = 0.011). The Perme Score and RASS (R = 0.745) were moderately correlated and APACHE II and Perme Score inversely moderately correlated (R = -0.526). Conclusion: Mobility assessed by the Perme Score was related to the clinical outcome and strongly associated with sedation level and patient severity.

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Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units

Cited by 53 publications

References 24 publications

Assessment of mobilization capacity in 10 different ICU scenarios by different professions

Assessment of mobilization capacity in 10 different ICU scenarios by different professions

Therapist perceptions of a rehabilitation research study in the intensive care unit: a trinational survey assessing barriers and facilitators to implementing the CYCLE pilot randomized clinical trial

Mobility and clinical outcome of patients admitted to an intensive care unit

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