Barriers to early mobilization in a neurological intensive care unit
DOI:
https://doi.org/10.11606/issn.2317-0190.v32i3a239666Keywords:
Intensive Care Units, Early Ambulation, Mobility LimitationAbstract
Objective: To quantify the prevalence of barriers to early mobilization (EM) in a neurological intensive care unit (ICU) and compare clinical and functional outcomes between patients with and without barriers to EM. Methods: Retrospective observational study conducted in the neurological ICU of a teaching hospital. Collected data: sex, age, diagnosis, comorbidities, days of hospitalization, length of stay on mechanical ventilation, functionality at discharge using the ICU mobility scale (IMS), rates of discharge or death in the ICU, and barriers. Results: A total of 468 patients were included, 58% male, mean age 57.1±16.7 years. The most prevalent barriers were fatigue, need for rest, and somnolence (23%), deep sedation and/or paralysis (17%), and baseline or new immobility/weakness (11%). The group with barriers had a significantly higher SAPS III score and ICU length of stay (p=0.001) than the group without barriers. The group without barriers had a significantly higher IMS score (p=0.001) and ICU discharge rate (p=0.006) than the group with barriers to out-of-bed ambulatory care. Conclusion: The most prevalent barriers to out-of-bed ambulatory care were fatigue, need for rest and somnolence, deep sedation and/or paralysis, and baseline or new immobility/weakness. The group with barriers to out-of-bed ambulatory care had higher prognostic scores for disease severity and ICU length of stay than the group without barriers, which had better functionality at discharge and a higher number of ICU discharges than the group with barriers to out-of-bed early mobilization.
Downloads
References
Paulo FVS, Viana MCC, Braide ASG, Morais MCS, Malveira VMB. Mobilização precoce a prática do fisioterapeuta intensivista: intervenções e barreiras. Rev Pesq Fisioter. 2021;11(2):298-306. Doi: https://doi.org/10.17267/2238-2704rpf.v11i2.3586
Latronico N, Gosselink R. A guided approach to diagnose severe muscle weakness in the intensive care unit. Rev Bras Ter Intensiva. 2015;27(3):199-201. Doi: https://doi.org/10.5935/0103-507X.20150036
Figueiredo F, Conceição T, Bündchen D. Prática clínica e barreiras relacionadas à mobilização precoce em unidade de terapia intensiva. Arq Cien Saúde UNIPAR. 2022;26(2):127-33. Doi: https://doi.org/10.25110/arqsaude.v26i2.2022.8449
Ramos SM, Vaceli JVS, Cavenaghi OM, Mello JRC, Brito MVC, Fernandes MJ et al. Associação entre funcionalidade e tempo de permanência de pacientes críticos em UTI. Fisioter Bras. 2021;22(2):120-31. Doi: https://doi.org/10.33233/fb.v22i2.3896
Vaceli J, Ramos S, Mello JRC, Cavenaghi OM, Fernandes MJ, Ferreira LL. Correlation between status and functional mobility in intensive care unit. J Health Sci. 2020;22(2):190-5. Doi: https://doi.org/10.17921/2447-8938.2020v22n2p190-195
Santos JS, Lima CA, Silva TVC, Carmo AROM, Souza CPV. Barreiras da mobilização precoce na unidade de terapia intensiva: revisão de literatura. Rev CPAQV. 2024;16(2):1-13. Doi: https://doi.org/10.36692/V16N2-18R
Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014;42(5):1178-86. Doi: https://doi.org/10.1097/CCM.0000000000000149
Fontela PC, Lisboa TC, Forgiarini-Júnior LA, Friedman G. Early mobilization practices of mechanically ventilated patients: a 1-day point-prevalence study in southern Brazil. Clinics (Sao Paulo). 2018;73:e241. Doi: https://doi.org/10.6061/clinics/2018/e241
Dubb R, Nydahl P, Hermes C, Schwabbauer N, Toonstra A, Parker AM, et al. Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units. Ann Am Thorac Soc. 2016;13(5):724-30. Doi: https://doi.org/10.1513/AnnalsATS.201509-586CME
Leditschke AI, Green M, Irvine J, Bissett B, Mitchell I. A. What are the barriers to mobilizing intensive care patients? Cardiopulm Phys Ther J. 2012;23(1):26–9. Doi: https://doi.org/10.1097/01823246-201223010-00005
Anekwe DE, Koo KKY, Marchie M, Goldberg P, Jayaraman D, Spahija J. Interprofessional survey of perceived barriers and facilitators to early mobilization of critically ill patients in montreal, Canada. J Int Care Med. 2017;34(3):218–26. Doi: https://doi.org/10.1177/0885066617696846
