RESUMEN
A scientific panel was created consisting of 23 interdisciplinary and interprofessional experts in intensive care medicine, physiotherapy, nursing care, surgery, rehabilitative medicine, and pneumology delegated from scientific societies together with a patient representative and a delegate from the Association of the Scientific Medical Societies who advised methodological implementation. The guideline was created according to the German Association of the Scientific Medical Societies (AWMF), based on The Appraisal of Guidelines for Research and Evaluation (AGREE) II. The topics of (early) mobilisation, neuromuscular electrical stimulation, assist devices for mobilisation, and positioning, including prone positioning, were identified as areas to be addressed and assigned to specialist expert groups, taking conflicts of interest into account. The panel formulated PICO questions (addressing the population, intervention, comparison or control group as well as the resulting outcomes), conducted a systematic literature review with abstract screening and full-text analysis and created summary tables. This was followed by grading the evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence and a risk of bias assessment. The recommendations were finalized according to GRADE and voted using an online Delphi process followed by a final hybrid consensus conference. The German long version of the guideline was approved by the professional associations. For this English version an update of the systematic review was conducted until April 2024 and recommendation adapted based on new evidence in systematic reviews and randomized controlled trials. In total, 46 recommendations were developed and research gaps addressed.
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Enfermedad Crítica , Ambulación Precoz , Humanos , Ambulación Precoz/métodos , Ambulación Precoz/normas , Enfermedad Crítica/terapia , Posicionamiento del Paciente/métodos , Posicionamiento del Paciente/normas , Cuidados Críticos/métodos , Cuidados Críticos/normasRESUMEN
OBJECTIVES: Analyse the effect of varying start times for early exercise interventions on the prevention of intensive care unit-acquired weakness. RESEARCH METHODOLOGY: We conducted a comprehensive search on PubMed, Cochrane Library, Web of Science, Embase, China Biology Medicine Disc, China National Knowledge Infrastructure, Wan Fang Database, and reference lists up to May 2023. SETTING: We systematically searched the literature for all randomized controlled trials on the effect of early mobilization in patients with critical illness. MAIN OUTCOME MEASURES: The primary outcome assessed was the incidence of intensive care unit-acquired weakness. The secondary outcomes included: the Medical Research Council Score, the Barthel Index, duration of mechanical ventilation, length of intensive care unit stay, total length of hospital stay, mortality and incidence of intensive care unit-related complications. RESULTS: The results of meta-analysis showed that compared with routine care, less than 24 hours after admission (RR = 0.44, 95 %CI: 0.28-0.68), more than 24 hours (RR = 0.33, 95 %CI: 0.16-0.67), less than 72 hours after admission (RR = 0.33, 95 %CI: 0.20-0.52) may lead to a lower incidence of intensive care unit-acquired weakness. The results of under surface cumulative ranking showed that early mobilization within 72 hours may have the lowest incidence of intensive care unit-acquired weakness (SUCRA = 81.9 %). CONCLUSIONS: The current empirical evidence from intensive care unit patients suggests that initiating mobilization protocols within 24-72 hours timeframe following admission to the intensive care unit could potentially be the most beneficial strategy to reduce the incidence of intensive care unit-acquired weakness and the related medical complications. Moreover, this strategy seems to significantly improve rehabilitation and treatment outcomes for these patients. IMPLICATIONS FOR CLINICAL PRACTICE: According to this study, medical and nursing staff in the intensive care unit have the chance to identify the most suitable timing for the implementation of early rehabilitative measures for patients. This can potentially prevent intensive care unit-acquired weakness and enhance various clinical outcomes for patients.
