Early Mobilization Program Research Articles

Mobility Deterioration During Acute Pneumonia Illness Is Associated With Increased Hospital Length of Stay and Health Service Costs: An Observational Study

Purpose: To assess the association of mobility deterioration during community-acquired pneumonia (CAP) illness on length of stay (LOS), readmissions, and institutional costs. Methods: This longitudinal observational study included 347 individuals hospitalized with CAP. All were offered routine early mobilization with a physiotherapist within 24 hours of admission and then daily during hospital stay. The exposure of interest was mobility status at time of clinical stability when compared with the premorbid level. Modelling adjusted for factors such as age, residential status, premorbid mobility level, comorbidities, and pneumonia severity. Results: One hundred forty-one (41%) individuals met the definition of mobility deterioration during the acute illness. The mean (95% confidence interval [CI]) time from achievement of clinical stability to hospital discharge for the groups with and without mobility deterioration was 5.7 (4.2–7.2) and 2.3 (1.4–3.2) days, respectively, with associated higher hospitalization costs (arithmetic mean ratio [95% CI] 1.61 [1.24–2.10]) in the mobility deterioration group. There was no evidence of an association between mobility deterioration and 90-day readmission (odds ratio [95% CI]: 1.34 [0.81–2.24]). Conclusions: Mobility deterioration during acute pneumonia illness has a significant impact on hospital LOS and resource use even in a hospital system that has an early mobility program. Further research is needed to investigate these associations and alternative interventions. Trial registration: ClinicalTrials.gov, Identifier: NCT02835040.

Can an early mobilisation programme prevent hospital-acquired pressure injures in an intensive care unit?: A systematic review and meta-analysis.

A systematic review and meta‐analysis were conducted to clarify the effect of an early mobilisation programme on the prevention of hospital‐acquired pressure injuries in an intensive care unit as opposed to standard care. We searched a total of 11 databases until 1 May 2020 and included seven studies (n = 7.520) related to the effect of early mobilisation protocol in the prevention of hospital‐acquired pressure injuries (five quasi‐experimental and two random comparative). The five quasi‐experimental studies were significantly heterogeneous (P = .02 for Q test and 66% for I 2), and the odds ratio was 0.97 (95% CI: 0.49‐1.91) with a non‐significant statistical difference between both groups (P = .93). Our study shows inconclusive outcomes related to the effect of the implementation of an early mobility programme in the prevention of pressure injuries in critical patients. Future research is needed considering the small number of articles on the topic.

Abstract 13523: Self-guided Mobilization in the Cardiac ICU During the COVID Era

Introduction: Measures instituted to prevent the spread of COVID may have an impact on cardiac ICU care practices, such as early mobility (EM) program delivery. A structured EM program was in place in our cardiac ICU prior to COVID. Restrictions on hallway ambulation and patient-provider interaction due to COID led us to modify our EM program to a nurse-assisted, patient-guided program. To our knowledge, there are no studies evaluating patient-guided mobilization in a critical care setting. Thus, our objective was to assess whether self-guided EM was safe and feasible in the cardiac ICU during the COVID period. Methods: We reviewed consecutive records in a tertiary care cardiac ICU over a 2-month period following initiation of the self-guided EM program. Only patients who were COVID negative or presumed negative were admitted to the cardiac ICU. Nurses assessed patients using the Level of Function Mobility Score (range 0 to 5, with higher scores indicating better mobility) and provided the current functional level to patients. Patients used their own smartphones or supplied tablets to view video modules, which guided performance of level-specific mobility activities. Patients with contraindications to mobilization based on prespecified criteria were not mobilized. There were 2 mobilization opportunities per day and 3 activities per opportunity. Results: There were 52 patients admitted to the CICU during the study period (mean age 67.4 ± 16.0 years; 38.5% female). Ten patients (19.2%) had contraindications to mobilization during unit stay; all of these patients were subsequently mobilized. Two-thirds (66.7%; 208/312) of mobilization opportunities had at least one mobility activity. 72.2% (676/936) of prescribed mobility activities were performed. The adverse event rate was 0.6% (4 events/676 activities); none of these were major or life-threatening. There were no falls or line dislodgements. Conclusions: Patient self-guided mobilization was safe and feasible during a period of limited provider-patient interaction in a cardiac ICU. Self-guided EM programs can be considered during periods of restrictions on usual mobility programs. Further studies are needed to evaluate EM in other settings, such as in COVID hospital wards.

