Exercise Physiologists: Key to Providing Early Mobilization in the Intensive Care Unit

Smith, Carine; Grami, Petra; Haseeb, Cheryl; Ababio, Yao

doi:10.4037/ajcc2019816

Cited by 5 publications

(11 citation statements)

References 26 publications

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“…These findings are consistent with other reported quality improvement (QI) projects despite variable patient population. 33,38,39 While the absolute magnitude of the program was small, in the backdrop of declining mobility in other areas of the hospital our data suggest that the presence of MTs may help buffer the effects of hospital-level changes negatively impacting mobility and provides important preliminary data to support future, more definite interventions.…”

Section: Discussionmentioning

confidence: 80%

“…These 2 deficits may have contributed to the drift compared with other studies that reported MTs were actively assigned patients and had established caseload expectations. 33,38 In the state of Maryland the MT cannot work under the license of a physical or occupational therapist; therefore, the process that is described by Coughenour et al 47 where MTs reported to and where assigned a caseload by the physical therapist would need to be modified to have the caseload assigned by the nurse.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, another common barrier involves the staffing models for rehabilitation therapists, which do not permit daily interventions for even the portion of hospitalized patients who receive a rehabilitation consult. [31][32][33] Hospitals have implemented multiple strategies to improve patients' mobility rates at reduced personnel cost. Such strategies include implementation of nursingdriven mobility screens, formation of mobility teams, and the creation of a mobility technician (MT) position, whose primary role is to increase out-of-bed activity and promote ambulation.…”

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confidence: 99%

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The Impact of Mobility Technicians on Mobility Rates for Hospitalized Adults in a Large Academic Medical Center

Wells,

Frampton,

Horn

et al. 2024

Journal of Acute Care Physical Therapy

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Introduction: Promotion of early mobility is part of an ongoing effort to mitigate the iatrogenic effects of hospitalization. To assist with mobilization efforts, nursing departments hire mobility technicians (MTs). However, little is known about whether hospital units that hire MTs have increased rates of patient mobilization. Purpose: The aim of this retrospective study was to determine whether units in an academic medical setting that hired an MT had greater improvements in mobility compared with similar units that did not hire an MT. Methods: Two levels of care-matched pairs of hospital units were used for this analysis. Within each pairing, one unit hired an MT. We captured activity days, defined as any documented out-of-bed activity in a 24-hour period, from standardized documentation. A monthly activity rate was calculated for each unit as the average daily percentage of patients who had out-of-bed orders. A difference-in-difference generalized linear model with a time-by-MT interaction, weighted for patient volume, was used to compare the relative improvement in mobility 6 months prior (baseline) to the hiring of an MT to periods 3 and 6 months post-hire. Results: There was a 2.3% absolute increase in activity rate from preperiod to the 3-month postperiod for units that hired an MT, as compared with a 5.1% decline in similar units that did not have an MT. This 8.4% difference in activity rates was statistically significant (P = .03). Over 6 months, the effects of the program waned. Control units continued to decline with a 7.1% drop from baseline) compared with a marginal 0.1% increase in activity rates for units with an MT from baseline. This relative 7.6% increase in mobility was not significant (P = .13). Conclusion: There was a significant improvement in activity rates associated with MT hire that declined over time. These results may be contributed to a nonstructured MT utilization, variability with nursing education on the role of the MT, and staffing challenges that diverted the use of the MT to nonmobility activities.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The Impact of Mobility Technicians on Mobility Rates for Hospitalized Adults in a Large Academic Medical Center

Wells,

Frampton,

Horn

et al. 2024

Journal of Acute Care Physical Therapy

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“…It will be important to build on multidisciplinary approaches which may be the most effective way to promote mobility in hospitalized older adults 16 and include co-design based on robust theoretical frameworks to measure process as well as outcomes. 55 Different ways of engaging and assisting people to be active in hospital in addition to physiotherapy and occupational therapy, 56 could include family, 57 trained volunteer, 58 allied health assistant, 59 exercise physiology 60 and mobility technician 61 programs.…”

Section: Discussionmentioning

confidence: 99%

A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalization

et al. 2020

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Objective: To identify interventions using wearable accelerometers to measure physical activity and/or sedentary behaviour in adults during hospitalization for an acute medical/surgical condition. Data sources: Four databases were searched in August 2019 (MEDLINE, CINAHL, Scopus, EMBASE). Review methods: Studies were selected if they described an intervention in adults with a medical/surgical condition, and concurrently reported an accelerometer-derived measure of physical activity and/or sedentary behaviour while participants were admitted. Items were screened for eligibility in duplicate. Included studies were synthesized to describe intervention types, feasibility and potential effectiveness. Results: Twenty-two studies were included, reporting on 3357 participants (2040 with accelerometer data). Identified types of interventions were: pre-habilitation ( n = 2) exercise ( n = 3), patient behaviour change with self-monitoring ( n = 6), models of care ( n = 5), implementing system change ( n = 2), surgical technique ( n = 2) patients wearing day clothes ( n = 1) and education about activity in hospital ( n = 1). Of 16 studies that reported intervention effects on physical activity, 11 reported a favourable impact including studies of: pre-habilitation, self-monitoring (accelerometry or an activity whiteboard), physiotherapy, an early mobility bundle, minimally invasive surgery, an education booklet and by implementing system change. Of the six studies that reported intervention effects on sedentary behaviour, there was a favourable impact with an activity whiteboard, models of care and an education booklet. Conclusion: Accelerometer-derived measures of physical activity and/or sedentary behaviour have been used to describe sample characteristics and intervention effects in studies of hospitalized adults. Interventions may involve a range of health professionals, but less is known about sedentary behaviour in this setting.

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“…Extending the measurement of mobilization to the pre-operative period allows investigation of the predictive power of physical activity/inactivity on clinically relevant outcomes such as the risk of complications, which may inform future interventions. It has previously been suggested that exercise physiologists could take on the role of early and progressive mobility specialists who reduces the burden on physical therapists and nurses 48 . An intervention supported by clinical exercise physiologists may be important in implementing tailored recommendations for physical activity, which is especially relevant for prehabilitation 49 .…”

Section: Additional Avenues Of Research Using Wearable Activity Trackers For Patients Undergoing Surgery For Head and Neck Cancermentioning

confidence: 99%

Wearable activity trackers and mobilization after major head and neck cancer surgery: You can't improve what you don't measure

Twomey

Culos‐Reed

Daun

et al. 2020

International Journal of Surgery

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Exercise Physiologists: Key to Providing Early Mobilization in the Intensive Care Unit

Cited by 5 publications

References 26 publications

The Impact of Mobility Technicians on Mobility Rates for Hospitalized Adults in a Large Academic Medical Center

The Impact of Mobility Technicians on Mobility Rates for Hospitalized Adults in a Large Academic Medical Center

A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalization

Wearable activity trackers and mobilization after major head and neck cancer surgery: You can't improve what you don't measure

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