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Table 4 Sub-themes, categories and example(s) of verbatim extracts of each theme in included studies

From: Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

Themes
Sub-themes
Categories Example(s) of verbatim extracts and references
Non-standardised definition
Practice variation Timing of commencement Beginning within 24 h of ICU admission [42];
Within 72 h of mechanical ventilation [45];
Where the patients could assist with the activity using their own muscle strength and control [48].
Activities Involved axial loading of the spine and/or long bones [35, 52];
Any activity beyond range of motion [43].
Team diversity A program of physiotherapist-directed [37];
Performed by a care provider (nursing, physical or occupational therapy) [43].
Expectation of outcome Preventative measures of ICU complications To prevent joint contractures [46];
Maintaining patient’s mobility • To maximize physical activity at the highest functional level the patient could achieve [37].
Improving impairment To induce acute physiological responses (enhancing ventilation, central and peripheral circulation, muscle metabolism, and alertness) [42]
Contextual factors
Mechanical ventilation utilisation Intubation types MV was provided to 51% of patients, including 14% with tracheostomy [42];
MV was defined as any ventilation via an endotracheal tube (ETT), tracheostomy tube, or non-invasive positive pressure ventilation [77].
Mechanical ventilation duration To initiate the early mobilization program within 72 hours of MV [87];
Occurred while the patient was receiving invasive ventilation [48].
ICU context ICU stay Continuing through the ICU stay [24].
Activity space Mobilizing patients out of bed in the ICU can be seen as an earlier rehabilitation[64];
Both leg and arm exercise with the patient in bed [75].
  Protocol vs order The early mobilization group (EMG) patients received a systematic early mobilization protocol, twice a day, every day of the week[46];
Activity orders for critically ill patients required a physician orders with all activity performed by either the bedside nurse and/or a physical occupational therapist [43].
Negotiated process   
Stakeholder decisions Clinical staff judgement The decision to mobilise patients out of bed only after tracheostomy formation is based on the decision that a tracheostomy presents as a stable airway [51].
Informed consent The physical therapy intervention started when the informed consent was obtained [72];
Acquire informed consent (e.g., waiting until evening family visits or allowing family members time to think about the decision to enrol) [49].
Goal setting Progressive mobility The types of functional activities performed during treatment sessions were recorded, including (1) rolling, (2) sitting at the edge of the bed, (3) transferring from sitting to standing, (4) ambulation [86].
Improving impairment The 30-minute PT sessions, including abdominal breathing training, respiratory muscle weight training, passive and active joints exercises, upper and lower limb exercises[79].
Regaining independence Sitting balance activities were followed by participation in activities of daily living (ADLs) and exercises that encouraged increased independence with functional tasks [25].
Collaboration between patients and staff
Patient participation Active Only in 24% of the sessions was more active functional mobilization performed (SOOB, standing, and walking)[68].
Passive A combination of passive exercise including positioning, joint range of movement, and hoist transfer to chair [85].
Level of assistance Independence Patients were first allowed to attempt each activity independently [26].
Staff assistance With the assistance of a physical therapist, respiratory therapist and an ICU nurse [103].
  1. Abbreviations: ADL activity of daily living, EMG early mobilisation group, ETT endotracheal tube, ICU intensive care unit, MP mobility protocol, MV mechanical ventilation, PT physiotherapy, SOOB sit out of bed, SPT standard physical therapy