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Clinical Outcomes of Patient Mobility in a Neuroscience Intensive Care Unit

Mulkey, Malissa; Bena, James F.; Albert, Nancy M.

Journal of Neuroscience Nursing: June 2014 - Volume 46 - Issue 3 - p 153–161
doi: 10.1097/JNN.0000000000000053
Article

ABSTRACT: Background: Patients treated in a neuroscience intensive care unit (NICU) are often viewed as too sick to tolerate physical activity. In this study, mobility status in NICU was assessed, and factors and outcomes associated with mobility were examined. Methods: Using a prospective design, daily mobility status, medical history, demographics, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and clinical outcomes were collected by medical records and database review. Depression, anxiety, and hostility were assessed before NICU discharge. Analyses included comparative statistics and multivariable modeling. Results: In 228 unique patients, median (minimum, maximum) age was 64.0 (20, 95) years, 66.4% were Caucasian, and 53.6% were men. Of 246 admissions, median NICU stay was 4 (1, 61) days; APACHE III score was 56 (16, 145). Turning, range of motion, and head of bed of >30° were uniformly applied (n = 241), but 94 patients (39%) never progressed; 94 (39%) progressed to head of bed of >45° or dangling legs, 29 (12%) progressed to standing or pivoting to chair, and 24 (10%) progressed to walking. Female gender (p = .019), mechanical ventilation (p < .001), higher APACHE score (p = .004), and 30-day mortality (p = .001) were associated with less mobility. In multivariable modeling, greater mobility was associated with longer unit stay (p < .001) and discharge to home (p < .001). Psychological profile characteristics were not associated with mobility level. Conclusion: Nearly 40% of patients never progressed beyond bed movement, and only 10% walked. Although limited mobility progression was not associated with many patient factors, it was associated with poorer clinical outcomes. Implementation and evaluation of a progressive mobility protocol are needed in NICU patients. Video Abstract: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/JNN/A10.

Supplemental digital content is available in the article.

Question or comments about this article may be directed to Malissa Mulkey, MSN RN, at malissa.mulkey@duke.edu. She is a Clinical Nurse Specialist, Neuroscience Services, Duke University Hospital, Durham, NC.

James F. Bena, MS, is a Biostatistician at Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.

Nancy M. Albert, PhD CCNS CCRN FCCM, is an Associate Chief Nursing Officer at Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH.

This work was partially supported by a grant from the American Association of Neurological Nursing.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jnnonline.com).

© 2014 American Association of Neuroscience Nurses