Patient, Practice, and Organizational Factors Associated With Early Mobility Performance in Critically Ill Adults

Area of Science:

• Critical Care Medicine
• Physical Therapy
• Patient Outcomes

Background:

• Early mobility interventions in intensive care units (ICUs) have faced slow and inconsistent adoption.
• Understanding factors influencing early mobility is crucial for improving patient care and outcomes in critical care settings.

Purpose of the Study:

• To identify factors associated with early mobility performance in critically ill adult patients.
• To evaluate the predictive impact of these factors on subsequent-day early mobility.

Main Methods:

• Secondary analysis of data from 66 ICUs, including patients admitted for at least 24 hours.
• Mixed-effects logistic regression modeling was employed to analyze the data.
• Area under the receiver operating characteristic curve (AUC) was calculated to assess model performance.

Main Results:

• Significant pain, documented sedation targets, spontaneous awakening/breathing trials, mobility safety screening, and prior physical/occupational therapy were associated with higher odds of next-day mobility.
• Deep sedation, delirium, benzodiazepine administration, physical restraints, and mechanical ventilation were associated with lower odds of next-day mobility.
• Black and Hispanic patients demonstrated lower odds of next-day mobility compared to other patient groups. The predictive model achieved high discriminant accuracy (AUC, 0.853).

Conclusions:

• Both modifiable and nonmodifiable factors significantly influence early mobility performance in critically ill patients.
• These identified factors collectively offer excellent predictive capability for next-day early mobility, informing clinical practice and intervention strategies.