Early mobilization intensivist physiotherapy practice: Interventions and barriers

Abstract

INTRODUCTION: Patients in the Intensive Care Unit (ICU) require long periods of hospitalization, being subjected to immobilization, which results in significant loss of muscle mass. Early mobilization is a therapy performed in the ICU environment and aims to reduce functional impairment resulting from hospitalization. OBJECTIVE: To analyze the practice of early mobilization performed by the intensive care physiotherapist, identify the main interventions used by these professionals, and describe the barriers found that make early mobilization unfeasible in patients admitted to intensive care units. METHODOLOGY: Field study, quantitative and transversal, carried out between February and May 2020, with intensive care physiotherapists from three hospitals in the city of Fortaleza, namely two of them are from the public network (one municipal and the other state) and the other from the private network. Intensive care physiotherapists working in the mentioned hospitals and who have a link with the institution were included in the study. Physiotherapists in the role of residents, interns, and preceptors present were excluded. For data collection, the online electronic form was made possible through the Google Forms application. The data were analyzed and tabulated using the Statistical Package for the Social Sciences (SPSS) version 20.0. The chi-square statistical tests were to determine differences in the responses of the safety criteria and barriers to the implementation of early mobilization and the length of experience in the intensive care unit and Kruskal-Wallis to compare early mobilization interventions between groups of physiotherapists from the three hospitals. RESULTS: 68 physiotherapists participated in the research, the majority (36.8%) having worked in intensive care for 6 to 10 years. The management of early mobilization is performed mostly by the physiotherapist. Regarding functional scales used in the ICU, the Medical Research Council (MRC) was the most cited by professionals with (67.7%). The most used mobilization strategy was sedestation (91.2%). Respiratory distress was the most frequently cited clinical situation for interrupting early mobilization (83.8%). CONCLUSION: The most frequent interventions were sedation, the cycle ergometer, and transfers from an armchair bed. The patient-related barriers were hemodynamic instability, use of sedative and analgesic drugs.