Patient, Practice, and Organizational Factors Associated With Early Mobility Performance in Critically Ill Adults.
Anna E Krupp, Alai Tan, Eduard E Vasilevskis and 6 others
PMID 39217113WHAT IT FOUND
In ICU records, prior-day physical or occupational therapy, sedation targets, awakening trials, breathing trials, and safety screens were linked with more next-day mobility.
Deep sedation, delirium, restraints, benzodiazepines, and mechanical ventilation were linked with less.
Key findings
01A prior-day physical or occupational therapy session was associated with higher odds of next-day early mobility.
02Deep sedation, delirium, benzodiazepines, mechanical ventilation, and physical restraints were associated with lower odds of next-day early mobility.
03Black patients were less likely than White patients to receive next-day early mobility, and Hispanic patients were less likely than non-Hispanic patients.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
This was an observational record review, so it shows associations, not that any factor caused more or less mobility. Sites volunteered for a quality improvement collaborative focused on the ABCDEF bundle, so they may not represent ordinary ICUs. Data covered only the first 7 days of ICU stay, so long-stay patients and later mobility patterns are missing. No safety events were recorded, so the analysis cannot tell whether mobility attempts were unsafe or appropriately withheld. Data were collected before the COVID-19 pandemic, so staffing and infection-control pressures may have changed the practice. The paper observed race and ethnicity differences but did not explain the mechanisms behind them.
Declared interests
The supplied text does not include a conflict-of-interest declaration. The article metadata lists non-U.S. government and NIH extramural research support.
The easy way to misread this
Do not conclude that PT or OT visits, safety screens, or fewer pain assessments caused more mobility. The study analysed records and adjusted associations. It did not randomise these practices, and the authors state the estimates are not causal.