Early mobilization and its impact on recovery in ICU patients with severe COVID-19: A randomized controlled trial

Abstract

Introduction. The COVID-19 pandemic has severely impacted critically ill patients, often leading to prolonged immobilization in intensive care units (ICUs), which can result in ICU-acquired weakness (ICUAW) and delayed recovery. Early mobilization has emerged as a promising intervention to counter these effects by promoting faster recovery and reducing complications. This study aims to investigate the effects of early mobilization on physical function, muscle strength, and recovery outcomes in ICU patients with severe COVID-19. Methods. This randomized controlled trial (RCT) included 100 ICU patients (50 in the early mobilization group, 50 in the control group) with severe COVID-19. Early mobilization began within 48 to 72 hours of ICU admission and followed a stepwise progression through four mobility levels. Outcome measures included the Physical Function ICU Test (PFIT), Medical Research Council (MRC) sum score, incidence of delirium, ICU and hospital stay length, ventilator-free days, mortality, and readmission rates. Statistical analysis used intention-to-treat methods, with continuous and categorical variables tested accordingly. Results. The early mobilization group had a significantly shorter time to first mobilization (2.3 days vs. 5.8 days, p < 0.001), higher PFIT scores at ICU discharge (25.4 vs. 18.2, p < 0.001), and improved MRC sum scores (48.6 vs. 35.4, p < 0.001) compared to the control group. The incidence of delirium was significantly lower in the early mobilization group (20% vs. 38%, p = 0.03). ICU and hospital stays were shorter in the early mobilization group (10.4 vs. 14.2 days, p < 0.001; 18.5 vs. 24.1 days, p < 0.001). The early mobilization group had more ventilator-free days (20.3 vs. 14.7, p < 0.001). Mortality and readmission rates were similar between groups. Conclusion. Early mobilization significantly improves functional outcomes, reduces ICU and hospital length of stay, and lowers the incidence of delirium in ICU patients with severe COVID-19. These findings support incorporating early mobilization as standard practice in ICUs to enhance recovery outcomes.