Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 20;11(1):56.
doi: 10.1186/s40560-023-00703-1.

The optimal dose of mobilisation therapy in the ICU: a prospective cohort study

Marco Lorenz  1   2 , Kristina Fuest  1 , Bernhard Ulm  1   3 , Julius J Grunow  2 , Linus Warner  2 , Annika Bald  2 , Vanessa Arsene  2 , Michael Verfuß  2 , Nils Daum  2 , Manfred Blobner  1   3 , Stefan J Schaller  4   5
Affiliations

The optimal dose of mobilisation therapy in the ICU: a prospective cohort study

Marco Lorenz et al. J Intensive Care. .

Abstract

Background: This study aimed to assess the impact of duration of early mobilisation on survivors of critical illness. The hypothesis was that interventions lasting over 40 min, as per the German guideline, positively affect the functional status at ICU discharge.

Methods: Prospective single-centre cohort study conducted in two ICUs in Germany. In 684 critically ill patients surviving an ICU stay > 24 h, out-of-bed mobilisation of more than 40 min was evaluated.

Results: Daily mobilisation ≥ 40 min was identified as an independent predictor of an improved functional status upon ICU discharge. This effect on the primary outcome measure, change of Mobility-Barthel until ICU discharge, was observed in three different models for baseline patient characteristics (average treatment effect (ATE), all three models p < 0.001). When mobilisation parameters like level of mobilisation, were included in the analysis, the average treatment effect disappeared [ATE 1.0 (95% CI - 0.4 to 2.4), p = 0.16].

Conclusions: A mobilisation duration of more than 40 min positively impacts functional outcomes at ICU discharge. However, the maximum level achieved during ICU stay was the most crucial factor regarding adequate dosage, as higher duration did not show an additional benefit in patients with already high mobilisation levels.

Trial registration: Prospective Registry of Mobilization-, Routine- and Outcome Data of Intensive Care Patients (MOBDB), NCT03666286. Registered 11 September 2018-retrospectively registered, https://classic.

Clinicaltrials: gov/ct2/show/NCT03666286 .

Keywords: Early mobilisation; Functional status; ICU; Mobilisation; Physical therapy modalities.

PubMed Disclaimer

Conflict of interest statement

SJS received grants and non-financial support from Reactive Robotics GmbH (Munich, Germany), ASP GmbH (Attendorn, Germany), STIMIT AG (Biel, Switzerland), ESICM (Geneva, Switzerland), grants, personal fees, and non-financial support from Fresenius Kabi Deutschland GmbH (Bad Homburg, Germany), grants from the Innovationsfond of The Federal Joint Committee (G-BA), personal fees from Springer Verlag GmbH (Vienna, Austria) for educational purposes and Advanz Pharma GmbH (Bielefeld, Germany), non-financial support from national and international societies (and their congress organisers) in the field of anesthesiology and intensive care medicine, outside the submitted work. Dr. Schaller holds stocks in small amounts from Alphabet Inc., Bayer AG, and Siemens AG; these holdings have not affected any decisions regarding his research or this study.

Figures

Fig. 1
Fig. 1
Strobe diagram
Fig. 2
Fig. 2
Model-based recursive partitioning with all confounding variables for the influence of duration of mobilisation on ∆ MTB until ICU discharge. The minimum number of patients in each end node was set to 10% of the sample size. Blue points represent mean ∆ MTB until ICU discharge of each group. ATE were calculated using linear regression models. *= 0.001. ATE average treatment effects,MTB mobility-transfer-Barthel, ICU intensive care unit, SOMS Surgical ICU optimal mobilisation score
See this image and copyright information in PMC

References

    1. Hodgson CL, Udy AA, Bailey M, Barrett J, Bellomo R, Bucknall T, et al. The impact of disability in survivors of critical illness. Intensive Care Med. 2017;43(7):992–1001. doi: 10.1007/s00134-017-4830-0. - DOI - PubMed
    1. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–1304. doi: 10.1056/NEJMoa1011802. - DOI - PubMed
    1. Kamdar BB, Huang M, Dinglas VD, Colantuoni E, von Wachter TM, Hopkins RO, et al. Joblessness and lost earnings after acute respiratory distress syndrome in a 1-year national multicenter study. Am J Respir Crit Care Med. 2017;196(8):1012–1020. doi: 10.1164/rccm.201611-2327OC. - DOI - PMC - PubMed
    1. Spies CD, Krampe H, Paul N, Denke C, Kiselev J, Piper SK, et al. Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings—results of an expert consensus and feasibility field test. J Intensive Care Soc. 2021;22(2):159–174. doi: 10.1177/1751143720923597. - DOI - PMC - PubMed
    1. Rengel KF, Hayhurst CJ, Pandharipande PP, Hughes CG. Long-term cognitive and functional impairments after critical illness. Anesth Analg. 2019;128(4):772–780. doi: 10.1213/ANE.0000000000004066. - DOI - PubMed

Associated data