Robot-assisted early mobilization for intensive care unit patients: Feasibility and first-time clinical use.

BACKGROUND: Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units. OBJECTIVE: Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice. SETTING: Two intensive care units guided by anesthesiology at a German university hospital. PARTICIPANTS: Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h. METHODS: Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively. RESULTS: Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ±â€¯1.3) and the intervention as feasible (mean 5.3 ±â€¯1.6). CONCLUSIONS: Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time. REGISTRATION: clinicaltrials.org TRN: NCT05071248; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248. TWEETABLE ABSTRACT: Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred.

Assistive robotic systems in nursing care: a scoping review.

BACKGROUND: The use of assistive robotic systems in care is intended to relieve nursing staff. Differentiated and literature-based findings on current application possibilities, technological developments and empirical findings are necessary to enable a goal-oriented and participatory development of assistive robotic systems of care. The aim of this review was to identify assistive robotic systems and their areas of application in nursing settings. Furthermore, an overview of existing social and nursing science findings from the research field of assistive robotic systems will be described. METHODS: A systematic literature search was performed based on the JBI scoping review methodology. During the period from May to August 2020, the databases MEDLINE via PubMed, CINAHL, Cochrane Library, Web of Science, and IEEE Xplore Digital Library were searched. In order to reflect current developments and evidence in the present literature work, a supplementary search with these same requirements was conducted in January 2022. RESULTS: The 47 included publications are divided into 15 studies, 23 technical articles and nine opinion-based articles (text-opinion). A total of 39 different assistive robotic systems were identified. There were 55% in the testing phase and 29% of the systems in the development phase. Assistive robotic systems can be divided into six fields of application: Information and patient data processing, assistance with activities of daily living, fetch and bring activities, telepresence and communication, monitoring, safety and navigation, and complex assistance systems. The description of the study findings is divided into "integration of technology and impact on practice" and "attitude and acceptance of elderly people towards assistive robotic systems". CONCLUSION: The results of the research show that the use of assistive robotic systems in care mainly take place in the context of development and testing phases. In addition to usability and acceptance issues, implementation factors must be integrated into theory-driven research projects.

[Early mobilization in the intensive care unit-Are robot-assisted systems the future?] / Frühmobilisation auf der Intensivstation ­ Sind robotergestützte Systeme die Zukunft?

BACKGROUND: Intensive care unit (ICU) acquired weakness is associated with reduced physical function, increased mortality and reduced quality of life, and affects about 43% of survivors of critical illness. Lacking therapeutic options, the prevention of known risk factors and implementation of early mobilization is essential. Robotic assistance devices are increasingly being studied in mobilization. OBJECTIVE: This qualitative review synthesizes the evidence of early mobilization in the ICU and focuses on the advantages of robotic assistance devices. RESULTS: Active mobilization should begin early during critical care. Interventions commencing 72 h after admission to the ICU are considered early. Mobilization interventions during critical care have been shown to be safe and reduce the time on mechanical ventilation in the ICU and the length of delirious episodes. Protocolized early mobilization interventions led to more active mobilization and increased functional independence and mobility at hospital discharge. In rehabilitation after stroke, robot-assisted training increases the chance of regaining independent walking ability, especially in more severely impaired patients, seems to be safe and increases muscle strength and quality of life in small trials. CONCLUSION: Early mobilization improves the outcome of the critically ill. Robotic devices support the gait training after stroke and are the subject of ongoing studies on early mobilization and verticalization in the intensive care setting.