Immobilization and subsequent weakness are consequences of critical illness. Despite the theoretical advantages of physical therapy
to address this problem, it has not been shown that physical therapy
initiated in the intensive care unit offers benefit.
Design and Setting:
Prospective cohort study in a university medical intensive care unit that assessed whether a mobility
protocol increased the proportion of intensive care unit patients receiving physical therapy
vs. usual care.
Medical intensive care unit patients with acute respiratory failure
requiring mechanical ventilation
on admission: Protocol, n = 165; Usual Care, n = 165.
An intensive care unit Mobility
Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation
Measurements and Main Results:
The primary outcome was the proportion of patients receiving physical therapy
in patients surviving to hospital discharge. Baseline characteristics were similar between groups. Outcome data are reflective of survivors. More Protocol patients received at least one physical therapy
session than did Usual Care (80% vs. 47%, p
≤ .001). Protocol patients were out of bed earlier (5 vs. 11 days, p
≤ .001), had therapy initiated more frequently in the intensive care unit (91% vs. 13%, p
≤ .001), and had similar low complication rates compared with Usual Care. For Protocol patients, intensive care unit length of stay was 5.5 vs. 6.9 days for Usual Care (p
= .025); hospital length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual Care (p
= .006) (intensive care unit/hospital length of stay adjusted for body mass index, Acute Physiology and Chronic Health Evaluation II, vasopressor). There were no untoward events during an intensive care unit Mobility
session and no cost difference (survivors + nonsurvivors) between the two arms, including Mobility
Team using a mobility
protocol initiated earlier physical therapy
that was feasible, safe, did not increase costs, and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy
during intensive care unit treatment compared with patients who received usual care.