Corrigendum to “Safety of Early Mobilization in Adult Neurocritical Patients: An Exploratory Review”

Introduction: Early mobilization has shown significant benefits in the rehabilitation of critically ill patients, including improved muscle strength, prevention of physical deconditioning, and reduced hospital length of stay. However, its safety in neurocritical patients, such as those with strokes, traumatic brain injuries, and postsurgical brain surgeries, remains uncertain. This study aims to map and examine the available evidence on the safety of early mobilization in adult neurocritical patients.Methods: A scoping review was conducted following PRISMA-SCR guidelines and the Joanna Briggs Institute (JBI) methodology. The research question focused on the safety of early mobilization in neurocritical patients, considering adverse events, neurological changes, hemodynamic changes, and respiratory changes. A comprehensive search was performed in databases such as PubMed, BVS–LILACS, Ovid MEDLINE, and ScienceDirect, using specific search strategies. The selected studies were assessed for methodological quality using JBI tools.Results: Of 1310 identified articles, 25 were included in the review. These studies comprised randomized controlled trials, prospective observational studies, retrospective studies, and pre- and postimplementation intervention studies. The review found that early mobilization in neurocritical patients is generally safe, with a low incidence of severe adverse events, and does not increase the risk of vasospasm, and most complications were manageable with protocol adjustments and continuous monitoring.Conclusion: Early mobilization in neurocritical patients has been shown to be potentially safe under specific conditions, without a significant increase in severe complications when properly monitored. However, the available evidence is limited by the heterogeneity of protocols and study designs, emphasizing the need for further research. The importance of tailoring mobilization protocols to each patient and ensuring continuous monitoring is highlighted. Additional studies with larger sample sizes are needed to fully understand the associated risks and optimize mobilization strategies.

The aim of this project was to improve early postoperative mobilization in patients undergoing abdominal surgery according to best practice. Early mobilization is a crucial element of postoperative care; however, there are challenges implementing early mobilization protocols in daily practice. This project used the evidence to improve awareness and practice of early mobilization in patients undergoing abdominal surgery. This study utilized clinical audit strategies under the JBI Practical Application of Clinical Evidence System (JBI PACES) module. An audit-feedback cycle was used from April 2018 to August 2018. The baseline audit was conducted using 18 nurses and 30 patients in a general surgery ward. The Getting Research into Practice audit and feedback tool was used to identify barriers, strategies, resources and outcomes. After implementing evidence-based strategies, a follow-up was conducted using the same number of samples and audit criteria. We analyzed the compliance with best practice and its impact on length of hospitalization, postoperative physical activities, gastrointestinal function and complications. After implementing best-practice strategies, the compliance rate of the six criteria improved as follows: criterion 1 from 0% to 100% (P = 0.000), criterion 2 from 87% to 100% (χ = 4.29, P = 0.038), criterion 3 from 60% to 70% (χ = 6.67, P = 0.010), criterion 4 from 7% to 79% (χ = 52.55, P = 0.000), criterion 5 from 40% to 70% (χ = 35.00, P = 0.000), and criterion 6 from 0% to 100% (P = 0.000). The differences in the length of hospitalization and physical activities between the pre-implementation and post-implementation were statistically significant (all P < 0.05). The rate of postoperative complications did not show a significant difference because of low occurrence. The results indicate that evidence-based practice is an effective method for enhancing early recovery in patients undergoing abdominal surgery through promoting early mobilization. Sustaining best practice should continue through further follow-up audits.

Background: At an urban public acute care hospital, a gap existed in the safety and efficacy of early mobilization (EM) of intensive care unit (ICU) patients, with the need for an evidence-based intervention. A literature review revealed that a nurse-driven mobility protocol could safely achieve early mobility in ICU patients. This quality improvement project aims to utilize a nurse-driven mobility protocol to determine its effects on EM of ICU patients. Objective: The purpose of this quality improvement project is to determine if the implementation of an early mobility program using the Bedside Mobility Assessment Tool (BMAT) would impact patient mobility compared to standard practice over eight weeks in the ICU setting of an urban Hospital in New York City. Method: The Bedside Mobility Assessment Tool (BMAT) was used to conduct a pilot project on all critically ill patients aged ≥18 years admitted to the 17-bed ICU in an acute care hospital. Kotter's Eight-Step Change Process underpinned by the Plan-Do-Study-Act method of change was used to implement and guide the change process. Result: A nonrandomized convenience sampling of patients was used to attain a total of N = 306 patients (n = 133 preintervention and n = 173 implementation). Between the preimplementation (patients previously mobilized using standard practice) and implementation groups (patients mobilized using BMAT), there was a statistical significance in mobilization rates observed with pre-implementation (n = 56, 42%) and postimplementation mobility rates (n = 132, 76%). Conclusion: EM of critical patients in the ICU using a nurse-driven protocol with the BMAT assessment tool proved efficacious in promoting early patient mobility activities in this setting. This project should be continued and disseminated to other units.

