Knowledge, Attitudes, and Perceived Barriers of Healthcare Providers Toward Early Mobilization of Adult Critically Ill Patients in Intensive Care Unit

Overview

Journal Indian J Crit Care Med

Specialty Critical Care

Date 2021 Jun 28

PMID 34177169

Citations 9

Authors

Pooja M Akhtar

Priyanka K Deshmukh

Affiliations

Soon will be listed here.

Abstract

Background: Early mobilization (EM) of critically ill adult patients in intensive care units (ICUs) is a newer concept. It is known to improve overall outcomes, but little is known regarding the attitude and knowledge of healthcare providers (HCPs) and multidisciplinary barriers to its use in the Indian scenario.

Aims And Objectives: To study the knowledge and attitude of HCPs in ICU about the EM of adult patients who are critically ill and identify perceived barriers to the application of EM.

Materials And Methods: In a cross-sectional survey conducted in a tertiary care academic institute, the HCPs, namely, physicians, anesthetists, surgeons, nursing staff, and physiotherapists working in ICU were interviewed using a self-structured questionnaire. The data were presented as descriptive statistics.

Results: There was 80% response rate. The benefits of EM as shortened length of mechanical ventilation (MV) were acknowledged by 78% respondents and 54% believed that it maintains muscle strength. It was considered crucial by 44% respondents, who opined that it should be started as the patient's cardiorespiratory status stabilizes. The favorable attitudes observed were recognition of benefits for patients under MV exceeded the risks and readiness by physicians to reduce sedation levels and change the parameters of MV. The main barriers identified were the absence of written guidelines or protocols for EM, limited staff to mobilize patients, inadequate training of HCP to facilitate EM, excessive sedation, and medical instability.

Conclusion: There exists an awareness of the benefits of EM and favorable attitudes to its application. However, the actual performance of EM was perceived as a challenge due to barriers identified in the study.

How To Cite This Article: Akhtar PM, Deshmukh PK. Knowledge, Attitudes, and Perceived Barriers of Healthcare Providers toward Early Mobilization of Adult Critically Ill Patients in Intensive Care Unit. Indian J Crit Care Med 2021;25(5):512-518.

Citing Articles

Early mobilisation in Windhoek intensive care units: Practices, attitudes and barriers.

du Plessis I, Francis S, Morrow B S Afr J Physiother. 2025; 81(1):2118.

PMID: 39968025 PMC: 11830905. DOI: 10.4102/sajp.v81i1.2118.

Perceived Barriers of Clinical Roles Towards Intensive Care Unit Mobility.

Aljohani H, Alammar S, Alnawmasi S, Alfawzan R, Alotaibi N, Mumenah N Rehabil Res Pract. 2024; 2024:5551184.

PMID: 39286774 PMC: 11405107. DOI: 10.1155/2024/5551184.

A Culture of Early Mobilization in Adult Intensive Care Units: Perspective and Competency of Physicians.

Albarrati A, Aldhahi M, Almuhaid T, Alnahdi A, Alanazi A, Alqahtani A Healthcare (Basel). 2024; 12(13).

PMID: 38998835 PMC: 11241168. DOI: 10.3390/healthcare12131300.

Current Practice and Barriers to the Implementation of Mobilization in ICUs in Japan: A Multicenter Prospective Cohort Study.

Sakuramoto H, Nakamura K, Ouchi A, Okamoto S, Watanabe S, Liu K J Clin Med. 2023; 12(12).

PMID: 37373649 PMC: 10299081. DOI: 10.3390/jcm12123955.

Clinicians' knowledge and attitude towards early mobilization in intensive care units in Ethiopian tertiary hospitals: A multi-centre study.

Dagnachew T, Berhe Y, Yalew Mustofa S, Chekol W SAGE Open Med. 2023; 11:20503121231172348.

PMID: 37205156 PMC: 10186578. DOI: 10.1177/20503121231172348.