Costa DK, White MR, Ginier E, Manojlovich M, Govindan S, Iwashyna TJ, et al. Identifying barriers to delivering the awakening and breathing coordination, delirium, and early exercise/mobility bundle to minimize adverse outcomes for mechanically ventilated patients. Chest. 2017;152(2):304–11. Doi: https://doi.org/10.1016/j.chest.2017.03.054
Goodson CM, Friedman LS, Mantheiy E, Heckle K, Lavezza A, Toonstra A, et al. Perceived barriers to mobility in a medical ICU: the patient mobilization attitudes & beliefs survey for the ICU. J Intensive Care Med. 2018;20(5):1026-31. Doi: https://doi.org/10.1177/0885066618807120
Barber EA, Everard T, Holland AE, Tipping C, Bradley SJ, Hodgson CL. Barriers and facilitators to early mobilisation in intensive care: a qualitative study. Aust Crit Care. 2015;28(4):177-82. Doi: https://doi.org/10.1016/j.aucc.2014.11.001
Hunter OO, George EL, Ren D, Morgan D, Rosenzweig M, Klinefelter Tuite P. Overcoming nursing barriers to intensive care unit early mobilisation: a quality improvement project. Intensive Crit Care Nurs. 2017;40:44-50. Doi: https://doi.org/10.1016/j.iccn.2016.10.005
Jolley S, Regan-Baggs J, Dickson R, Hough C. Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study. BMC Anesthesiology. 2014;14(1):84. Doi: https://doi.org/10.1186/1471-2253-14-84
Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Baylor University Medical Center Proceedings. 2014;27(3):203–7. Doi: https://doi.org/10.1080/08998280.2014.11929108
Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP. Iniciativa STROBE: subsídios para comunicação de estudos observacionais. Rev Saúde Pública. 2010;44(3):559-65. Doi: https://doi.org/10.1590/S0034-89102010000300021
Moralez GM, Rabello LSCF, Lisboa TC, Lima MFA, Hatum RM, De Marco FVC, et al. External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs. Ann Int Care. 2017;7(1):53-9. Doi: https://doi.org/10.1186/s13613-017-0276-3
Kawaguchi YMF, Nawa RK, Figueiredo TB, Martins L, Pires-Neto RC. Perme intensive care unit mobility score e ICU mobility scale: tradução e adaptação cultural para a língua portuguesa falada no Brasil. J Bras Pneumol. 2016;42(6):429-34. Doi: https://doi.org/10.1590/S1806-37562015000000301
Aquim EE, Bernardo WM, Buzzini RF, Azeredo NSG, Cunha LS, Damasceno MCP, et al. Diretrizes brasileiras de mobilização precoce em unidade de terapia intensiva. Rev Bras Ter Intensiva. 2019;31(4):434–43. Doi: https://doi.org/10.5935/0103-507X.20190084
Azer BTS, Silva YP, Lenci SS, Oliveira TB, Silva LDN, Annoni R. Barreiras para a implementação e a prática de reabilitação precoce em pacientes críticos na UTI. Cons Saúde. 2023;22(1):e23261. Doi: https://doi.org/10.5585/22.2023.23261
Oliveira GR, Sánchez APS, Sousa FKV, Santos JKM, Viana MCC, Nogueira IC. Barreiras enfrentadas por fisioterapeutas para realizar a mobilização precoce em unidades de terapia intensiva. ASSOBRAFIR Ciênc. 2023;14:e46327. Doi: https://doi.org/10.47066/2177-9333.AC.2022.0054
Fontela PC, Forgiarini LA Jr, Friedman G. Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units. Rev Bras Ter Intensiva. 2018;30(2):187-194. Doi: https://doi.org/10.5935/0103-507X.20180037
Alaparthi GK, Gatty A, Samuel SR, Amaravadi SK. Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit. Crit Care Res Pract. 2020;2020:7840743. Doi: https://doi.org/10.1155/2020/7840743
Ferreira LL, Sousa ACM, Sanchez LCA. Desfechos clínicos de pacientes neurológicos com e sem ventilação mecânica prolongada. Rev Pesq Fisioter. 2021;11(4):671-8. Doi: https://doi.org/10.17267/2238-2704rpf.v11i4.4025
Sousa ACM, Sanchez LCA, Ferreira LL. Desfechos clínicos de pacientes submetidos à ventilação mecânica invasiva em uma UTI neurocirúrgica. ASSOBRAFIR Ciênc. 2021;12:e42286. Doi: https://doi.org/10.47066/2177-9333.AC.2020.0021
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Acta Fisiátrica
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
O conteúdo do periódico está licenciado sob uma Licença Creative Commons BY-NC-SA. Esta licença permite que outros remixem, adaptem e criem a partir do seu trabalho para fins não comerciais, desde que atribuam ao autor o devido crédito e que licenciem as novas criações sob termos idênticos.
