Authors (including presenting author) :
Man JYH(1), Fong HC(1), Lam YC(1), Cheung PC(1), Kwan WS(2), To WK(1)
Affiliation :
(1)Physiotherapy Department, Pok Oi Hospital, (2)Physiotherapy Department, Tuen Mun Hospital
Introduction :
ICU admissions often lead to prolonged immobilisation, causing a decline in functional mobility and ICU-acquired weakness. Despite recent advances in critical care, integrating systematic early mobility programmes remains limited. This study serves to evaluate the ICU Early Mobilisation programme at Pok Oi Hospital.
Objectives :
To reduce the incidence of ICU-acquired weakness and to enhance overall functional mobility upon discharge from ICU.
Methodology :
All ICU patients indicated for early mobilisation were recruited except those with unstable medical conditions. Passive range of motion exercises (Level 1), strengthening exercises (Level 2), functional mobility (Level 3) and ambulatory training (Level 4), were given according to the patient’s consciousness level, medical condition and muscle strength. Medical Research Council Sum-Score (MRC-SS) and ICU Mobility Scale (ICUMUS) were measured upon ICU admission and discharge. Wilcoxon signed-rank test was conducted to reveal any significant changes. Subgroup analysis was performed by categorising recruits based on their initial mobility level corresponding to the appropriate level of treatment received.
Result & Outcome :
Data collected from Oct-2023 to Sept-2024 was reviewed. 291 patients with an average age of 62.4 ± 15.0 were recruited. Initially, there were 64 (22%) Level 1, 162 (56%) Level 2, 29 (10%) Level 3 and 36 (12%) Level 4 patients respectively. 1388 treatment sessions were conducted, averaging 4.7 sessions per patient. No adverse events were reported.
There was a significant overall improvement in ICUMS (d = 4.24, z = 13.41, p < 0.01) and MRC-SS (d = 12.6, z = 9.03, p < 0.01). Subgroup analysis revealed the largest significant enhancement of ICUMS in Level 2 (d = 5.43, z = 11.02, p < 0.01), followed by Level 1 (d = 4.75, z = 6.71, p < 0.01), with both surpassing the minimal important difference of 3, underscoring clinical significance. Level 3 showed the least significant increase (d = 1.34, z = 3.16, p < 0.01). For MRC-SS, the improvement was significant in Level 1 (d = 29.1, z = 6.33, p < 0.01) and Level 2 (d = 7.85, z = 6.33, p < 0.01). Level 3 demonstrated no significant improvement in MRC-SS (z = 2.16, p = 0.03). No significant changes in ICUMS and MRC-SS were observed in Level 4.
The programme demonstrated clinical significance in enhancing patient mobility and effectively combating ICU-acquired weakness. Structured ICU early mobilisation should continue as a standard practice.
