Describing Usual Care Mobilization with Mechanically Ventilated Patients According to the Rehabilitation Treatment...

Mobilization in the intensive care unit (ICU) for mechanically ventilated patients is a complex intervention. In critical care rehabilitation, patient recovery should not be limited by hospital location (e.g., ICU or hospital ward). Critically ill patients are among the most medically complex in the hospital; therefore, clinicians providing mobilization require a thorough understanding of critical illness, patient recovery trajectories, and available rehabilitation techniques. Mobilization requires coordination among multidisciplinary team members, careful preparation, and strong clinical assessment and decision-making skills. Usual care is the most common comparator group in randomized controlled trials of ICU mobilization; however, it is often under-specified. As a result, there is limited understanding of the specific activities, clinical decision-making processes, and therapist actions that constitute usual care. In this manuscript, the Rehabilitation Treatment Specification System (RTSS) is applied to describe protocols for common usual care mobilization activities for mechanically ventilated ICU patients. Preparation, clinician actions (e.g., instructions, feedback, and equipment provision), progression considerations, and clinical decision-making are described for each activity to enhance transparency and support reproducibility of usual care mobilization practices.