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Ambulación Precoz , Unidades de Cuidados Intensivos , Humanos , Ambulación Precoz/métodos , Ambulación Precoz/estadística & datos numéricos , Ambulación Precoz/normas , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Factores de Tiempo , Metaanálisis en Red , Tiempo de Internación/estadística & datos numéricos , Enfermedad Crítica/enfermeríaRESUMEN
OBJECTIVES: To determine the influence of active mobilization during critical illness on health status in survivors 6 months post ICU admission. DESIGN: Post hoc secondary analysis of a prospective cohort study conducted between November 2013 and March 2015. SETTING: Two tertiary hospital ICU's in Victoria, Australia. PATIENTS: Of 194 eligible patients admitted, mobility data for 186 patients were obtained. Inclusion and exclusion criteria were as per the original trial. INTERVENTIONS: The dosage of mobilization in ICU was measured by: 1) the Intensive Care Mobility Scale where a higher Intensive Care Mobility Scale level was considered a higher intensity of mobilization or 2) the number of active mobilization sessions performed during the ICU stay. The data were extracted from medical records and analyzed against Euro-quality of life-5D-5 Level version answers obtained from phone interviews with survivors 6 months following ICU admission. The primary outcome was change in health status measured by the Euro-quality of life-5D-5 Level utility score, with change in Euro-quality of life-5D-5 Level mobility domain a secondary outcome. MEASUREMENTS AND MAIN RESULTS: Achieving higher levels of mobilization (as per the Intensive Care Mobility Scale) was independently associated with improved outcomes at 6 months (Euro-quality of life-5D-5 Level utility score unstandardized regression coefficient [ß] 0.022 [95% CI, 0.002-0.042]; p = 0.033; Euro-quality of life-5D-5 Level mobility domain ß = 0.127 [CI, 0.049-0.205]; p = 0.001). Increasing the number of active mobilization sessions was not found to independently influence health status. Illness severity, total comorbidities, and admission diagnosis also independently influenced health status. CONCLUSIONS: In critically ill survivors, achieving higher levels of mobilization, but not increasing the number of active mobilization sessions, improved health status 6 months after ICU admission.
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Ambulación Precoz/normas , Estado de Salud , Sobrevivientes/estadística & datos numéricos , Adulto , Anciano , Estudios de Cohortes , Enfermedad Crítica/enfermería , Ambulación Precoz/estadística & datos numéricos , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , VictoriaRESUMEN
BACKGROUND: Postoperative care has been evolving since the concept of enhanced recovery after surgery (ERAS) was introduced in China. This study aimed to evaluate the effects of early ambulation within 24 h after unilateral total knee arthroplasty (TKA) on postoperative rehabilitation and costs in a Chinese population. METHODS: This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24 h (Group A) and 3761 who began ambulating later than 24 h (Group B). The outcome measurements, such as length of stay (LOS), total hospitalization costs, dynamic pain level, knee flexion range of motion (ROM), results of the 12-Item Short Form Survey (SF-12), incidence of thromboembolic events and other complications, were recorded and compared. RESULTS: The early ambulation group (Group A) had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group (Group B). There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B. In Group A, patients had significantly higher postoperative SF-12 scores than those in Group B. The incidence of deep venous thrombosis (DVT) and pulmonary infection was significantly lower in Group A than in Group B. The incidence of pulmonary embolism (PE) and other complications did not differ between the two groups. CONCLUSION: Early ambulation within 24 h after TKA was associated with reduced LOS, improved knee function, lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.
