Early mobilization in clinical practice: the reliability and feasibility of the 'Start To Move' Protocol

Early mobilization in intensive care unit in Latin America: A survey based on clinical practice

BACKGROUND

The application of early mobilization (EM) in intensive care units (ICUs) has shown to improve the physical and ventilatory status of critically ill patients, even after ICU stay. This study aimed to describe the practices regarding EM in ICUs in Latin America.

METHODS

We conducted an observational, cross-sectional study of professionals from all countries in Latin America. Over 3 months, professionals working in ICU units in Latin America were invited to answer the survey, which was designed by an expert committee and incorporated preliminary questions based on studies about EM recommendations.

RESULTS

As many as 174 health professionals from 17 countries completed the survey. The interventions carried out within each ICU were active mobilization (90.5%), passive mobilization (85.0%), manual and instrumental techniques for drainage of mucus secretion (81.8%), and positioning techniques (81%). The professionals who most participated in the rehabilitation process in ICUs were physiotherapists (98.7%), intensive care physicians (61.6%), nurses (56.1%), and respiratory therapists (43.8%). In only 36.1% of the ICUs, protocols were established to determine when a patient should begin EM. In 38.1% of the cases, the onset of EM was established by individual evaluation, and in 25.0% of the cases, it was the medical indication to start rehabilitation and EM.

CONCLUSION

This report shows us that EM of critically ill patients is an established practice in our ICUs like in other developed countries.

Impact of Physiotherapy on Patients Suffering from COVID-19: An Observational Study

Introduction: COVID-19 was the turning point of 2020, endangering the health of the entire population around the world. Among other therapeutic methods and supportive measures, physiotherapy represents a useful intervention applied on COVID-19 patients suffering from respiratory symptoms, this being supported by recent literature data. Materials and Methods: The study was performed on 45 patients diagnosed with COVID-19 (28 men, 17 women, mean age = 65.03, standard deviation = 14.83). They participated for 2 weeks (the required period of hospitalization) to a series of 14 physiotherapy sessions, which included: position changing, respiratory control, passive joint movements, bed workout, and walking exercises. Depending on the status of the patient, two distinct types of physiotherapy were performed (mild and active). The status of the patients was assessed through a basic assessment of the vital signs, range of motion, degree of dyspnea, and also through the UZ Leuven Start To Move protocol (STMP). The statistical analysis of the data was performed using the Statistica 10 program and included the Spearman correlations (for measuring the strength and direction of association between the ranked variables), the Mann-Whitney test (for measuring the significance of the differences between the groups of patients who undergone light vs. active physiotherapy) and factor analysis (for assessing the changes of the clinical parameters investigated in the study, depending on the type of applied therapy). All differences were considered significant at p < 0.05. Results: The majority of patients (n = 38) benefited from physiotherapy, with the complete disappearance of symptoms met only in the group of patients who followed active physiotherapy. These effects depended on the applied type of physiotherapy (mild vs. active, p = 0.47). In contrast, all patients who were unable to perform physiotherapy (n = 7) remained symptomatic at discharge. Conclusion: The results of this study point out the significant additional role of physiotherapy for a better management of COVID-19 patients. More studies are needed to investigate not only the impact that physiotherapy has on the symptoms of this disease, but also its effects on effort capacity, muscle strength and lung capacity.