There is significant clinical evidence to support that early patient mobility as part of an ICU (Intensive Care Unit) rehabilitation program can help to counter the effects of ICU acquired weakness, which in turn can improve the patient recovery process and long-term functional outcomes.^1,2,3

Immobility can contribute in the development of weakness which is associated with functional impairment in an ICU survivors’ post discharge physical ability, quality of life, and eventual return to work.^4,5,6,7,8

Key body systems impacted by immobility in critically ill patients include the brain, lungs, heart, skin, and the musculoskeletal system⁹.

Critically ill patients may lose significant muscle mass; Herridge et al⁴ found an 18% reduction in body weight of ARDS patients at time of ICU discharge. In addition, physical inactivity contributes to the development of atelectasis, insulin resistance, and joint contractures.¹⁰

Early mobilisation including occupational and physiotherapy in the earliest days of critical illness has shown to be safe and well tolerated, resulting in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care.^11,12

Early mobilisation of ICU patients is performed with the aim to:

• Improve functional exercise capacity, self-perceived functional status, and muscle force at hospital discharge¹³
• Reduce ICU acquired weakness and improve quality of life¹⁴
• Decrease ICU and hospital length of stay^{5,15, 16}
• Reduce the risk for delirium¹⁷

Mobilising mechanically ventilated patients in ICU by sitting and standing out of bed has been demonstrated as feasible and safe.¹² There have been multiple studies demonstrating successful outcomes combined with low rates of serious adverse events.^{1, 2}  The recommendations of the European Respiratory Society and European Society of Intensive Care Medicine (ESICM) states that a multidisciplinary focus on early mobilisation is necessary as part of daily clinical routines in the ICU. 

Early activity and mobility programmes have proven to be safe and feasible, demonstrating improved functional outcomes for patients and cost benefits to healthcare facilities¹⁸

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References

1. McWilliams D (2017) Implementation of early and structured rehabilitation in ICU The importance of multidisciplinary team working and communication https://healthmanagement.org/uploads/article_attachment/mcwilliams-implementationrehab-2017-v17-i4.pdf[Accessed August 2022]
2. Engel HJ, Needham DM, Morris PE, Gropper MA (2013) ICU early mobilisation: from recommendation to implementation at three medical centers. Critical Care Med 2013 Sept; 41 (9 Suppl1) S 69 – 80.)
3. McWilliams DJ, Pantelides KP (2008) Does Physiotherapy led early mobilisation affect length of stay on ICU. ACPRC Journal. 40; 5-11
4. Herridge et al 2003 One-Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome https://www.nejm.org/doi/full/10.1056/NEJMoa022450Accessed August 2022
5. Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. CritCare Med. 2008;36(8):2238–2243,
6. Alder J, Malone D (2012) Early Mobilization in the Intensive Care Unit: A Systematic Review Journal List Cardiopulm Phys TherJ v.23(1); 2012 Mar; 23(1): 5–13
7. McWilliams, D., Weblin, J, Atkins G, BionJ, Williams J,  Elliott C, Whitehouse T, Snelson, C (2015) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: A quality improvement project Journal of critical care. 30(1):13-8
8. National Institute for Health and Care Excellence (2017) Implementing early and structured rehabilitation for patients admitted to critical care https://www.nice.org.uk/sharedlearning/implementating-early-and-structured-rehabilitation-for-patients-admitted-to-critical-care Accessed August 2022
9. ICU Early Mobility Solutions, Clinical Evidence Summary (2019) A00007.1.2.UKI.EN Page 4
10. Herridge M, Tansey C, Matte A et al (2011).Functional disability 5 years after acute respiratory distress syndrome. NEJM;  364(14):1293-­‐1304. https://www.nejm.org/doi/pdf/10.1056/NEJMoa1011802?articleTools=true [Accessed August 2022]
11. Brahmbhatt, N.,Murugan, R.,Milbrandt, E., (2010)  Early Mobilization Improves Functional Outcomes in Critically Ill patients

http://www.biomedcentral.com/content/pdf/cc9262.pdf [Accessed August 2022]

12. McWilliams D, Atkins G, HodsonJ et al. (2016) The Sara Combilizer® as an early mobilization aid for critically ill patients: A prospective before and after study. AustCritCare, 30(4): 189-195
13. Burtin C, Clerckx B, Robbeets C, et al.: Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med, 2009, 37: 2499–2505
14. Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017;43:171–183. doi: 10.1007/s00134-016-4612-0
15. Wang, YT., et al (2022) Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis*, Critical Care Medicine: March 2022 - Volume 50 - Issue 3 - p 375-388 https://journals.lww.com/ccmjournal/Fulltext/2022/03000/Physical_Rehabilitation_in_the_ICU__3.aspx Accessed August 2022
16. McWilliams D, Weblin J, Atkins G, Bion J, Williams J, Elliott C, Whitehouse T, Snelson C. Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project. J Crit Care. 2015 Feb;30(1):13-8. doi: 10.1016/j.jcrc.2014.09.018. Epub 2014 Oct 2. PMID: 25316527.
17. Devlin JW, SkrobikY, GélinasC, Needham DM, et al (2018)Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU CritCare Med. 2018 Sep;46(9):e825-e873.
18. Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, Brower RG, Fan E. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med 2010 Apr;91(4):536-42