Abstract 13167: Early Mobilization in Postoperative Cardiac Surgical Patients

Introduction: Early mobilization (EM) is recommended by cardiac surgical societies. However, the optimal method of EM delivery has yet to be determined. Our objective was to assess whether a bedside nurse-driven EM strategy is safe and associated with improved outcomes following cardiac surgery. Methods: Consecutive post-cardiac surgery patients in a cardiovascular intensive care unit (CVICU) at an academic tertiary care centre from 2017 to 2019 prior to and after EM program implementation were reviewed. Postoperative cardiac surgery patients were initially managed in a general ICU and transferred to the CVICU when hemodynamic stability was achieved, typically postoperative day 1 or 2. Functional status was assessed by the nurse on CVICU admission using the Level of Function (LOF) Mobility Scale, which ranges from LOF 0 (bed immobile) to LOF 5 (walks > 50 feet). The nurse uses the LOF score to guide twice-daily level-specific mobility activities. The primary outcome was hospital length of stay. Results: There were 504 patients included in the study (preintervention, N=329; Intervention, N=175). There was no difference in age, sex or comorbid illness between the groups (Table). The LOF was 4.7 ± 0.5 prior to surgery, 3.4 ± 1.1 on CVICU admission, and 4.3 ± 0.6 on CVICU discharge in patients undergoing EM. Patients were mobilized during nearly all mobilization opportunities (98.7%; 685/694). Adverse events were rare (0.4%; 8 events/1901 mobilization activities), minor and transient. There was no difference is postoperative hospital length of stay, in-hospital mortality, discharge home or 30-day hospital re-admission (all P>0.05). Conclusion: A nurse-driven EM program was safe and associated with improvement in functional status in postoperative cardiac surgery patients. The EM program was not associated with improved short-term outcomes. Further studies are needed to understand optimal delivery of EM in cardiac surgical patients.

Abstract 13123: Early Mobilization of Older Adults in the Cardiac Intensive Care Unit

Background: Early mobilization (EM) is beneficial in general critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods: Consecutive admissions of adults ≥ 80 years old to a cardiac ICU at an academic tertiary care centre before (January to December 2017) and after (February 2018 to June 2019) implementation of a structured nurse-driven EM program. Mobility was measured using the validated Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk > 50 feet). The primary outcome was discharge home. Results: There were 412 patients included (N=234, intervention; N=178, preintervention). There was no difference in mean age between groups (overall mean age 86.3±4.8 years old) or sex (overall female N=215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prior to hospitalization and in 209 patients (89.3%) on admission. Nearly half of patients undergoing EM (N=107; 45.7%) improved their LOF by ≥1 during cardiac ICU stay. Mobilization occurred during nearly all opportunities (838/850; 98.6%) and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2%]) and transient (N=5). There were no falls, line dislodgements, or healthcare team injuries). Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4% vs. 65.7%, P=0.047, respectively) and had a lower rate of in-hospital death (6.4% vs. 14.6%, P=0.006, respectively). There was no difference in length of hospital stay or re-admission. In the multivariable analysis, predictors of discharge home were younger age, heart failure, and higher prehospital LOF. Outcomes were similar in adults ≥ age 90. Conclusion: EM is safe in older adults in the cardiac ICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.

Abstract 13410: Patient and Family Perspectives of Early Mobilization in Acute Cardiovascular Care

