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Randomized Controlled Trial
. 2024 May 22;28(1):172.
doi: 10.1186/s13054-024-04940-0.

Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial

Hsiao-Ching Yen  1 , Hung-Jui Chuang  2 , Wei-Ling Hsiao  2 , Yun-Chen Tsai  2 , Po-Min Hsu  2 , Wen-Shiang Chen  2 , Yin-Yi Han  3
Affiliations
Randomized Controlled Trial

Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial

Hsiao-Ching Yen et al. Crit Care. .

Abstract

Introduction: Traumatic brain injury (TBI) is a major cause of neurodisability worldwide, with notably high disability rates among moderately severe TBI cases. Extensive previous research emphasizes the critical need for early initiation of rehabilitation interventions for these cases. However, the optimal timing and methodology of early mobilization in TBI remain to be conclusively determined. Therefore, we explored the impact of early progressive mobilization (EPM) protocols on the functional outcomes of ICU-admitted patients with moderate to severe TBI.

Methods: This randomized controlled trial was conducted at a trauma ICU of a medical center; 65 patients were randomly assigned to either the EPM group or the early progressive upright positioning (EPUP) group. The EPM group received early out-of-bed mobilization therapy within seven days after injury, while the EPUP group underwent early in-bed upright position rehabilitation. The primary outcome was the Perme ICU Mobility Score and secondary outcomes included Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), the length of stay in the intensive care unit (ICU), and duration of ventilation.

Results: Among 65 randomized patients, 33 were assigned to EPM and 32 to EPUP group. The EPM group significantly outperformed the EPUP group in the Perme ICU Mobility and FIM-motor scores, with a notably shorter ICU stay by 5.9 days (p < 0.001) and ventilation duration by 6.7 days (p = 0.001). However, no significant differences were observed in PhAs.

Conclusion: The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI. Our study's results support further investigation of EPM through larger, randomized clinical trials. Clinical trial registration ClinicalTrials.gov NCT04810273 . Registered 13 March 2021.

Keywords: Early ambulation; Early mobilization; Intensive care; Intensive care units; Rehabilitation; Traumatic brain injury.

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Conflict of interest statement

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Fig. 1
Fig. 1
Flow diagram of patients based on CONSORT
Fig. 2
Fig. 2
Total scores from the Perme ICU Mobility Score (A) and Functional Independence Measure’s motor domain (FIM-Motor) (B) at baseline and subsequent follow-up assessments across both groups. The graphs display medians, first and third quartiles, and range. Plus symbols (+) indicate means, connected by lines to illustrate the comparative mean values between the two groups
See this image and copyright information in PMC

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