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Clinical and Psychological Effects of Early Mobilization in Patients Treated in a Neurologic ICU: A Comparative Study*

Klein, Kate ACNP-BC, CCRN1; Mulkey, Malissa MSN, RN, CCNS, CCRN, CNRN2; Bena, James F. MS3; Albert, Nancy M. PhD, CCNS, CCRN, FCCM4

doi: 10.1097/CCM.0000000000000787
Neurologic Critical Care

Objective: To determine if an early mobilization protocol increased mobility and improved clinical and psychological outcomes. Currently, there is minimal research on the effects of early mobilization in patients with primary neurologic injury.

Design: Prospective, two-group pre/post comparative design with data collection 4 months pre- and postintervention with a 4-month run-in period.

Setting: Twenty-two-bed neurologic ICU in a 1,200-bed urban, quaternary-care, academic hospital in Northeast Ohio.

Subjects: Critically ill patients with primary neurologic injury admitted to the neurologic ICU.

Intervention: An early mobility program included a progressive mobility protocol, written orders, and staff (clinical nurse specialist clinical technician) who advocated for and assisted with mobility. Highest mobility achieved was assessed daily for 13 days, clinical outcomes were retrieved from electronic databases, and psychological profile was collected by valid, reliable questionnaire at/after neurologic ICU discharge. Analyses included comparative statistics and multivariable modeling.

Measurements and Main Results: Of 637 patients, 260 were preintervention and 377 were postintervention. Patient characteristics were similar between groups, except postintervention group patients had less history of using walking aids and more gait abnormalities, and were less likely to require mechanical ventilation in the neurologic ICU (all p ≤ 0.006). Compared with preintervention, postintervention patients had higher mobility levels and decreased hospital and neurologic ICU length of stay; were more likely to be discharged home (all p ≤ 0.002); had decreased bloodstream infection, hospital-acquired pressure ulcer, and anxiety rates (all p < 0.03); and had no change in mortality, ventilator-associated pneumonia, deep vein thrombosis, depression, and hostility. In multivariable analyses, postintervention patients had higher mobility levels (p < 0.001), had shorter mean hospital and neurologic ICU length of stay (both p < 0.001), and were more likely to be discharged home (p = 0.033) compared with preintervention patients.

Conclusions: A neurologic ICU early mobility protocol increased highest neurologic ICU mobility and discharge home and decreased length of stay, but did not improve quality metrics or psychological profile.

1Neurological Intensive Care Unit, Cleveland Clinic Foundation, Cleveland, OH.

2Neuroscience Services, Duke University Hospital, Durham, NC.

3Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, OH.

4Nursing Research and Innovation, Cleveland Clinic Health System, Cleveland OH.

* See also p. 926.

Supported, in part, by the American Association of Neurological Nurses and Hill-Rom, Batesville, IN, and by internal funding from the Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland OH.

Ms. Klein’s institution received grant support from Hill-Rom and American Association of Neurological Nurses (AANN), and she received an honorarium from Hill-Rom for speaking at a national meeting. Ms. Mulkey’s former institution received grant support from Hill-Rom and AANN Dr. Albert’s institution received grant support from Hill-Rom and AANN. Mr. Bena has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: kleink@ccf.org

Copyright © by 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.