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VOLUME 25 , ISSUE 5 ( May, 2021 ) > List of Articles


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

Pooja Akhtar, Priyanka K Deshmukh

Citation Information : Akhtar P, 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.

DOI: 10.5005/jp-journals-10071-23835

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; The Author(s).


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.

  1. Fontela PC, ForgiariniJr LA, 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. DOI: 10.5935/0103-507X.20180037.
  2. Koo KK, Choong K, Cook DJ, Herridge M, Newman A, Lo V, et al. 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. DOI: 10.9778/cmajo.20160021.
  3. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. 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):1188–1199. DOI: 10.1007/s00134-008-1026-7.
  4. Hodgson CL, Capell E, Tipping CJ. Early mobilization of patients in intensive care: organization, communication and safety factors that influence translation into clinical practice. Critical Care 2018;22(1):1–7. DOI: 10.1186/s13054-018-1998-9.
  5. 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(2):171–183. DOI: 10.1007/s00134-016-4612-0.
  6. Zanni JM, Korupolu R, Fan E, Pradhan P, Janjua K, Palmer JB, et al. Rehabilitation therapy and outcomes in acute respiratory failure: anobservational pilot project. J Crit Care 2010;25(2):254–262. DOI: 10.1016/j.jcrc.2009.10.010.
  7. Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acuterespiratory failure: a quality improvement project. Arch Phys Med Rehabil 2010;91(4):536–542. DOI: 10.1016/j.apmr.2010.01.002.
  8. Engel HJ, Needham DM, Morris PE, Gropper MA. ICU early mobilization: from recommendation to implementation at three medical centers. Crit Care Med 2013;41(9 Suppl. 1):S69–S80. DOI: 10.1097/CCM.0b013e3182a240d5.
  9. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014;18(6):1–9. DOI: 10.1186/s13054-014-0658-y.
  10. Jolley SE, Regan-Baggs J, Dickson RP, Hough CL. 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. DOI: 10.1186/1471-2253-14-84.
  11. Balas MC, Burke WJ, Gannon D, Cohen MC, Colburn L, Bevil C, et al. 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 guidelines. Crit Care Med 2013;41(9 Suppl. 1):S116–S127. DOI: 10.1097/CCM.0b013e3182a17064.
  12. Carrothers KM, Barr J, Spurlock B, Ridgely MS, Damberg CL, Ely EW. 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–S135. DOI: 10.1097/CCM.0b013e3182a2c2b1.
  13. Dubb R, Nydahl P, Hermes C, Schwabbauer N, Toonstra A, Parker AM, et al. Barriers and strategies for early mobilization of patients in intensive care units. Ann Am Thorac Soc 2016;13(5):724–730. DOI: 10.1513/AnnalsATS.201509-586CME.
  14. Flanders SA, Harrington L, Fowler RJ. Falls and patient mobility in critical care: keeping patients and staff safe. AACN Adv Crit Care 2009;20(3):267–276. DOI: 10.1097/NCI.0b013e3181ac2628.
  15. Lee CM, Fan E. ICU-acquired weakness: what is preventing its rehabilitation in critically ill patients? BMC Med 2012;10:115. DOI: 10.1186/1741-7015-10-115.
  16. Doherty-King B, Bowers BJ. Attributing the responsibility for ambulating patients: a qualitative study. Int J Nurs Stud 2013;50(9): 1240–1246. DOI: 10.1016/j.ijnurstu.2013.02.007.
  17. Appleton RTD, MacKinnon M, Booth MG, Wells J, Quasim T. Rehabilitation within Scottish intensive care units: a national survey. J Intensive Care Soc 2011;12(3):221–227. DOI: 10.1177/175114371101200309.
  18. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point prevalence study in Germany. Crit Care Med 2014;42(5):1178–1186. DOI: 10.1097/CCM.0000000000000149.
  19. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373(9678):1874–1882. DOI: 10.1016/S0140-6736(09)60658-9.
  20. Hodgin KE, Nordon-Craft A, McFann KK, Mealer ML, Moss M. Physical therapy utilization in intensive care units: results from a national survey. Crit Care Med 2009;37(2):561–568. DOI: 10.1097/CCM.0b013e3181957449.
  21. Skinner EH, Berney S, Warrillow S, Denehy L. Rehabilitation and exercise prescription in Australian intensive care units. Physiotherapy 2008;94(3):220–229. DOI: 10.1016/
  22. Kumar JA, Maiya AG, Pereira D. Role of physiotherapists in intensive care units of India: a multicenter survey. Indian Crit Care Med 2007;11(4):198–203. DOI:10.4103/0972-5229.37715.
  23. Vazquez A, Arnold S, Johnson MM. Early mobilization of intensive care unit patients: staff attitudes and opinions. Am J RespirCrit Care Med 2010;181:A3767. DOI: 10.1164/ajrccm-conference.2010.181.1_MeetingAbstracts.A3767.
  24. Doherty-King B, Yoon JY, Pecanac K, Brown R, Mahoney J. Frequency and duration of nursing care related to older patient mobility. J Nurs Scholarsh 2014;46(1):20–27. DOI: 10.1111/jnu.12047.
  25. Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S, Bittner EA, et al. Early mobilization in critically ill patients: patients’ mobilization level dependson health care provider's profession. PM R 2011;3(4):307–313. DOI: 10.1016/j.pmrj.2010.12.022.
  26. Schweickert WD, Kress JP. Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest 2011;140(6):1612–1617. DOI: 10.1378/chest.10-2829.
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