Abstract
BackgroundThe shift of focus in outcome measures from mortality to assessment of functional status in intensive care unit (ICU) patients has resulted in the emergence of mobilisation of critically ill patients as a standard physiotherapy practice in most medium and high income countries. The aim of this study was to determine the feasibility of an early mobilisation program and to report on the changes in patient clinical outcomes following the intervention in a low income country.MethodsA prospective cohort study was carried out at one public hospital. An adult cohort of 35 patients was recruited within 24 h of being admitted into the unit, irrespective of ventilation method over a period of three months. An early mobilisation programme was implemented and prescribed using the Physical Function ICU Test (PFIT-s) which commenced in either the ICU or high dependent unit.ResultsThe median age of the 35 patients was 29 years (IQR = 24–45 years). More than half of the patients had undergone surgery due to either gastrointestinal problems or obstetrical complications. A total of 94 out of a possible of 219 exercise sessions were delivered to the patients (43.0 %). The tool was implemented in 32 (91.4 %) patients on the initial PFIT-s measurement and 16 (45.7 %) of the patients required the assistance of two people to stand. The Initial PFIT-s mean score was 5.3 ± 1.8. On final PFIT-s measurement, out of the 30 (85.7 %) patients seen, 15 (42.9 %) of the patients did not require any assistance to stand and the final PFIT-s mean score was 7.0 ± 1.9. There was a significant difference in both the initial PFIT-s total score (t-value = 2.34, df = 30, p = .03) and the final PFIT-s score (t-value = 3.66, df = 28, p = .001) between males and females. During the treatment, no adverse event occurred in any of the patients.ConclusionAn early mobilisation program using PFIT-s was feasible and safe. There was a difference in functional capability based on gender, with males being more functionally active. Specific inclusion and exclusion criteria can lead to a delayed early mobilisation activities in ICU patients.Trial registrationPan African Clinical Trials Registry PACTR201408000829202. Registered 15 August 2014.
Highlights
The shift of focus in outcome measures from mortality to assessment of functional status in intensive care unit (ICU) patients has resulted in the emergence of mobilisation of critically ill patients as a standard physiotherapy practice in most medium and high income countries
The mortality rate was 14 % as five of the patients died during ICU stay
This shows the study was conducted in a different cohort compared to the previous work involving Physical Function ICU Test (PFIT-s) because of the younger age of the population and the difference in diagnosis of the patients, with majority presenting with abdominal problems and obstetrical complications
Summary
The shift of focus in outcome measures from mortality to assessment of functional status in intensive care unit (ICU) patients has resulted in the emergence of mobilisation of critically ill patients as a standard physiotherapy practice in most medium and high income countries. Prolonged immobility is harmful with rapid reductions in muscle mass, bone mineral density and impairment in other body systems evident within the first week of bed rest, which is further exacerbated in individuals with critical illness [13] Both CIP and CIM have been reported to delay weaning, compromising rehabilitation, leading to increased hospital and ICU morbidity and mortality [2, 7, 14]. Knowledge of the effects of prolonged bed rest on multiple body systems and its association with long-term outcomes of the patients has resulted in changes in standard clinical practice [13, 15]
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