References

Zanni J, Korupolu R, Fan E, Pradhan P, Janjua K, Palmer J . Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. J Crit Care. 2009; 25(2):254-62. DOI: 10.1016/j.jcrc.2009.10.010. View

Schweickert W, Pohlman M, Pohlman A, Nigos C, Pawlik A, Esbrook C . Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678):1874-82. PMC: 9906655. DOI: 10.1016/S0140-6736(09)60658-9. View

Carrothers K, Barr J, Spurlock B, Ridgely M, Damberg C, Wesley Ely E . Contextual issues influencing implementation and outcomes associated with an integrated approach to managing pain, agitation, and delirium in adult ICUs. Crit Care Med. 2013; 41(9 Suppl 1):S128-35. DOI: 10.1097/CCM.0b013e3182a2c2b1. View

Koo K, Choong K, Cook D, Herridge M, Newman A, Lo V . Early mobilization of critically ill adults: a survey of knowledge, perceptions and practices of Canadian physicians and physiotherapists. CMAJ Open. 2016; 4(3):E448-E454. PMC: 5047804. DOI: 10.9778/cmajo.20160021. View

Dubb R, Nydahl P, Hermes C, Schwabbauer N, Toonstra A, Parker A . Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units. Ann Am Thorac Soc. 2016; 13(5):724-30. DOI: 10.1513/AnnalsATS.201509-586CME. View

Doherty-King B, Bowers B . Attributing the responsibility for ambulating patients: a qualitative study. Int J Nurs Stud. 2013; 50(9):1240-6. PMC: 3711943. DOI: 10.1016/j.ijnurstu.2013.02.007. View

Fontela P, Forgiarini Jr L, Friedman G . Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units. Rev Bras Ter Intensiva. 2018; 30(2):187-194. PMC: 6031424. DOI: 10.5935/0103-507X.20180037. View

Needham D, Korupolu R, Zanni J, Pradhan P, Colantuoni E, Palmer J . Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010; 91(4):536-42. DOI: 10.1016/j.apmr.2010.01.002. View

Tipping C, Harrold M, Holland A, Romero L, Nisbet T, Hodgson C . The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2016; 43(2):171-183. DOI: 10.1007/s00134-016-4612-0. View

10.

Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M . Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008; 34(7):1188-99. DOI: 10.1007/s00134-008-1026-7. View

11.

Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S, Bittner E . Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession. PM R. 2011; 3(4):307-13. DOI: 10.1016/j.pmrj.2010.12.022. View

12.

Hodgin K, Nordon-Craft A, McFann K, Mealer M, Moss M . Physical therapy utilization in intensive care units: results from a national survey. Crit Care Med. 2008; 37(2):561-6. PMC: 2908523. DOI: 10.1097/CCM.0b013e3181957449. View

13.

Nydahl P, Ruhl A, Bartoszek G, Dubb R, Filipovic S, Flohr H . Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2013; 42(5):1178-86. DOI: 10.1097/CCM.0000000000000149. View

14.

Doherty-King B, Yoon J, Pecanac K, Brown R, Mahoney J . Frequency and duration of nursing care related to older patient mobility. J Nurs Scholarsh. 2013; 46(1):20-7. DOI: 10.1111/jnu.12047. View

15.

Schweickert W, Kress J . Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest. 2011; 140(6):1612-1617. DOI: 10.1378/chest.10-2829. View

16.

Balas M, Burke W, Gannon D, Cohen M, Colburn L, Bevil C . Implementing the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle into everyday care: opportunities, challenges, and lessons learned for implementing the ICU Pain, Agitation, and Delirium.... Crit Care Med. 2013; 41(9 Suppl 1):S116-27. PMC: 4096994. DOI: 10.1097/CCM.0b013e3182a17064. View

17.

Lee C, Fan E . ICU-acquired weakness: what is preventing its rehabilitation in critically ill patients?. BMC Med. 2012; 10:115. PMC: 3520774. DOI: 10.1186/1741-7015-10-115. View

18.

Jolley S, Regan-Baggs J, Dickson R, Hough C . Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study. BMC Anesthesiol. 2014; 14:84. PMC: 4192294. DOI: 10.1186/1471-2253-14-84. View

19.

Flanders S, Harrington L, Fowler R . Falls and patient mobility in critical care: keeping patients and staff safe. AACN Adv Crit Care. 2009; 20(3):267-76. DOI: 10.1097/NCI.0b013e3181ac2628. View

20.

Engel H, Needham D, Morris P, Gropper M . ICU early mobilization: from recommendation to implementation at three medical centers. Crit Care Med. 2013; 41(9 Suppl 1):S69-80. DOI: 10.1097/CCM.0b013e3182a240d5. View