It has been recommended that critically ill patients start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low in the intensive care unit (ICU), and respiratory therapists and nurses are the primary practitioners of early mobilization in China. The aim of this study is to investigate the knowledge, attitudes, and perceived barriers of ICU nurses regarding the early mobilization of ICU patients. A descriptive and cross-sectional design was used. A cross-sectional design was used, with an e-questionnaire for ICU nurses (n = 227) to assess knowledge and attitudes regarding early mobilization via the "Tencent WeChat" app on their smart phones. As the primary implementers of the early mobilization of ICU patients in China, more than half of ICU nurses passed the knowledge test (scored ≥20/25 points) and had positive attitudes (scored 45/55 points) regarding early mobilization. Nurses had good knowledge (more than 96.5%) of the benefits and stopping indications of early mobilization; however, they had a poor understanding (less than 51.1%) of the population in which early mobilization is applicable and monitoring indicators during early mobilization, and 39.2% of nurses did not support routine implementation of early mobilization for patients in the ICU. The major barriers that they perceived were very heavy workload (76.8%), insufficient equipment and devices (50.2%), lack of written protocols or guidelines (50.2%), inadequate training (47.1%), potential work risks (42.3%), and limited staffing (41.4%). Although over half of ICU nurses exhibited relatively comprehensive knowledge of and positive attitudes to early mobilization, some misunderstandings, negativity, and barriers remain. Training programmes should be conducted continuously, especially focused on common misunderstandings and negative attitudes. Organizational support is required to overcome barriers to the implementation of early mobilization.

Early mobilization has been shown to promote functional recovery and prevent complications in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the efficacy of early mobilization in patients with aSAH remains unclear. This study aimed to investigate the association between early mobilization and functional outcomes in patients with aSAH. This multicenter retrospective study was conducted in Japan and included patients with aSAH who received physical therapy with or without occupational therapy from April 2014 to March 2019. The primary outcome was the modified Rankin Scale (mRS) score, with a favorable functional outcome defined as an mRS score of 0-2 and an unfavorable outcome with an mRS score of 3-5. Patients initiating walking training within 14days of aSAH onset were classified into the early mobilization group, whereas those initiating training after 14days were classified into the delayed mobilization group. Propensity score matching analysis was performed to assess the association between early mobilization and favorable outcomes. A total of 718 patients were screened, and 450 eligible patients were identified. Before matching, 229 patients (50.9%) were in the early mobilization group and 221 (49.1%) were in the delayed mobilization group. After matching, each group consisted of 122 patients, and the early mobilization group exhibited a higher proportion of favorable outcomes than did the delayed mobilization group (81.1% vs. 52.5%, risk difference 28.7%, 95% confidence interval 17.4-39.9, p < 0.001). This multicenter retrospective study suggests that initiating walking training within 14days of aSAH onset is associated with favorable outcomes.

The purpose of the study was to compare the impact of approaches to early mobilization of cardiac surgery patients on the duration of hospitalization. Materials and methods. Early mobilization of patients after cardiac surgery and study of its effectiveness is an important issue of physical therapy. The beginning of the development of cardiac surgery was characterized by the fact that patients after surgery were in the intensive care unit on a bed rest for several days to improve recovery and prevent complications. The benefits of early mobilization were later recognized, and patient verticalization began earlier. The study involved 90 patients (over 18 years old). Patients were divided into two groups. The first group of mobilization (GM1, n = 49) included patients who underwent surgery on Monday or Tuesday, performed standing and if possible walking on the spot on the first postoperative day with a physical therapist. The second group of mobilization (GM2, n = 41) included patients who underwent surgery on Friday, were mobilized to sit in bed on the first postoperative day; performed standing and walking on the spot on the second or third postoperative day with the participation of medical staff. In addition, other early mobilization points (chamber walking and corridor walking) were performed statistically later in GM2. Patients did not differ in other features of physical therapy. All patients were told during the preoperative consultation with a physical therapist that if they were operated on Friday, they would perform mobilization and therapeutic exercises with medical staff on weekends. Patient case data (age, sex, study protocols and operations) were studied. Results and discussion. Among GM1 patients, the part of men was 69.39%, and in the GM2 group – 78.05% (χ² = 0.856; p = 0.355). Groups of patients did not have significant differences in age, anatropometric parameters, key results of preoperative studies, characteristics of surgical interventions. The study did not establish the effect of more progressive early mobilization performed in GM1 on the length of stay in the postoperative ward (7 (6; 8) nights versus 7 (5; 8) nights; p=0.428) and the total duration of postoperative hospitalization (9 (8; 10) nights against 10 (7; 11) nights; p=0.733). Statistically better indicators of the GM1 group were obtained in the number of nights spent in intensive care (all patients – two nights, except 3 patients in GM1 and 11 in GM2 – three nights; p=0.007), but this advantage should be considered taking into account the impact of patient logistics, namely longer stay in intensive care on weekends. Conclusion. The data confirmed the same effectiveness of approaches to early mobilization of cardiac surgery patients in terms of duration of postoperative hospitalization

