Variables associated with mobility levels in critically ill patients: A cohort study

Area of Science:

• Critical Care Medicine
• Physical Therapy
• Nursing Science

Background:

• Early mobilization in the intensive care unit (ICU) is crucial for improving patient functional status post-discharge.
• Despite its benefits, numerous barriers impede the implementation of early mobilization protocols in ICUs.

Purpose of the Study:

• To determine the mobility levels achieved by critically ill patients.
• To identify factors influencing patient mobility within the ICU setting.

Main Methods:

• A multi-center cohort study involving adult patients on invasive mechanical ventilation for at least 48 hours.
• Mobility was assessed using the ICU mobility scale; logistic regression analyzed associations with patient and resource variables.
• Data collected focused on days 3-5 of ICU stay to identify predictors of active mobility.

Main Results:

• Active mobility (moving in/out of bed) occurred in 9.9% of patient-days by day 8; bed exercises/passive transfers in 45.6%; immobility in 42.2%.
• Higher physiotherapist hours, a 1:4 nurse-patient ratio, higher MRC sum-score, and delirium presence were associated with increased active mobility.
• Factors hindering active mobility included higher BMI, a 1:3 nurse-patient ratio, and shift-dependent nurse-patient ratios.

Conclusions:

• Immobility and passive mobilization are common in ICUs.
• High MRC sum-score and delirium are protective factors for patient mobilization.
• A 1:4 nurse-patient ratio is more strongly associated with active mobility than a 1:3 ratio.