Introduction: Early mobilization (EM) is safe, feasible, and associated with good outcomes in people with acute CV disease. While studies have explored the perspectives of care providers on mobilization, little is known about patient and family member perspectives and experience with mobilization. Methods: Patient and family member surveys were developed using previously validated surveys (Family Satisfaction with Care in the ICU and the Patient Mobilization Attitudes & Beliefs survey). The survey assessed attitudes toward and knowledge of mobilization, the family member’s role in providing care and the mobilization care they received. Surveys were distributed to patients and their family members in an acute CV unit of a tertiary care centre in Montreal, Canada over a 4-month period. Results: 102 participants completed the survey (78 patients and 24 family members). Most patients (N=54; 69.2%) agreed or strongly agreed that EM should be routinely performed, although nearly half of the patients (N=37, 47.4%) felt that mobilization soon after admission was potentially dangerous. Out of 64 patients who underwent EM, 60 (93.8%) felt that mobilization helped their recovery (Figure). 35 patients (54.7%) felt that family member participation helped their mobilization. Family members included 12 (50.0%) spouses/partners, 10 (41.7%) children, 1 (4.2%) siblings, and 1 parent (4.2%). Most family members felt that mobilizing their relatives too soon after admission was potentially dangerous (N=17, 70.8%). However, family members were interested in being involved with mobilization (N=22; 91.7%) and only a few felt that mobilization should not be routinely performed (N=2; 8.3%). Conclusion: Patients felt that EM helped with their recovery process. Family members were interested in being involved in mobilizing their relatives. Our findings should inform efforts to overcome patient and family-related barriers to mobilization and design an EM program for acute CV care.

Standardisation, multi-measure, data quality and trending: A qualitative study on multidisciplinary perspectives to improve intensive care early mobility monitoring

ObjectiveTo explore multi-clinician perspectives on intensive care early mobility, monitoring and to assess the perceived value of technology-generated mobility metrics to provide user feedback to inform research, practice improvement, and technology development. MethodsWe performed a qualitative descriptive study. Three focus groups were conducted with critical care clinicians, including nurses (n = 10), physical therapists (n = 8) and physicians (n = 8) at an academic medical centre that implemented an intensive care early mobility programme in 2012. Qualitative thematic analysis was used to code transcripts and identify overarching themes. FindingsAlong with reaffirming the value of performing early mobility interventions, four themes for improving mobility monitoring emerged, including the need for: 1) standardised indicators for documenting mobility; 2) inclusion of both quantitative and qualitative metrics to measure mobility 3) a balance between quantity and quality of data; and 4) trending mobility metrics over time. ConclusionIntensive care mobility monitoring should be standardised and data generated should be high quality, capable of supporting trend analysis, and meaningful. By improving measurement and monitoring of mobility, future researchers can examine the arc of activity that patients in the intensive care unit undergo and develop models to understand factors that influence successful implementation.

Efficacy of neuromuscular electro stimulation on muscle strength in elderly patients with diabetes mellitus underwent cardiovascular surgery – a multicenter randomized controlled trial

Abstract Introduction Cardiovascular surgery causes muscle weakness probably due to a postoperative increase in inflammatory cytokine production, and diabetes mellitus (DM) may promote the postoperative muscle weakness because of increased insulin resistance. Purpose A multicenter randomized controlled trial was conducted to examine the effects of postoperative neuromuscular electrical stimulation (NMES) on muscle strength for elderly patients with DM after cardiovascular surgery (UMIN000029940). Methods Patients underwent cardiovascular surgery were consecutive screened for eligibility (With DM and age ≥65 years) as study subjects. If eligible, patients were randomly assigned either to the NMES or the sham group. Both of group underwent NMES or sham stimulation (60 minutes / 5 times) and usual postoperative early mobilization program until postoperative day (POD) 7. The primary outcome was the percent change in knee extensor isometric muscle strength (%ΔKEIS) between preoperative to POD 7. Secondary outcomes were the percent change in usual (%ΔUsual walking speed) and maximum walking speed (%ΔMaximum walking speed) and grip strength (%ΔGS). Assessors for physical function were blinded to the outcomes. The statistician who was blinded to the allocation analyzed the data using preoperative value adjusted ANCOVA. Results Of 1151 consecutive patients screened for eligibility from February 2018 to January 2020, 158 participants (NMES group, n=79; sham group, n=79) were enrolled. NMES group demonstrated significantly lower %ΔKEIS compared with those in the sham group (Table). Among secondary outcomes, NMES group showed significantly lower %ΔMaximum walking speed and tendency of lower %ΔUsual walking speed and %ΔGS (Table). Conclusion NMES prevented postoperative muscle weakness in the elderly patients with DM, indicating that NMES along with early mobilization could be implicated as specific intervention to those populations. Funding Acknowledgement Type of funding source: None

Effect of an early mobilisation programme on pain intensity after laparoscopic surgery: a randomised clinical trial

BackgroundPain is a common complication after laparoscopic surgery. This study aimed to examine the effect of an early mobilisation programme on postoperative pain intensity after laparoscopic surgery.MethodsA randomised controlled clinical...