Background: Cardiovascular diseases are currently the main cause of mortality and hospitalization in the adult population and cardiac surgery is an option of treatment. Postoperative complications are still frequent and can determines the length of hospital staying. Early mobilization can be used in these patients to reduce such complications and the evidences for such intervention remains unknown. Objective: Systematically review the effects of early mobilization on length of hospital stay and on postoperative complications in patients undergoing elective cardiac surgery. Methods: Randomized controlled trials using early mobilization in patients after cardiac surgery were searched and selected on the following databases: Medline, Embase, CINAHL, PEDro, Web of Science and Cochrane Central Register of Controlled Trials. Early mobilization was defined as any form of exercise within 72 hours after surgery. Results: 2514 studies were identified and 18 articles were full read for eligibility analysis. Nine studies were included and they present low risk of bias by PEDro score (range 5 to 9). The length of hospital staying ranged from 5.9 to 12.2 days. Only three studies observed that the early mobilization group reduced the length of hospital stay when compared to the control group. Five studies evaluated postoperative complications and only one showed lower incidence of complications with early mobilization. Conclusion: The results of this systematic review show that there is still low quality evidence suggesting that early mobilization can reduce the incidence of postoperative complications and the length of hospital stay in patients submitted to cardiac surgery.

BACKGROUNDExtracorporeal membrane oxygenation (ECMO) is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments. Patients that are supported with veno-arterial ECMO (VA-ECMO) are considered very-high risk patients to participate in any type of physical therapy (PT) or mobilization. However, cumulative evidence suggests that early mobilization of critically ill patients is feasible, safe, and efficient under certain circumstances.AIMTo summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODSThis is a scoping review that used systematic electronic literature searches (from inception until January 2025) on MEDLINE (PubMed), PEDro, DynaMed, CINAHL, Scopus, Science direct and Hellenic Academic Libraries. Snowball searching method was also applied. Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT, published in English and utilized any primary evidence study design. Studies on children, animals and patients placed on any other ECMO, secondary evidence, and ‘grey’ literature were excluded.RESULTSA total of 316 articles were retrieved and 13 were included in the study. Of those, 1 study was a randomized control trial, 4 retrospective studies, 4 retrospective cohort studies, 1 case series and 3 case reports. The sample size of the included studies ranged from 1 to 104 VA-ECMO patients, who were ambulated or received PT interventions, and mobilization frequency ranged from 2 per day to 4 per week. Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position. PT and early mobilization were associated with better weaning from mechanical ventilation, gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSIONEarly mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times. High quality research on early mobilization in VA-ECMO patients is warranted.

Background: Early mobilization of patients with critical illness reduces the consequences of extended periods of bed rest and improves self-care functions and quality of life. Early mobilization for mechanically ventilated patients in any ICU prevents patients from a spiral of progressive complications, leading to either nursing home placement or persistent critical illness. Early mobilization of ICU patients has been associated with improved muscle strength and functional independence, a shorter duration of delirium, mechanical ventilation, and ICU length of stay. Objective: This study was undertaken to assess the impact of physiotherapy management and early mobilization on Functional Status and Length of Stay in patients admitted to the Intensive Care Unit. Methods: An observational study was conducted at a tertiary care university teaching hospital in Mysore, South India, among patients admitted to medical and surgical intensive care units. The patients were assessed, and the patient’s baseline characteristics were recorded. The study subjects were divided into two groups, the intervention and the control groups. There were 71 patients in the intervention group and 67 patients control group. Subjects in the intervention group underwent physiotherapy management and early mobilization. Subjects in the control group did not undergo physiotherapy management and early mobilization. Physiotherapy intervention was given 2-3 times/day, and the outcome measures were the length of stay in ICU and assessment of physical morbidity using the Chelsea Critical Care Physical Assessment Tool (CPAx). Results: The results showed that subjects in the intervention group were weaned from the ventilator support (3.86±3.4 and 5.59±4.3, p = 0.005) and oxygen support (5.23±0.99 and 7.48±2.0, p = 0.000) much earlier than the subjects in the control group. The length of ICU stay was significantly less in the intervention group than in the control group (7.71±3.70 days and 11.64±4.8 days with a p-value, p = 0.000). respectively Conclusion: This study demonstrated that implementation of physiotherapy intervention and early mobilization in critically ill patients undergoing treatment in intensive care unit resulted in early weaning from ventilator support and supplemental oxygen therapy, with improvement in functional status leading to reduced length of ICU stays compared to the patients who were not given physiotherapy intervention and early mobilization.