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Artroplastia de Reemplazo de Rodilla/métodos , Ambulación Precoz/normas , Anciano , China , Estudios de Cohortes , Ambulación Precoz/enfermería , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: This systematic review and meta-analysis aimed to determine the effectiveness of systematic early mobilization in improving muscle strength and physical function in mechanically ventilated intensive care unit (ICU) patients. METHODS: We conducted a two-stage systematic literature search in MEDLINE, EMBASE and the Cochrane Library until January 2019 for randomized controlled trials (RCTs) examining the effects of early mobilization initiated within 7 days after ICU admission compared with late mobilization, standard early mobilization or no mobilization. Priority outcomes were Medical Research Council Sum Score (MRC-SS), incidence of ICU-acquired weakness (ICUAW), 6-min walk test (6MWT), proportion of patients reaching independence, time needed until walking, SF-36 Physical Function Domain Score (PFS) and SF-36 Physical Health Component Score (PCS). Meta-analysis was conducted where sufficient comparable evidence was available. We evaluated the certainty of evidence according to the GRADE approach. RESULTS: We identified 12 eligible RCTs contributing data from 1304 participants. Two RCTs were categorized as comparing systematic early with late mobilization, nine with standard early mobilization and one with no mobilization. We found evidence for a benefit of systematic early mobilization compared to late mobilization for SF-36 PFS (MD 12.3; 95% CI 3.9-20.8) and PCS (MD 3.4; 95% CI 0.01-6.8), as well as on the proportion of patients reaching independence and the time needed to walking, but not for incidence of ICUAW (RR 0.62; 95% CI 0.38-1.03) or MRC-SS. For systematic early compared to standard early mobilization, we found no statistically significant benefit on MRC-SS (MD 5.8; 95% CI - 1.4 to 13.0), incidence of ICUAW (RR 0.90; 95% CI 0.63-1.27), SF-36 PFS (MD 8.1; 95% CI - 15.3 to 31.4) or PCS (MD - 2.4; 95% CI - 6.1 to 1.3) or other priority outcomes except for change in 6MWT from baseline. Generally, effects appeared stronger for systematic early compared to late mobilization than to standard early mobilization. We judged the certainty of evidence for all outcomes as very low to low. CONCLUSION: The evidence regarding a benefit of systematic early mobilization remained inconclusive. However, our findings indicate that the larger the difference in the timing between the intervention and the comparator, the more likely an RCT is to find a benefit for early mobilization. STUDY REGISTRATION: PROSPERO (CRD42019122555).
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Ambulación Precoz/normas , Respiración Artificial/efectos adversos , Factores de Tiempo , Ambulación Precoz/métodos , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/normas , Respiración Artificial/métodos , Respiración Artificial/enfermeríaRESUMEN
OBJECTIVES/HYPOTHESIS: To confirm the standard of care pertaining to postoperative mobilization practices following initial tracheostomy, to establish face validity of novel early mobilization tools, and to conduct a safety and feasibility pilot study. STUDY DESIGN: Multi-institutional survey and prospective cohort study. METHODS: Experts at our tertiary-care children's hospital developed an Early Pediatric Mobility Pathway for tracheostomy patients utilizing a novel risk-assessment tool. Surveys were distributed to professional colleagues in similar children's hospitals to establish face validity and incorporate respondent feedback. Additional surveys were disseminated to tertiary-care children's hospitals across the country to establish the current standard of care, and a pilot study was conducted. RESULTS: Seventy-seven percent of respondents from tertiary hospitals across the country confirmed the standard of care to defer mobilization until the first trach change. Greater than 83% of the respondents used to establish face validity of the tools agreed with the clinical components and scoring structure. The safety and feasibility of early mobilization prior to initial trach change was confirmed with a pilot of 10 pediatric patients without any adverse events. CONCLUSIONS: Mobilization of pediatric patients prior to initial trach change is feasible and can be safe when risk factors are assessed by a multidisciplinary team. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E653-E658, 2021.
