Related Experiment Video
Updated: Dec 12, 2025
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Early mobilization for children in intensive therapy: A protocol for systematic review and meta-analysis
Samantha Guerra Cabó Nunes Gomes1, Luis Carlos Uta Nakano2, Ana Carolina Pereira Nunes Pinto3
1Division of Evidence-based Medicine, Department of Medicine, Universidade Federal de Sao Paulo, Brazil.
Insights
Early mobilization in pediatric intensive care can help prevent long-term complications. This systematic review assesses its effects on critically ill children to inform practice guidelines.
Area of Science:
- Pediatric critical care medicine
- Rehabilitation science
- Clinical trial methodology
Background:
- Intensive care units (ICUs) can lead to long-term complications in survivors, including muscle disorders and functional disability.
- Early mobilization, initiated after physiological stabilization, shows promise in mitigating these issues in adults.
- There's a lack of evidence and guidelines regarding early mobilization's safety and benefits in critically ill children.
Purpose of the Study:
- To systematically assess the effects of early mobilization interventions for children admitted to intensive therapy units.
- To identify and evaluate the evidence on the benefits and risks of early mobilization in pediatric critical care.
Main Methods:
- Comprehensive systematic searches of multiple electronic databases (MEDLINE, EMBASE, Cochrane, CINAHL, PEDro) and clinical trial registries (WHO ICTRP, ClinicalTrials.gov).
- Inclusion of individual parallel, cross-over, and cluster randomized controlled trials comparing early mobilization with other interventions.
- Independent data extraction and quality assessment by two reviewers, with discrepancies resolved through discussion or arbitration.
Main Results:
- Primary outcomes include mortality and adverse events.
- Secondary outcomes encompass duration of critical care, mechanical ventilation, muscle strength, pain, and neurodevelopmental outcomes.
- A descriptive analysis will be performed if meta-analysis is not feasible due to heterogeneity.
Conclusions:
- This review will provide crucial insights into the efficacy and safety of early mobilization for critically ill children.
- Findings will inform the development of much-needed practice guidelines for pediatric intensive care units.
- The study aims to improve long-term outcomes and quality of life for pediatric ICU survivors.
Introduction:
Intensive care units focus primarily on life support and treatment of critically ill patients, but there are many survivors with complications, such as generalized muscle disorders, functional disability and reduced quality of life after hospital discharge, resulting from prolonged stays in these units. The current evidence suggests that early mobilization-based rehabilitation (exercise initiated immediately after the patient's significant physiological changes have stabilized) in critically ill adults can alleviate these complications from immobility and critical illness. However, there are a lack of practice guidelines, conflicting perceptions about safety, and knowledge gaps about benefits in the critically ill paediatric population. Therefore, we aim to assess the effects of early mobilization for children in intensive therapy.
Methods And Analysis:
Systematic searches will be carried out in Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Centre on Health Sciences Information, Cumulative Index to Nursing & Allied Health Literature and physiotherapy evidence database databases at a minimum without date or language restrictions for relevant individual parallel, cross-over and cluster randomized controlled trials. In addition, a search will also be carried out in the World Health Organization International Clinical Trials Registry Platform, and in the clinical trial registries of ClinicalTrials.gov, looking for any on-going randomised controlled trials that compare early mobilization with any other type of intervention. Two review authors will independently perform data extraction and quality assessments of data from included studies, and any disagreements will be resolved by discussion or by arbitration. The primary outcomes will be mortality and adverse events. Secondary outcomes will include duration of critical care (days), duration of mechanical ventilation support, muscle strength, pain and neuropsychomotor development. The Cochrane handbook will be used for guidance. If the results are not appropriate for a meta-analysis in RevMan 5 software (e.g., if the data have considerable heterogeneity and are drawn from different comparisons), a descriptive analysis will be performed.
Ethics And Dissemination:
This protocol was prospectively registered at Open Science Framework and approved by the Ethics and Research Committee of the Federal University of Sao Paulo (8543210519). We intend to update the public registry used in this review, report any important protocol amendments and publish the results in a widely accessible journal. REGISTRATION:: osf.io/ebju9.