In this edition, a series of papers focus on early mobilisation of patients in the intensive care unit (ICU). Interest in this intervention has been spurred on by the recognition that many ICU patients experience muscle wasting, sometimes termed ICU‐acquired weakness.1, 2 One review identified that, depending on the ICU population, ICU‐acquired weakness occurs in 24% to 67% of patients.3 Early mobilization is one strategy used to try to prevent this occurrence. It has been defined in various ways2 but generally reflects ventilated patients' active participation in exercises, meaning they are using their own muscle strength and control.4 Importantly, what this active participation may entail, including the treatment goals and activities, varies widely across studies,2 which is important to keep in mind when considering the beneficial effects of early mobilization.

Background/Purpose: Research about mobilization of patients who receive IV-tPA is scarce. Patients are routinely kept on bed rest for 24-48 hours after tPA for monitoring despite a lack of evidence justifying this lengthy immobilization. Several stroke rehabilitation studies report mobilizing patients within 24 hours of stroke. However, none of these studies included patients who received tPA and there are no published recommendations for safe timeframes for initiating mobilization of these patients. We completed a preliminary study to assess the hypothesis that adverse safety outcomes of early mobilization of this patient population are minor. Methods: We conducted a study between June 2011 and July 2012 involving early mobilization (i.e. PT/OT between 13 and 24 hours) of patients administered tPA. A safety screen was performed before mobilization occurred to verify hemodynamic stability of patients. Mobilization may have included sitting, standing, transferring to a chair, and ambulation. Results: Nearly 97% (30/31) of patients provided consent (12 female, 18 male; mean age: 66.8, range: 32-89; mean admission NIHSS 5.37, range 0 - 27). All consented patients were screened and 23/30 were mobilized without adverse response. Eighty-six percent (70/81) of activity events had no adverse response. The adverse events that were observed were transient and minor: 2 subjects reported “dizziness” (without a corresponding drop in BP), 3 subjects had an increase in DBP to &gt; 105 (with resting DBPs as follows: 93, 104, and 62 mmHg), 1 subject had a HR &gt; 100 bpm (resting HR was 96 bpm), and 1 had new-onset of neurological signs (transient L hemiparesis that resolved within an hour). Analysis is currently being performed Biostatistician. Conclusion: Early mobilization of patients post ischemic stroke 13-24 hours after IV-tPA infusion appears safe for 76.7% of patients and during 86.4% of activity events. In conclusion, adverse responses were largely minor with no sustained worsening of neurologic deficits. Study investigators recommend larger-powered studies for validation of safety findings to develop evidenced-based guidelines for early mobilization of this patient population.

The primary aim of this study was to evaluate the safety and efficacy of early mobilization in patients with aneurysmal subarachnoid haemorrhage. Systematic review with meta-analysis of randomized controlled studies and observational studies. Patients with aneurysmal subarachnoid haemorrhage. PubMed, Embase, CINAHL, Web of Science, Pedro, and the Cochrane Library databases were searched. A systematic review and meta-analysis were performed. Screening and data extraction were performed by 2 independent reviewers. Sixteen studies involving 1,757 patients were included. Meta-analysis of the data estimated that early mobilization improved mRS score at discharge (mean difference -1.39, 95% CI -2.51 to -0.28, I2 = 86%) and at 3 months (mean difference -1.10, 95% CI -1.54 to -0.66, I2 = 7%). Early mobilization was associated with a reduction in cerebral vasospasm rate, both radiological (OR 0.66, 95% CI 0.45 to 0.96, I2 = 7%) and clinical (OR 0.44, 95% CI 0.27 to 0.72, I2 = 8%); 6% of mobilization sessions involved adverse events, mostly haemodynamic changes. This review found moderate-quality evidence supporting the safety and effectiveness of early mobilization in patients with SAH. Further randomized controlled trials are needed to identify the appropriate mobilization strategy and confirm these results.

