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Keywords

Activities of daily living, Critical care, Early mobility

 

Authors

  1. Tymkew, Heidi DPT, MHS, PT, CCS
  2. Sledge, Jennifer A. PhD, MSW
  3. Vyers, Kara BS
  4. Arroyo, Cassandra PhD, MS
  5. Schallom, Marilyn PhD, RN, CCNS, CCRN-K

Abstract

Background: Early mobility benefits include improved strength, decreased length of stay (LOS), and delirium. The impact of an early mobility protocol on return to activities of daily living (ADL) is less studied.

 

Objective: The aim of this study was to examine 1-year outcomes including ADL performance after the institution of an ICU early mobility protocol.

 

Methods: One year after the initiation of an early mobility protocol in 7 intensive care units (ICUs) at an academic medical center, patients with an ICU stay of 7 days or more were enrolled in a 1-year follow-up phone call study. Baseline demographic data included the following: average ICU mobility and highest ICU mobility level achieved (4 levels), highest ICU mobility score (10 levels) at ICU admission, ICU discharge (DC), hospital DC, LOS, and delirium positive days. At 4 time points after DC (1, 3, 6, 12 months), patients were contacted regarding current residence, employment, readmissions, and current level of ADL from the Katz ADL (scored 0-6) and Lawton instrumental ADL scales (scored 0-8).

 

Results: A convenience sample of 106 patients was enrolled with a mean age of 58 +/- 15.4 years, ICU LOS of 18 +/- 11.5 days, and hospital LOS of 37.5 +/- 31 days; 58 (55%) were male; 4 expired before DC. Mobility results included mean mobility level of 1.6 +/- 0.8, mean highest mobility level 3.3 +/- 0.9; ICU mobility score was 5.9 +/- 2.4 at time of ICU DC and 7.3 +/- 2.5 at hospital DC. Katz ADL scores improved from 4.8 at 1 month to 5.6 at 12 months (P = .002), and Lawton IADL scores improved from 4.2 to 6.6 (P < .001). Mobility scores were predictors of 1 month Katz (P = .004) and Lawton (P < .001) scores. None of the mobility levels or scores were predictive for readmissions. Most patients were not working before admission, and not all returned to work. Days positive for delirium were predictive of 1 month Katz and Lawton (P = .014, .002) scores. Impact of delirium was gone by 1 year.

 

Discussion: In this critically ill patient population followed for 1 year, ICU mobility positively impacted return to ADLs and improved ADLs over time but not readmissions. Delirium positive days decreased ADL scores, but the effect diminished over time.