Barriers and facilitators to implementation of early mobilisation of critically ill patients in Zimbabwean and South African public sector hospitals: a qualitative study.
Cathrine Tadyanemhandu, Heleen van Aswegen, Veronica Ntsiea
PMID 34461792WHAT IT FOUND
Physiotherapists in Zimbabwean and South African ICUs identified 23 barriers to early mobilisation.
Key obstacles included unclear team roles, low staff motivation due to pay, inconsistent referrals, and lack of equipment. Facilitators included dedicated staffing, awareness programmes, and clear protocols.
Key findings
01Participants identified a total of 23 barriers and 12 facilitators to early mobilisation, clustered into domains such as social/professional roles, beliefs about consequences, environmental context, and behavioural regulation.
02A major barrier was the lack of clarity regarding professional roles and accountability, including uncertainty about who could prescribe mobilisation and who was responsible for returning patients to bed.
03Environmental and resource barriers included inadequate staffing, lack of appropriate equipment like portable ventilators and hoists, and physical constraints from patient attachments and lines.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study only interviewed physiotherapists, so the perspectives of nurses, doctors, and other team members who influence mobilisation were not captured. Time constraints during interviews may have limited the depth of responses, as some participants rushed through the process. Findings are specific to public sector hospitals in Zimbabwe and South Africa and may not transfer to private sector or high-income country settings. The definition of 'early mobilisation' varied among participants, which may have influenced how barriers and facilitators were perceived.
Declared interests
The authors declare that they have no competing interests. The work was supported by non-U.S. government and N.I.H. extramural research funding.
The easy way to misread this
Do not interpret the identified barriers as evidence that early mobilisation is ineffective or unsafe. These are implementation challenges reported by therapists, not clinical outcomes. The study does not prove that overcoming these barriers improves patient recovery, only that these factors hinder the delivery of the intervention.