Preventing muscle loss through early mobilization in non-critically ill older adults admitted to surgical intensive care units

Abstract

Intensive care unit-acquired weakness impairs recovery among older adults. We evaluated whether an early mobilization protocol reduces loss of muscle strength and mass compared with usual care in postoperative surgical intensive care unit (SICU) patients. In a before-and-after cohort at Siriraj Hospital, Thailand, 90 patients aged ≥ 65 years received usual care (June 2018–October 2019) and 90 subsequent patients followed a protocol-driven early-mobilization program (October 2019–November 2021). Daily assessments included muscle strength, Medical Research Council sum score (MRC-SS) and handgrip dynamometry, muscle mass (bioelectrical impedance vector analysis), and SICU optimal mobilization score (SOMS). Functional status 1 week post-discharge was measured by telephone using the Barthel Index for activities of daily living (ADL). Groups were comparable in age, sex, Acute Physiology and Chronic Health Evaluation II, and sequential organ failure assessment scores. The median change in the MRC-SS was + 1 point in both groups (P = 0.149), and the median muscle-mass change was + 0.2 kg versus + 0.5 kg (P = 0.713). The intervention arm achieved a higher median SOMS (2.0 vs. 1.0; P < 0.001) and fewer nosocomial infections (11.1% vs. 35.6%; P < 0.001). Barthel ADL scores improved in proportion to rehabilitation intensity, and no serious mobilization-related adverse events occurred. Early mobilization did not significantly alter muscle strength or mass but safely increased mobilization intensity, reduced infections, and improved short-term functional outcomes in older SICU patients. Trial registration: Thai Clinical Trials Registry. Trial no. TCTR20210203006. Retrospectively registered on January 31, 2021.