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Ambulación Precoz/métodos , Medición de Riesgo/métodos , Traqueostomía/efectos adversos , Adolescente , Niño , Preescolar , Protocolos Clínicos/normas , Ambulación Precoz/efectos adversos , Ambulación Precoz/normas , Humanos , Proyectos Piloto , Estudios Prospectivos , Traqueostomía/rehabilitaciónRESUMEN
BACKGROUND: The aim was to complete a feasibility study that would test the methods of the main trial, that will investigate whether early thoracic and shoulder girdle exercises reduce chronic pain in patients with blunt chest wall trauma, when compared with normal care. METHODS: A single centre, parallel, feasibility randomised controlled trial was completed at a University Teaching Hospital in Wales between June and September 2019. Adult patients with blunt chest wall trauma, admitted to hospital for greater than 24 hours, with no concurrent, immediately life-threatening injuries, were included. The intervention was a simple physiotherapy programme comprising thoracic and shoulder girdle exercises. Feasibility outcome measures included: primary outcomes: (1) 80% or more of identified eligible patients were approached for potential recruitment to the trial (2) 30% or less of approached, eligible patients dissented to participate in the trial; secondary outcomes: (3) follow-up data for patient secondary outcomes can be collected for 80% or more of patients, (4) there should be no greater than 10% increase in serious adverse events in the intervention group compared with the control group. RESULTS: A total of 19/19 (100%) patients were deemed eligible for the trial and were approached for participation, 5/19 (26%) eligible patients declined to participate in the trial, follow-up data were collected for n=10/14 (71%) patients and there were no serious adverse events reported in either group. CONCLUSIONS: We have demonstrated that a fully powered randomised clinical trial of the EarLy Exercise in blunt Chest wall Trauma Trial is feasible. TRIAL REGISTRATION NUMBER: ISRCTN16197429.
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Ambulación Precoz/normas , Terapia por Ejercicio/normas , Pared Torácica/lesiones , Heridas no Penetrantes/terapia , Anciano , Anciano de 80 o más Años , Ambulación Precoz/métodos , Ambulación Precoz/estadística & datos numéricos , Terapia por Ejercicio/métodos , Terapia por Ejercicio/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Pared Torácica/fisiopatología , Gales , Heridas no Penetrantes/complicacionesAsunto(s)
Cuidados Críticos/estadística & datos numéricos , Ambulación Precoz/normas , Gravedad del Paciente , Factores de Tiempo , APACHE , Adulto , Anciano , Cuidados Críticos/métodos , Cuidados Críticos/normas , Ambulación Precoz/métodos , Ambulación Precoz/estadística & datos numéricos , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Planificación de Atención al PacienteRESUMEN
BACKGROUND: Mobilization of intensive care patients is a multi-professional task. Aim of this study was to explore how different professions working at Intensive Care Units (ICU) estimate the mobility capacity using the ICU Mobility Score in 10 different scenarios. METHODS: Ten fictitious patient-scenarios and guideline-related knowledge were assessed using an online survey. Critical care team members in German-speaking countries were invited to participate. All datasets including professional data and at least one scenario were analyzed. Kruskal Wallis test was used for the individual scenarios, while a linear mixed-model was used over all responses. RESULTS: In total, 515 of 788 (65%) participants could be evaluated. Physicians (p = 0.001) and nurses (p = 0.002) selected a lower ICU Mobility Score (-0.7 95% CI -1.1 to -0.3 and -0.4 95% CI -0.7 to -0.2, respectively) than physical therapists, while other specialists did not (p = 0.81). Participants who classified themselves as experts or could define early mobilization in accordance to the "S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders" correctly selected higher mobilization levels (0.2 95% CI 0.0 to 0.4, p = 0.049 and 0.3 95% CI 0.1 to 0.5, p = 0.002, respectively). CONCLUSION: Different professions scored the mobilization capacity of patients differently, with nurses and physicians estimating significantly lower capacity than physical therapists. The exact knowledge of guidelines and recommendations, such as the definition of early mobilization, independently lead to a higher score. Interprofessional education, interprofessional rounds and mobilization activities could further enhance knowledge and practice of mobilization in the critical care team.
