Early mobilization in the neurotrauma intensive care unit: a service evaluation of current practice and barriers

Early mobilization (EM) refers to active exercise commenced while patients are on the intensive care unit (ICU). Although the benefits of EM are well established in general ICU populations, evidence specific to the neurotrauma intensive care unit (NTICU) remains limited. This service evaluation aimed to review current EM practices in a single-center NTICU and explore the perceived barriers to EM implementation.

A service evaluation was conducted from 5th December 2023 to 28th March 2024, including all patients resident in the NTICU. During this period, patients underwent daily physiotherapy assessments, at which data were prospectively recorded for the suitability for EM, and barriers to EM, where this was not performed. Mobility status was quantified using the Manchester Mobility Scale (MMS), with mobilization defined as an MMS ≥ 2 (i.e., sitting on the edge of the bed or higher). Data for patient characteristics and outcomes were retrospectively collected from the electronic health record system.

Of 253 patients included in the service evaluation, EM (i.e., MMS ≥ 2 in the NTICU) was achieved in 149 (58.9%), with a further 76 (30.0%) mobilized on the ward after being discharged from NTICU. The most common primary barriers to EM were sedation (38.4%) and the need for acute medical care (33.9%). Logistical and process issues were the primary barrier to EM in 15.4% of assessments, most commonly insufficient staffing.

This service evaluation is the first known report of perceived barriers to EM in a UK-based NTICU. Targeted strategies to address modifiable barriers may facilitate earlier mobilization within major trauma services. Further research is needed to evaluate the safety and impact of NTICU-specific EM protocols.