Structured Mobilization for Critically Ill Patients: A Pragmatic Cluster-randomized Trial.

Area of Science:

• Critical Care Medicine
• Rehabilitation
• Health Services Research

Background:

• Mobilization interventions are recommended for critically ill patients, but real-world effectiveness remains unclear.
• Previous small trials suggest benefits, yet large-scale data on multifaceted approaches are limited.
• Evaluating low-cost, systematic interventions is crucial for improving patient recovery in intensive care settings.

Purpose of the Study:

• To assess the effectiveness and safety of a multifaceted mobilization intervention in diverse intensive care units (ICUs).
• To determine the impact of the intervention on patient mobility and functional outcomes.
• To identify potential mediators of the intervention's effect on patient recovery.

Main Methods:

• A stepped-wedge cluster-randomized trial involving 12 ICUs with varied patient populations.
• Intervention included daily mobilization goals, interprofessional communication, and performance feedback.
• Primary sample: mechanically ventilated patients (>=48 hours) ambulatory before admission; Secondary sample: all ICU patients (>=48 hours).

Main Results:

• The intervention did not significantly improve the primary outcome of maximal mobility score (ICU Mobility Scale).
• Significantly more patients in the intervention group achieved the ability to stand before ICU discharge (OR, 1.48; P=0.04).
• Physical therapy frequency mediated 90.1% of the intervention's effect on standing ability; ICU mortality and safety outcomes were similar.

Conclusions:

• A low-cost, multifaceted mobilization intervention is safe and improves the odds of patients standing before ICU discharge.
• While overall mobility did not improve, the intervention shows promise for functional recovery.
• The findings support the integration of structured mobilization protocols in critical care settings.