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Ambulación Precoz/normas , Adhesión a Directriz/estadística & datos numéricos , Personal de Salud/psicología , Unidades de Cuidados Intensivos/normas , Posicionamiento del Paciente/normas , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Encuestas y CuestionariosRESUMEN
OBJECTIVES: To evaluate the methodological quality and thematic completeness of existing clinical practice guidelines, addressing early mobilization of adults in the ICU. DATA SOURCES: Systematic review of Medline, Embase, CINAHL, Cochrane, and grey literature from January 2008 to February 2020. STUDY SELECTION: Two reviewers independently screened titles and abstracts and then full texts for eligibility. Ten publications were included. DATA EXTRACTION: A single reviewer extracted data from the included publications and a second reviewer completed cross-checking. Qualitative data were extracted in five categories relating to the key factors influencing delivery of early mobilization to critically ill patients. DATA SYNTHESIS: Methodological quality was appraised using the Appraisal of Guidelines for Research and Evaluation II tool. Appraisal of Guidelines for Research and Evaluation II scores for applicability were low. Median quality scores for editorial independence, rigor of development, and stakeholder engagement were also poor. Narrative synthesis of publication content was undertaken. All publications supported implementation of early mobilization. Most documents agreed upon seven topics: 1) early mobilization is safe and may reduce healthcare costs, 2) safety criteria should be provided, 3) a protocolized or structured approach should be used, 4) collaborative teamwork is required, 5) staff require specific skills or experience, 6) patient and family engagement is important, and 7) program evaluation and outcome measurement are a key component of implementation. There was no consensus on dosage and patient selection. The areas of team culture and leadership were poorly addressed. CONCLUSIONS: Despite significant variation in the methodological quality of clinical practice guidelines for early mobilization, there were important consistencies in recommendations internationally. Future research should address gaps related to patient selection, dosage, team culture, and expertise. Future clinical practice guidelines in this area should focus on engagement of patients and families in the development process and provision of resources to support implementation based on the consideration of known barriers and facilitators.
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Ambulación Precoz/normas , Unidades de Cuidados Intensivos/normas , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization. OBJECTIVES: To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care. METHODS: Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members' attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops. RESULTS: Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months. CONCLUSION: Participation in the workshops improved the staff's attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.
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Cuidados Críticos/psicología , Cuidados Críticos/normas , Enfermedad Crítica/enfermería , Enfermedad Crítica/psicología , Ambulación Precoz/psicología , Ambulación Precoz/normas , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/psicología , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Calidad de la Atención de Salud/normas , Estados UnidosRESUMEN
BACKGROUND: Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. METHODS: A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation. RESULTS: The study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. CONCLUSIONS: Implementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.
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Enfermería de Cuidados Críticos/normas , Ambulación Precoz/normas , Unidades de Cuidados Intensivos/normas , Tiempo de Internación/estadística & datos numéricos , Grupo de Atención al Paciente/normas , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad/normas , Adulto , Anciano , Anciano de 80 o más Años , Curriculum , Educación Continua en Enfermería , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paquetes de Atención al Paciente , Sociedades de Enfermería , Estados UnidosRESUMEN
BACKGROUND: Bilateral cervicofacial burn contracture initially affects facial expressions and later affects tempero mandibular joint (TMJ) function of the patient. It further tightens the ligaments and capsules around the TMJ and leads to tempero mandibular dysfunction. The consequences of temporomandibular joint dysfunction will be pain, limitation of mouth opening, functional disability and poor quality of life (Qol). However, studies examining the efficacy of Maitland joint mobilization technique in this population are lacking. OBJECTIVES: To find the short term effects of Maitland joint mobilization technique on pain, mouth opening, functional limitation, kinesiophobia, sleep quality and Quality of life in tempero mandibular joint dysfunction following bilateral cervicofacial burns. METHODS: Thirty subjects with temporomandibular joint dysfunction following cervicofacial burn (N=30) were allocated to Maitland joint mobilization group (n=15) and home based training group (n=15) randomly to receive Maitland joint mobilization technique and home based training for 4 weeks. All the participants received ultrasound therapy as common treatment. Primary (Numeric Pain Rating Scale - NPRS, maximal mouth opening - MMO & Tempero mandibular disability index - TDI) and secondary (Tampa Scale of Kinesiophobia - TSK-17, Sleep quality questionnaire - SSQ & Global Rating of Change - GRC) outcome measures were measured at baseline, after four weeks and three months follow up. Repeated measures of ANOVA and independent t test were performed for analyzing the dependent variables in both groups. RESULTS: Baseline demographic characters and study variables show homogenous distribution between the groups (p>0.05). Four weeks following different training protocols Maitland joint mobilization group shows more significant changes in pain intensity, mouth opening, functional limitation, kinesiophobia, sleep quality and Qol than home based training group (p≤0.05). Also Maitland joint mobilization group show significant improvement in study variables than home based training group (p≤0.05) at three months follow up. CONCLUSION: Both groups improved over time, however, differences between the groups were noticed small. However, physiotherapy management which includes Maitland joint mobilization technique and therapeutic exercise program has an effective strategy in the treatment of tempero mandibular joint dysfunction following cervicofacial burns.