Early Mobilization Rehabilitation Program for Children With Cerebral Palsy Undergoing Single-Event Multilevel Surgery.

This study investigates functional and technical outcomes to support an early mobilization approach to rehabilitation after single-event multilevel surgery (SEMLS) for children with cerebral palsy (CP), and disseminates innovative guidelines emphasizing early walking. Twenty-three participants with spastic diplegic CP ages 7 through 17 years, Gross Motor Function Classification System levels I to III, who underwent an early mobilization program after SEMLS were reviewed. Outcomes were examined from motion analysis data and clinical documentation. All participants were able to return to school walking at discharge. At 1-year postoperatively, participants had returned to their prior walking level or better. Change in Gait Deviation Index and Pediatric Outcomes Data Collection Instrument indicated improvements in functional mobility and gait consistent with or greater than the literature. This intensive early mobilization program restores participation in daily activities, walking, and school within the first month postoperatively.

The Effects of Early Mobilization on Patients Requiring Extended Mechanical Ventilation Across Multiple ICUs.

Objectives:1) To successfully implement early mobilization of individuals with prolonged mechanical ventilation in multiple ICUs at a tertiary care hospital and 2) to reduce length of stay and improve quality of care to individuals in the ICUs.Design:Comparative effectiveness cohort study based on a quality improvement project.Setting:Five ICUs at a tertiary care hospital.Patients:A total of 541 mechanically ventilated patients over a 2-year period (2014–2015): 280 and 261, respectively. Age ranged from 19 to 94 years (mean, 63.84; sd, 14.96).Interventions:A hospital-based initiative spurred development of a multidisciplinary team, tasked with establishing early mobilization in ICUs.Measurements and Main Results:Early mobilization in the ICUs was evaluated by the number of physical therapy consults, length of stay, individual treatment sessions utilizing functional outcomes, and follow-up visits. Implementation of an early mobilization protocol across all ICUs led to a significant increase in the number of physical therapy consults, a significant decrease in ICU and overall lengths of stay, significantly shorter days to implement physical therapy, and a significantly higher physical therapy follow-up rate.Conclusions:Mobilizing individuals in an intensive care setting decreases length of stay and hospital costs. With an interdisciplinary team to plan, implement, and evaluate stages of the program, a successful early mobilization program can be implemented across all ICUs simultaneously and affect change in patients who will require prolonged mechanical ventilation.

Benefits of an early mobility program for hospitalized cancer patients: A pilot study.

7008 Background: Cancer patients are often hospitalized with complications from cancer and cancer treatment. Many experience a decline in physical functioning which likely contributes to increased length of stay (LOS) and excess days, increased readmissions and decreased patient experience. We aimed to determine whether a mobility program project would improve quality of care and decrease healthcare utilization. Methods: We implemented a mobility aide program on an oncology unit in a large academic medical center between April 2, 2019 to December 31, 2019. The program consisted of nursing evaluation using the Activity Measure for Postacute Care (AMPAC), an ordinal scale ranging from bed rest to ambulating ≥250 feet, was used to quantify mobility. Plan of care was determined in a multidisciplinary manner with physical therapy (PT), nursing and a mobility aide, a medical assistant with enhanced rehabilitation training. Patients were then mobilized two times per day seven days a week. Using descriptive statistics we evaluated the programs impact on excess days, readmissions, changes in mobility and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) during this time period compared to the 6 month interval prior to implementation. Results: During the study interval, 988 patients were admitted and received the mobility program. There was a 6% reduction in excess days (p = 0.04). Similarly, readmission rates decreased from 25% to 19% (p = 0.03). Overall 76% of patients wither maintained or improved their mobility score. During this time period HCAHPS scores (willingness to recommend hospital) increased from 63% at baseline to 91% (p = 0.01). Conclusions: Use of this mobility program resulted in a significant decrease in healthcare utilization and improvement in patient experience. This demonstrates that non-PT professionals can mobilize hospitalized cancer patients decreasing the burden of PT and nursing resources. Future work will evaluate the sustainability of the program and evaluate association with healthcare costs.

Integrating Safe Patient Handling and Early Mobility: Combining Quality Initiatives.

