An evaluation of mobility in the intensive care unit - one size may not fit all.

Abstract

Patients who step to a chair on ICU discharge experience better post-intensive care unit (ICU) management and in-hospital outcomes. Evidence identifying patients more or less likely to achieve this milestone is limited. This service evaluation identifies factors associated with achieving a step transfer on ICU discharge and explores its relationship with rehabilitation delivery. A retrospective analysis of 355 consecutive patients admitted to a UK general ICU for ≥5 days was conducted. Multivariable logistic regression analysed demographic and clinical variables for independence of association with achieving a step to a chair (Manchester Mobility Score [MMS] ≥ 5) on ICU discharge. Absence of ICU-Acquired Weakness (ICU-AW) was independently associated with achieving MMS ≥5 on ICU discharge (OR 6.09 95% CI 1.24 to 29.80 <i>p</i> = 0.03). Patients achieving MMS ≥5 on first mobility utilised less rehabilitation resource (MMS ≥5 4 sessions vs MMS ≤4 7, <i>p</i> < 0.001), achieving higher discharge mobility levels (MMS 7 vs 5, <i>p</i> < 0.001) in a shorter time frame (3 days vs 6, <i>p</i> < 0.001). Rehabilitation interventions should be prioritised for patients presenting with ICU-AW. Resources should be reappropriated to patients not achieving MMS ≥5 on their first mobility in ICU, to deliver impairment focussed and individualised rehabilitation.