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Quemaduras/complicaciones , Ambulación Precoz/normas , Rango del Movimiento Articular/fisiología , Trastornos de la Articulación Temporomandibular/etiología , Adolescente , Adulto , Quemaduras/terapia , Método Doble Ciego , Ambulación Precoz/métodos , Ambulación Precoz/estadística & datos numéricos , Femenino , Humanos , Manejo del Dolor/métodos , Manejo del Dolor/normas , Calidad de Vida/psicología , Recuperación de la Función/fisiología , Arabia Saudita/epidemiología , Trastornos del Sueño-Vigilia/epidemiología , Encuestas y Cuestionarios , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/epidemiologíaRESUMEN
BACKGROUND: It has been recommended that critically ill patients start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low in the intensive care unit (ICU), and respiratory therapists and nurses are the primary practitioners of early mobilization in China. AIM: The aim of this study is to investigate the knowledge, attitudes, and perceived barriers of ICU nurses regarding the early mobilization of ICU patients. DESIGN: A descriptive and cross-sectional design was used. METHODS: A cross-sectional design was used, with an e-questionnaire for ICU nurses (n = 227) to assess knowledge and attitudes regarding early mobilization via the "Tencent WeChat" app on their smart phones. RESULTS: As the primary implementers of the early mobilization of ICU patients in China, more than half of ICU nurses passed the knowledge test (scored ≥20/25 points) and had positive attitudes (scored 45/55 points) regarding early mobilization. Nurses had good knowledge (more than 96.5%) of the benefits and stopping indications of early mobilization; however, they had a poor understanding (less than 51.1%) of the population in which early mobilization is applicable and monitoring indicators during early mobilization, and 39.2% of nurses did not support routine implementation of early mobilization for patients in the ICU. The major barriers that they perceived were very heavy workload (76.8%), insufficient equipment and devices (50.2%), lack of written protocols or guidelines (50.2%), inadequate training (47.1%), potential work risks (42.3%), and limited staffing (41.4%). CONCLUSIONS: Although over half of ICU nurses exhibited relatively comprehensive knowledge of and positive attitudes to early mobilization, some misunderstandings, negativity, and barriers remain. RELEVANCE TO CLINICAL PRACTICE: Training programmes should be conducted continuously, especially focused on common misunderstandings and negative attitudes. Organizational support is required to overcome barriers to the implementation of early mobilization.
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Enfermería de Cuidados Críticos/normas , Enfermedad Crítica/enfermería , Ambulación Precoz/normas , Conocimientos, Actitudes y Práctica en Salud , Adulto , China , Cuidados Críticos , Estudios Transversales , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Masculino , Encuestas y CuestionariosRESUMEN
INTRODUCTION: This systematic review aimed to evaluate early ambulation protocols implemented for traumatic solid organ injury. METHODS: The electronic databases PubMed, Medline (Ovid), Embase and Cochrane Library were searched without time constraint to identify prospective and retrospective analyses, randomised controlled trials, cohort studies, and case series that investigated early ambulation in solid organ trauma. RESULTS: Six studies met the predefined inclusion criteria and were reviewed. Three studies investigated early ambulation protocols in direct comparison with bed rest. The remaining three studies were early ambulation case series. In all studies there was no convincing evidence to suggest differences in clinical outcomes between early ambulation and bed rest protocols. In all studies early ambulation resulted in a reduced length of hospitalisation and decreased cost to national healthcare services. CONCLUSIONS: This systematic review has found preliminary evidence that suggests bed rest has no clinical benefit in those with low-grade to mid-grade (grades 1-2) solid organ injury. Further studies are required to inform guidance to improve trauma patient outcomes.