Safe Patient Handling and Mobility (SPHM) programs reduce staff injuries from lifting and repositioning patients. Early Mobility programs improve many patient-centered outcomes. Reframing SPHM equipment as mobilization tools can help safely mobilize hospitalized patients to their highest abilities. Combining SPHM and Early Mobility programs is logical, but to date, no one has articulated the process of integration. A quality improvement process was developed at the Phoenix Veterans Affairs Health Care System to integrate an Early Exercise and Progressive Mobility initiative in the intensive care unit into an ongoing SPHM program using the Iowa Model for Evidence-Based Implementation. Integration of these programs was possible through extensive collaboration between stakeholders throughout planning, implementation, and refinement phases. Interdisciplinary Early Exercise and Progressive Mobility simulation training, standardized assessment, communication of patient status, and appropriate equipment use facilitated staff confidence to safely mobilize patients. Successful integration of Early Exercise and Progressive Mobility and SPHM was achieved at the Phoenix Veterans Affairs Health Care System.

Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial.

The aim was to investigate whether patients who participated in a mobility program in the ICU performed better on functional status, muscle, mobility, and respiratory assessments upon discharge than patients who received conventional physiotherapy. Randomized controlled trial. Blind evaluation. Adults with previous functional independence and without contraindications for mobilization were eligible. The intervention group participated in an early and progressive mobility program with five levels of activity. The control group underwent the conventional treatment without a preestablished routine. We evaluated functional status, level of activity, respiratory status, muscle strength, and mobility at ICU discharge. We analyzed 49 patients in the control group and 50 patients in the intervention group. Our data showed patients with better functional status and more functionally independent patients in the intervention group compared with those in the control group (96% vs 44%; p < 0.001). The results of the sit-to-stand and 2-minute walk tests, as well as the results of the maximum voluntary ventilation tests, also varied between the groups. The intervention group had shorter ICU stays than the control group. Higher Barthel index scores were associated with the amount of activity and participation in the protocol. The benefits to functional status remained during follow-up. Patients who participated in an ICU mobility program had better functional status at discharge from the ICU. The other benefits of the program included better performance in the mobility tests and improved maximum voluntary ventilation performance.

Changes in Body Muscle and Limbs Muscle among Immobilized Critically Ill Patients with Acute Stroke

Objectives This study examined the body muscle and limbs muscle loss among critically ill patients with acute stroke. Methods In this cross-sectional study, the clinical characteristics, lean body muscle and limbs muscle were measured on admission day, the 2nd day and the 7th day after admission in 23 acute stroke patients recruited from at a tertiary neuroscience intensive care unit. Immobilization was defined by medical research council score (MRCs≤48) and Richmond agitation and sedation score (RASS≤-2). Data were analyzed by repeated measures of ANOVA with Bonferroni’s correction and rank ANCOVA. Results Most clinical indices were improved on the 2nd day. The muscle loss incidence of lean body muscle, upper limb and lower limb was 65.2%, 56.5%, and 73.9% on the 7th day, respectively. Lean body muscle reduced by 1.05% at the 2nd day and by 1.45% at 7th day. Upper and lower limbs muscle reduced by 3.34% and 3.53% at 7th day, respectively. Conclusions Immobilization may lead to muscle loss in acute stroke patients. An early mobility program may help prevent muscle loss for immobilized acute stroke patients at the neuroscience intensive care unit. Key words: Stroke, Immobilization, Muscle strength, Unconsciousness, Muscle

The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project

Traumatic injury survivors often face a difficult recovery. Surgical and invasive procedures, prolonged monitoring in the intensive care unit (ICU), and constant preventive vigilance by medical staff guide standards of care to promote positive outcomes. Recently, patients with traumatic injuries have benefited from early mobilization, a multidisciplinary approach to increasing participation in upright activity and walking. The purpose of this project was to determine the impact of an early mobility program in the trauma ICU on length of stay (LOS), ventilator days, cost, functional milestones, and rehabilitation utilization. A quality improvement project compared outcomes and cost before and after the implementation of an early mobility program. The trauma team assigned daily mobility levels to trauma ICU patients. Nursing and rehabilitation staff collaborated to set daily goals and provide mobility-based interventions. Forty-four patients were included in the preintervention group and 43 patients in the early mobility group. Physical therapy and occupational therapy were initiated earlier in the early mobilization group (p = .044 and p = .026, respectively). Improvements in LOS, duration of mechanical ventilation, time to out-of-bed activity and walking, and discharge disposition were not significant. There were no adverse events related to the early mobility initiative. Activity intolerance resulted in termination of 7.1% of mobility sessions. The development and initiation of a trauma-specific early mobility program proved to be safe and reduce patient care costs. In addition, the program facilitated earlier initiation of physician and occupational therapies. Although not statistically significant, retrospective data abstraction provides evidence of fewer ICU and total hospital days, earlier extubations, and greater proactive participation in functional activities.

Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative.

Introduction:Mobilizing patients during an intensive care unit admission results in improved clinical and functional outcomes. The goal of this quality improvement project was to increase the percentage of patients in the pediatric intensive care unit (PICU) mobilized early from 62% to 80%. Early mobilization was within 18 hours of admission for nonmechanically ventilated (non-MV) patients and 48 hours for mechanically ventilated (MV) patients.Methods:We collected data from September 15, 2015, to December 15, 2016, identified key drivers and barriers, and developed interventions. Interventions included the development of an algorithm to identify patients appropriate for mobilization, management of barriers to mobilization, and education on the benefits of early mobilization. The percentage of PICU patients mobilized early; the percentage of patients with physical therapy, occupational therapy (OT), speech-language pathology (SLP), and activity orders; identified barriers; PICU and hospital length of stay (LOS) and discharge disposition, were compared between the pre- and postintervention groups and the non-MV and MV subgroups. The MV subgroup was too small for statistical testing.Results:All measures in the combined postintervention group improved and reached significance (<0.05), except for the percentage of SLP orders and discharged home. Percentage mobilized early increased 25%, activity orders 50%, physical therapist orders 14%, OT orders 11%, SLP orders 7%, and discharged home 6%. Hospital LOS decreased by 35%, and PICU LOS decreased by 34%. All measures in the postintervention, non-MV subgroup improved and reached significance (<0.05).Conclusions:This early mobilization program was associated with statistically significant improvements in the rate of early mobilization, activity and therapy orders, and hospital and PICU LOS.

The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project.

The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project.

Change in Autonomic Nervous System Activity during an Early Mobilization Program for Patients after Coronary Artery Bypass Surgery

Change in Autonomic Nervous System Activity during an Early Mobilization Program for Patients after Coronary Artery Bypass Surgery

Level of function mobility scale for nurse-driven early mobilisation in people with acute cardiovascular disease.

There are currently no validated tools that are reliable and easy to use for nurses to assess mobility in people with acute cardiovascular disease in the Cardiovascular Intensive Care Unit (CICU). A multidisciplinary team at an academic tertiary care centre developed the Level of Function (LOF) Mobility Scale for use in a nurse-driven early progressive mobilisation in the CICU. To determine inter-rater reliability, the prehospital and admission LOF were assessed independently by two CICU nurses. Pairwise comparisons between raters were evaluated using Cohen's kappa statistic. To determine convergence validity, the LOF and Activity Measure for Post-Acute Care 6-Clicks score upon admission were compared with Spearman's correlation. To determine feasibility, a 9-item mobility scale questionnaire was distributed to CICU nurses with and without experience using the LOF Mobility Scale. The STROBE reporting guidelines were used. The LOF Mobility Scale had good inter-rater reliability for assessment of LOF prior to hospitalisation (N=131, kappa=0.66, p<.001) and at the time of CICU admission (N=131, kappa=0.71, p<.001). There was a moderate correlation (N=79 observations; correlation coefficient=0.525; p<.01) between the bedside nurses LOF and the 6-Clicks score. All nurses surveyed (N=54; 100%) thought that the LOF Mobility Scale was clear and unambiguous, the LOFs were well-defined and the scale was an appropriate length. Nearly all of the nurses with experience using the scale (N=22/24; 92%) felt that the scale took less than one minute to complete, compared with about half (N=14/30; 47%) in the group of nurses without experience using the scale. The LOF Mobility Scale is reliable and feasible for mobility assessment in a nurse-driven early progressive mobilisation programme in patients with acute cardiovascular disease in the CICU. A nurse-driven EM programme can be implemented in the CICU.