Effectiveness of Progressive Mobility Programs on the Functional States of ICU Patients

A large number of patients who survive hospitalization in the Intensive Care Unit (ICU) experience medium to long-term consequences from their stay. Patients may experience a period of inactivity that results in changes in various systems of the body. For instance, in the respiratory system, the main consequences of immobilization are atelectasis, mechanical ventilation, and hospital-associated pneumonia. Muscular dysfunction can also occur due to inflammation and immobility.

Progressive mobility programs are becoming more prevalent for their demonstrated benefits on functional states of ICU patients. Progressive mobility is defined as a series of planned movements beginning at a patient’s current mobility status, often within 48 hours of ICU admission, with the goal of returning to his/her baseline after discharge¹. The program consists of different levels of mobilization with progressive levels of activity, intensity, and types of exercise. The appropriate level for each patient is determined by his/her ability to understand commands as well as muscle strength. 

There is more and more clinical evidence for the effectiveness of progressive mobility programs. A recent single-blind, randomized controlled trial studied the impact of a progressive mobility program on the functional status of the respiratory and muscular systems of ICU patients, and found that the intervention group had shorter ICU stays than the control group, as well as better functional status.² Another study evaluated the effectiveness of a progressive mobility protocol in post-operative cardiothoracic surgical patients. They compared a randomly selected sample of the pre-intervention group (n=30) to a matched post-intervention group (n=30). The analysis compared outcomes including length of ICU stay among other metrics, and suggested that the post-intervention group showed a clinically significant reduction in the length of their ICU and hospital stay.³

A larger scale study in 2016 examined the benefits of early mobility programs in the ICU. The study lasted 1 year and recruited 3233 patients, focusing on hospital-acquired pressure ulcers but including other metrics such as mobility level, length of ICU stay, and hospital readmission rate. At the end of the study, the patient group enrolled in the program showed a statistically and clinically significant decrease in ICU-acquired ulcers, along with a statistically significant decrease in length of ICU stay and hospital readmission rate.⁴

Most studies, regardless of their clinical setting, demonstrate that a progressive mobility program is effective in improving the functional states of ICU patients. While the effectiveness of these programs is evident, sometimes ICU clinicians and nurses are challenged to establish and implement the programs with their own patients – a daunting process. Other common concerns include patient safety and insufficiently trained staff, as well as the time required to implement these programs.⁵ These challenges present barriers to a broad implementation of progressive mobility programs in ICUs, despite the programs’ demonstrated clinical benefits.

References

1. Schujmann DS, Lunardi AC, Fu C. Progressive mobility program and technology to increase the level of physical activity and its benefits in respiratory, muscular system, and functionality of ICU patients: study protocol for a randomized controlled trial. Trials. 2018;19(1):274. Published 2018 May 10. 
2. Schujmann DS, Teixeira Gomes T, Lunardi AC, et al. Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial. Crit Care Med. 2020;48(4):491-497. 
3. Floyd S, Craig SW, Topley D, Tullmann D. Evaluation of a Progressive Mobility Protocol in Postoperative Cardiothoracic Surgical Patients. Dimens Crit Care Nurs. 2016;35(5):277-282. 
4. Azuh O, Gammon H, Burmeister C, et al. Benefits of Early Active Mobility in the Medical Intensive Care Unit: A Pilot Study. Am J Med. 2016;129(8):866-871.e1. 
5. Fontela PC, Forgiarini LA Jr, Friedman G. Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units. Atitudes clínicas e barreiras percebidas para a mobilização precoce de pacientes graves em unidades de terapia intensiva adulto. Rev Bras Ter Intensiva. 2018;30(2):187-194.