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Reposo en Cama/efectos adversos , Reposo en Cama/normas , Ambulación Precoz/normas , Supervivencia Tisular/fisiología , Reposo en Cama/tendencias , Bases de Datos Factuales/estadística & datos numéricos , Ambulación Precoz/tendencias , HumanosRESUMEN
Purpose: To describe health professionals' perceptions of the role of allied health during the acute phase following elective lower limb joint replacement surgery to inform the development of efficient allied health service models.Methods: This was a qualitative descriptive study conducted using semi-structured focus groups and thematic analysis. Participants were 25 medical, nursing, and allied health professionals working on two orthopaedic wards in a tertiary hospital in Victoria, Australia. Focus groups elicited staff perceptions regarding the aims and roles of acute allied health intervention following hip and knee replacement, how these services are currently provided, and how these services can best be provided. This study was undertaken alongside two stepped wedge cluster randomised controlled trials during which existing weekend allied health services were to be temporarily removed with opportunity to contribute to a stakeholder-driven model of these services.Results: The main theme that emerged was a sense of unrealised potential amongst health professionals in terms of patient outcomes following hip and knee joint replacement surgery arising from tension between perceptions of actual versus ideal allied health practice. Assessing function and planning for discharge accordingly was perceived to be a higher priority than intervening to improve functional independence.Conclusion: Prioritising allied health intervention to low functioning and complex patients could be a more efficient use of allied health expertise in patients following lower limb replacement surgery than current practice in this setting that prioritises discharge.Implications for RehabilitationAllied health service delivery in the acute phase following hip and knee joint replacement needs to balance the needs of the health service with those of the patients.Prioritising allied health intervention to low functioning and complex patients could be a more efficient use of allied health expertise in this population than current practice, which is to prioritise discharge.There may be more scope for nurses to be involved in promoting early postoperative mobilisation following joint replacement surgery, especially in uncomplicated cases.
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Técnicos Medios en Salud , Artroplastia de Reemplazo/rehabilitación , Ambulación Precoz , Cadera/cirugía , Rodilla/cirugía , Terapia Ocupacional/métodos , Modalidades de Fisioterapia , Artroplastia de Reemplazo/métodos , Actitud del Personal de Salud , Ambulación Precoz/métodos , Ambulación Precoz/normas , Femenino , Estado Funcional , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Alta del PacienteRESUMEN
PURPOSE: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. MATERIALS AND METHODS: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). RESULTS: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach α: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach α: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (-0.8 for each additional year; P = 0.02). CONCLUSIONS: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABS-ICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting.
