Dose of Early Therapeutic Mobility: Does Frequency or Intensity Matter?

Winkelman, Chris; Sattar, Abdus; Momotaz, Hasina; Johnson, Kimberly D.; Morris, Peter E.; Rowbottom, James; Thornton, J. Daryl; Feeney, Sheryl; Levine, Alan D.

doi:10.1177/1099800418780492

Cited by 33 publications

(41 citation statements)

References 47 publications

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“…Several studies reported that EM-MV was initiated using a protocol or an order. EM-MV was automatically triggered by a protocol to initiate activities following patients’ admissions to ICU in 31 studies [24–26, 35–40, 42, 46, 49, 58, 60, 66, 67, 72, 74–76, 80, 83, 84, 87, 93, 94, 101–105]. Across the studies reporting the requirement of a formal order to initiate EM-MV, staff prescribing the order varied from physicians [43, 47, 64, 79, 86], PTs [48, 51, 68, 85], PTs and OTs [44, 71] to the care team [45].…”

Section: Resultsmentioning

confidence: 99%

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

et al. 2019

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BackgroundMechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature.MethodsWhittemore and Knafl’s framework guided this review. CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, and Cochrane Library were searched to capture studies from 2000 to 2018, combined with hand search of grey literature and reference lists of included studies. The Critical Appraisal Skills Programme tools were used to assess the methodological quality of included studies. Data extraction and quality assessment of studies were performed independently by each reviewer before coming together in sub-groups for discussion and agreement. An inductive and data-driven thematic analysis was undertaken on verbatim extracts of EM-MV definitions and activities in included studies.ResultsSeventy-six studies were included from which four major themes were inferred: (1) non-standardised definition, (2) contextual factors, (3) negotiated process and (4) collaboration between patients and staff. The first theme indicates that EM-MV is either not fully defined in studies or when a definition is provided this is not standardised across studies. The remaining themes reflect the diversity of EM-MV activities which depends on patients’ characteristics and ICU settings; the negotiated decision-making process between patients and staff; and their interdependent relationship during the implementation.ConclusionsThis review highlights the absence of an agreed definition and on what constitutes early mobilisation in mechanically ventilated patients. To advance research and practice an agreed and shared definition is a pre-requisite.

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Section: Resultsmentioning

confidence: 99%

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

et al. 2019

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“…This has been acknowledged in prior studies as an existing barrier that is often a concern for multiple groups of unit stakeholders, including physical therapy [ 44 , 45 ]. However, many existent studies are still solely nursing driven [ 21 , 37 , 46 – 48 ]. Our intervention established a multidisciplinary focus of incorporating nurses, certified nursing assistants (CNAs), physicians, and physical therapists to ease workflow and relieve this burden.…”

Section: Discussionmentioning

confidence: 99%

A novel early mobility bundle improves length of stay and rates of readmission among hospitalized general medicine patients

Bergbower

Herbst

Cheng

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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Inpatient early mobility initiatives are effective therapeutic interventions for improving patient outcomes and decreasing use of hospital resources among adult ICU and general medicine patients. To establish and demonstrate guidelines for early patient ambulation, we developed and implemented a novel multidisciplinary mobility bundle utilizing the JH-HLM (Johns Hopkins Highest Level of Mobility) scale for mobility classification, on a single adult general medicine unit of a community hospital. Our results show that patients admitted to the unit after implementation of the mobility bundle had improved mobility scores, reduced rates of 30-day hospital readmission, and a shortened length of hospital stay. This study emphasizes the importance of measuring mobility using a systematic method, easing workflow among unit practitioners, and allowing mobility initiatives to be jointly driven by nursing, physical therapy, and physicians.

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“…O período de dezasseis dias de internamento sem perda de amplitudes articulares e com aumento em dois segmentos revela-se um importante contributo na mitigação das complicações da imobilidade tal como verificado em estudos com doentes críticos em UCI (25,26) . Um estudo randomizado que envolveu 54 doentes internados em UCI com ventilação invasiva superior a 48 horas concluiu que planos de mobilização realizados por enfermeiros melhoram a força muscular, a força de preensão, diminuem o delírio, não agravam marcadores inflamatórios e reduzem o tempo de internamento (27) . Também num estudo de avaliação funcional dos doentes no momento da alta em UCI concluiu que os cuidados de enfermagem de reabilitação precoces têm impacto na funcionalidade (28) .…”

Section: Discussionunclassified

Manter a mobilidade articular no doente critico: estudo de caso

Beliz

Bule

Sousa

2020

RPER

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Introdução: A imobilidade no doente crítico é condicionada pela condição de doença ou ainda, pelo efeito de fármacos, mas, em ambos os casos, emerge como um problema na perspetiva da recuperação funcional. A diminuição da massa muscular e da amplitude articular atrasam ou dificultam os processos de recuperação da ventilação espontânea e os autocuidados. Quando o repouso no leito se impõe, os cuidados de enfermagem de reabilitação seguros são um recurso com vista à mitigação dos problemas associados à imobilidade. Objetivo: Avaliar resultados dos cuidados de enfermagem de reabilitação após a aplicação de uma intervenção estruturada de cuidados de mobilização articular passiva em doente crítico. Método: Estudo qualitativo, tipo estudo de caso. É apresentado o caso de uma pessoa adulta em situação crítica á qual foram realizadas oito sessões de mobilização articular por enfermeiro de reabilitação. Avaliada a amplitude articular com recurso a goniometria antes e após a aplicação de um programa de reabilitação. Estudo aprovado em comissão de ética. Resultados: Verificou-se que em 26 dias de internamento em unidade de cuidados intensivos a amplitude articular se manteve nos diferentes segmentos e houve ganhos nos movimentos de supinação do antebraço, extensão da mão esquerda e flexão do joelho direito. A realização de exercícios passivos de mobilização articular não interferiu com a estabilidade de parâmetros fisiológicos ou de adaptação à prótese ventilatória. Conclusões: Os resultados revelam a não ocorrência de diminuição da amplitude articular e são sensíveis aos cuidados de enfermagem de reabilitação, num plano estruturado e regular de mobilizações. Houve ganhos em saúde e a minimização das complicações associadas à imobilidade. Outros estudos devem ser realizados no sentido de parametrizar não só o plano de intervenção bem como a evidência dos resultados obtidos. Descritores: Cuidados Intensivos, Enfermagem de Reabilitação, Acamado, exercícios terapêuticos

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Dose of Early Therapeutic Mobility: Does Frequency or Intensity Matter?

Abstract: Findings from this study suggest that nurses can provide twice-daily mobility interventions that include sitting on the edge of the bed once patients have a stable status without altering a pro-inflammatory serum biomarker profile.

Cited by 33 publications

References 47 publications

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

A novel early mobility bundle improves length of stay and rates of readmission among hospitalized general medicine patients

Manter a mobilidade articular no doente critico: estudo de caso

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