Early Therapeutic Mobility and Changes in Scores for Pain and Fatigue.
Chris Winkelman, Abdus Sattar, Hasina Momotaz and 4 others
PMID 31575592WHAT IT FOUND
Early mobility in 39 ICU patients showed only small average pain and fatigue score changes.
A few reports rose by 4 or more, especially at first sitting up, so assess before and after.
Key findings
01Pain and fatigue did not differ significantly after early therapeutic mobility between once-daily and twice-daily sessions or between in-bed and out-of-bed activities.
02On a 0 to 10 verbal numerical scale, the mean change in pain was 0.13 and the mean change in fatigue was 0.18.
03Increases of 4 to 5 occurred in 7 pain sessions (7%), and increases greater than 4 occurred in 9 fatigue reports (9%); all patients with these increases had out-of-bed activity such as sitting at the edge of the bed.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 39 patients were analyzed, and the study was not powered to give a definitive answer about pain or fatigue during early therapeutic mobility. All patients could communicate and had a Glasgow Coma Scale score of 12 or above, so findings do not apply to nonverbal patients or those with decreased consciousness. Pain relief was requested when pre-ETM pain was greater than 5, and only the reassessed pain score was used, so the results may reflect well-managed pain rather than unadjusted mobility. Patients could delay or have the activity slowed if fatigue was high, which may have reduced reported fatigue increases. The intensity range was narrow, with no in-bed cycling and no walking more than 1 meter, so it does not cover higher-intensity mobility. Pain and fatigue were not measured during the intervention, and the study did not measure whether the symptoms were distressing. The sample came from 4 ICUs in 2 academic medical centers, so generalizability to other ICU staffing models is unclear.
The easy way to misread this
Do not conclude that early therapeutic mobility is harmless for all ICU patients. This analysis included only 39 patients who could report pain or fatigue, was not powered, and allowed pain treatment and activity delays or slowing before and during ETM. Seven pain sessions (7%) and nine fatigue reports (9%) increased by 4 or more after the activity.