Despite compelling evidence of the benefits of early mobility in the ICU, adoption rates remain slow. Many ICUs that promote an early mobility culture focus their efforts on in-bed mobility activities and extend their practice less frequently to out-of-bed exercise and rehabilitation.
A recent article6 examined data from 40 studies and reported a number of barriers to early mobility. Those barriers identified varied across ICUs and within disciplines and were dependent on the ICU culture, patient population and setting. Most barriers were deemed modifiable and appropriate strategies were identified.
Perceived risk of injury to patients and staff is an important consideration and often acts as a barrier to implementation of early mobility and rehabilitation activities. One common barrier voiced by ICU clinicians relates to the lack of equipment available within their ICU to help facilitate early mobility safely and often for their patients. Having access to appropriate equipment and training to support early mobility strategies could help improve adoption.
The process of sitting on the edge of the bed is usually a key first step in the out-of-bed mobility process. This can, at times, be labor intensive, particularly for patients who are obese, of low arousal or with profound ICU-acquired weakness, which may require multiple staff members to transfer the patient to the edge of the bed. Alternatively, factors such as a poorly tolerated airway, multiple attachments including positional femoral lines, low-dose inotropic support and postural hypotension may raise safety concerns around the process of moving a patient to sitting on the edge of the bed.
As patients improve, progression can be made to more active transfers out of bed. This can be facilitated by utilizing equipment, such as hoists or lateral transfer devices initially, until assisted-standing transfers to the chair can be achieved.
As patients continue to progress, they may be able to achieve a full standing position but not quite have the ability to take any steps. This can often be a frustrating time for patients and a safety concern for staff as they make additional attempts stepping to a chair. In this situation, a mobility solution to allow patients to stand and be transferred to a chair with minimal caregiver assistance is needed.
For more information, visit our dedicated early mobility section or contact us.
- Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012;23:5–13.
- Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil. 2013;94:551–561.
- Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144:825–847.
- Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013;41:1543–1554.
- Cameron S, Ball I, Cepinskas G, Choong K, Doherty TJ, Ellis CG, Martin CM, Mele TS, Sharpe M, Shoemaker JK, et al. Early mobilization in the critical care unit: a review of adult and pediatric literature. J Crit Care. 2015;30:664–672.
- Dubb R, Nydahl P, Hermes C et al. Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units. Ann Am Thorac Soc 2016;13(5):724–730.