Asunto(s)
Actitud del Personal de Salud , Cuidados Críticos/psicología , Ambulación Precoz/psicología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Cuerpo Médico de Hospitales/psicología , Adulto , Cuidados Críticos/normas , Ambulación Precoz/normas , Femenino , Encuestas de Atención de la Salud , Humanos , Unidades de Cuidados Intensivos/normas , Masculino , Persona de Mediana Edad , Mejoramiento de la CalidadRESUMEN
BACKGROUND: The aim of this meta-analysis was to assess if early mobilization and rehabilitation in the intensive care unit (ICU) could reduce ICU-acquired weakness (ICU-AW), improve functional recovery, improve muscle strength, shorten the length of ICU and hospital stays, and reduce the mortality rate. METHODS: A comprehensive literature search in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and National Knowledge Infrastructure, China (CNKI) was performed. Results were expressed as a risk ratio (RR) with 95% confidence intervals (95% CIs) or weight mean difference (WMD) with 95% CIs. Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among studies. RESULTS: Fifteen randomized controlled trials involving a total of 1941 patients were included in this meta-analysis. Pooled estimates suggested that early mobilization significantly reduced the incidence of ICU-AW (RR = 0.49, 95% CI: 0.26, 0.91; P = .025), shortened the length of ICU (WMD = -1.82 days, 95% CI: -2.88, -0.76; P = .001) and hospital (WMD = -3.90 days, 95% CI: -5.94, -1.85; P < .001) stays, and improved the Medical Research Council score (WMD = 4.47, 95% CI: 1.43, 7.52; P = .004) and Barthel Index score at hospital discharge (WMD = 21.44, 95% CI: 10.97, 31.91; P < .001). Moreover, early mobilization also decreased complications such as deep vein thrombosis (RR = 0.16, 95% CI: 0.04, 0.59; P = .006), ventilator-associated pneumonia (RR = 0.26, 95% CI: 0.11, 0.63; P = .003), and pressure sores (RR = 0.14, 95% CI: 0.04, 0.44; P = .001). However, early mobilization did not reduce the ICU mortality rate (RR = 1.31, 95% CI: 0.97, 1.76; P = .074), improve the handgrip strength (WMD = 4.03 kg, 95% CI: -0.68, 8.74; P = .094), and shorten the duration of mechanical ventilation (WMD = 0.20 days, 95% CI: -0.10, 0.50; P = .194). CONCLUSION: This study indicated that early mobilization was effective in preventing the occurrence of ICU-AW, shortening the length of ICU and hospital stay, and improving the functional mobility. However, it had no effect on the ICU mortality rate and ventilator-free days. RELEVANCE TO CLINICAL PRACTICE: ICU-AW is a common neuromuscular complication of critical illness, and it is predictive of adverse outcomes. Early mobilization of critically ill patients is a candidate intervention to reduce the incidence and severity of ICU-AW. Some clinical studies have demonstrated this, whereas others found opposite results. The aim of our study is to assess if early mobilization and rehabilitation in the ICU could reduce the ICU-AW, improve functional recovery, improve muscle strength, shorten length of ICU and hospital stay, and reduce the mortality rate.
Asunto(s)
Enfermedad Crítica/enfermería , Ambulación Precoz/normas , Neumonía Asociada al Ventilador/prevención & control , Respiración Artificial/estadística & datos numéricos , China , Mortalidad Hospitalaria/tendencias , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación/estadística & datos numéricos , Alta del Paciente , Úlcera por Presión/prevención & controlRESUMEN
BACKGROUND: Enhanced recovery after surgery (ERAS) expedites return to patient baseline and functional status by reducing surgical trauma, stress, and organ dysfunction. Despite the potential benefits of enhanced recovery protocols, limited research has been done in low-resource settings, where 95% of cesarean deliveries are emergent and could possibly benefit from the application of ERAS protocols. METHODS: In a prospective, randomized, single-blind, controlled trial, mothers delivering by emergency cesarean delivery were randomly assigned to either an ERAS or a standard of care (SOC) recovery arm. Patients in the ERAS arm were treated with a modified ERAS protocol that included modified counseling and education, prophylactic antibiotics, antiemetics, normothermia, restrictive fluid administration, and multimodal analgesia. They also received early initiation of mobilization, feeding, and urethral catheter removal. The primary end point was length of hospital stay. The secondary end points were complications and readmission rates. Mean length of stay in the intervention and control arms were compared using t tests. Statistical analyses were performed using STATA version 13 (College Station, TX). RESULTS: A total of 160 patients were enrolled in the study, with 80 randomized to each arm. There was a statistically significant shorter length of stay for the ERAS arm compared to SOC, with a difference of -18.5 hours (P < .001, 95% confidence interval [CI], -23.67, -13.34). The incidence of complications of severe pain and headache was lower in the ERAS arm compared to SOC (P = .001 for both complications). However, pruritus was more common in the ERAS arm compared to SOC (P = .023). CONCLUSIONS: Use of an ERAS protocol for women undergoing emergency cesarean delivery in a low-income setting is feasible and reduces length of hospital stay without generally increasing the complication rate.