IntroductionIntercostal Drains (ICDs) are used to reinflate the lung and drain air, pleural fluid, or blood collected in the pleural or mediastinal regions.1,2 ICDs cause pain, restrict mobility, and impair pulmonary function, presenting significant barriers to early mobilization (EM).2–4 EM requires careful coordination among healthcare providers, making it a multidisciplinary approach, of which physiotherapists are an integral part.3ObjectivesTo assess and determine the knowledge, attitude and practice (KAP) of physiotherapists practicing in India towards early mobilization of patients with intercostal drain.Materials and methodsEthical approvals were obtained from Institutional Research and Ethics Committees and the study was registered in Clinical Trial Registry-India. In this cross-sectional survey study, the KAP questionnaire was developed and validated by experts in the field. The questionnaire consists of 16 questions including demographic details and on the domains of knowledge, attitude and practice of physiotherapists towards patients with intercostal drain. The questionnaire was circulated via mail with a Google Forms link (n = 1282). Study participants are physiotherapists, practicing in India, with at least one year of experience in ICU setup. This is an ongoing study, where data will be collected till January 2025.ResultsInterim analysis was carried out on the data collected. Eighty-five responses have been received from ten states of India. The population had the highest number of MPT (50.6%), followed by BPT (40%) and then PhD (pursuing/completed- 7.1%/2.4% respectively). The average number of patients with intercostal drain being seen was 12–13 patients per month. A positive attitude towards early mobilization of these patients was seen with 81.2% of the population stating that EM should start within 24-48 hours post-operatively while agreeing that physiotherapists are solely responsible for early mobilization of patients with intercostal drain (52.9%). Adequate knowledge was seen regarding identifying and preventing potential complications with physiotherapists prioritizing haemodynamic stability, drain function, tube integrity, site inspection, and patient readiness before mobilizing a patient with an intercostal drain.ConclusionsIndian physiotherapists demonstrate adequate knowledge and a positive attitude towards early mobilization. Effective EM often requires a multidisciplinary approach involving surgeons, nurses, and other healthcare providers to ensure safety and comprehensive patient care.

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Introduction The long-standing mobility guideline for patients with lower extremity (LE) split-thickness skin grafts (STSG) in our burn unit is as follows: post-op day (POD) #1-4 bed rest, POD#5 edge of bed sitting, POD#6 transfers, POD#7 ambulation. Prolonged bed rest, however, can result in detrimental physiological effects, and practice guidelines for early ambulation have recommended mobility earlier than POD#5 for burn patients with LE STSG. Therefore, an early mobility timeline was developed to mobilize patients with LE STSG on POD#3. We hypothesize that early mobility will not result in graft loss when external compression is utilized, and hospital length of stay (LOS) will decrease. Methods The developed early mobility timeline is as follows: POD#3: transfer out of bed to a chair with LE ace wraps; use splints when STSG crosses a joint POD#4: remove splints, ambulate in-room distances POD#5: ambulate hallway distances A prospective case series study was completed from October 2021 to April 2023 (1.5 years), during which 51 patients with LE STSG received early mobility. Any graft loss on the day of dressing takedown (POD#4) and hospital LOS were recorded. Patients who received a single-stage STSG or a two-stage skin substitute followed by STSG surgeries were included. A retrospective data collection of the 1.5 years before the initiation of early mobility was also performed. 32 patients were identified; all had mobilized on POD#5 and after. This was used to compare the hospital LOS before and after implementing early mobility for patients with LE STSG. Results On graft loss: 51 patients who received early mobility had TBSA involvement between 1-25% (avg 6.8%). 49 of them did not demonstrate LE graft loss during dressing takedown. Of the 2 patients that did present with graft loss, both graft losses were &amp;lt; 1% TBSA and healed without further surgery. No other complication occurred during early mobility intervention. On hospital LOS: Hospital LOS was compared between the prospective and retrospective groups. In the retrospective group, 32 patients who were mobilized on POD#5 and after had TBSA involvement between 3-45% (avg 11.3%). When early mobility was utilized in the single-stage STSG group, LOS decreased by 1.2 days. In the 2-stage skin substitute followed by the STSG group, LOS decreased by 0.8 days. Conclusions Early mobilization for patients with LE STSG can be successfully implemented on POD#3 with external compression. Most patients (96%) did not demonstrate graft loss, and the minority of patients who had minimal graft loss healed without further surgery. Hospital LOS also decreased by an average of 1 day when patients were mobilized on POD#3 instead of POD#5. Applicability of Research to Practice Early mobility for patients with LE STSG can be safely implemented and help to decrease hospital LOS. Increased research on the success of early mobility programs can contribute to the possible standardization of mobility protocols within burn rehabilitation. Funding for the Study N/A