Effect of a structured early mobilization protocol on the level of mobilization and muscle strength in critical care patients: A randomized clinical trial

Background Few studies have evaluated the effects of structured early mobilization (EM) protocols on the level of mobilization in critical care patients.Objective To evaluate the impact of a structured EM protocol on the level of mobilization, muscle strength, and the level of activities of daily living (LADL) after intensive care unit (ICU) and hospital discharge.Methods This randomized clinical trial (U1111-1245-4840) included adults patients who were randomized into two groups: intervention (n = 40) and control (n = 45). The intervention group underwent conventional physiotherapy and structured EM protocols, and the control group underwent conventional physiotherapy. The level of mobilization from 0 (no mobilization) to 5 (walking), muscle strength (Medical Research Council scale), LADL (Katz Index), and incidence of complications were evaluated.Results The level of mobilization from day 1 to day 7 increased in the intervention group compared with the control group (p < .05). Muscle strength did not change during the protocol in the intervention and control groups {day 1 [effect size (r) = 0.15, p = .161], at ICU discharge [r = 0.16, p = .145], and after ICU discharge [r = 0.16, p = .191]}. The LADL did not differ between the intervention and control groups after ICU discharge [4 (1–6) vs. 3 (1–5), p = .702] or 30 days after hospital discharge [6 (5–6) vs. 6 (5–6), p = .945]. The structured EM protocol was safe, and no severe complications were observed during the protocol.Conclusion A structured EM protocol increased the level of mobilization without improving muscle strength and the LADL compared with conventional physiotherapy.