Table 5 A chronological summary of included studies
Author (publication year) Country | Study design* | Setting | Study aim(s) | Total sample size (n) | Theme** | |||
|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | |||||
Martin et al. (2005) [74] USA | Cohort | Post ICU | To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. | 49 | ✓ | ✓ | ✓ | |
Chiang et al. (2006) [73] Taiwan | RCT | Post ICU | To examine the effects of 6 weeks of physical training on the strength of respiratory and limb muscles, on ventilator-free time and on functional status in patients requiring prolonged mechanical ventilation. | 32 | ✓ | ✓ | ||
Bailey et al. (2007) [24] USA | Cohort | Respiratory ICU | To determine whether early physical activity is feasible and safe in respiratory failure patients. | 103 | ✓ | ✓ | ✓ | ✓ |
Bahadur et al. (2008) [51] United Kingdom | Cohort | General ICU | To define the number of occasions of sitting out of bed in patients in the ICU following tracheostomy formation. | 30 | ✓ | ✓ | ✓ | ✓ |
Morris et al. (2008) [104] USA | Cohort | Medical ICU | To assess the frequency of physical therapy, site of initiation of physical therapy and patient outcomes comparing respiratory failure patients who received usual care compared with patients who received physical therapy from a Mobility Team using the mobility protocol. | 330 | ✓ | ✓ | ✓ | |
Skinner et al. (2008) [107] Australia | Cohort | General ICUs | To identify methods of exercise prescription by physiotherapists across Australian ICUs, including the most commonly used activities for both mechanically ventilated and spontaneously breathing patients; and to determine the outcome measures used for the evaluation of exercise intervention. | 111 | ✓ | ✓ | ✓ | |
Thomsen et al. (2008) [38] USA | Cohort | Respiratory ICU | To determine whether transfer of respiratory failure patients to the respiratory ICU improved ambulation, independent of the underlying pathophysiology. | 104 | ✓ | ✓ | ✓ | ✓ |
Malkoç et al. (2009) [105] Turkey | Case control | Medical ICU | To evaluate the effect of physiotherapy on ventilator dependency and lengths of ICU stay. | 510 | ✓ | ✓ | ||
Schweickert et al. (2009) [25] USA | RCT | Medical ICU | To assess the efficacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care. | 104 | ✓ | ✓ | ✓ | |
Bourdin et al. (2010) [64] France | Cohort | Medical ICU | To describe the experience in early rehabilitation of ICU patients undergoing mechanical ventilation and its effects on physiologic outcomes. | 20 | ✓ | ✓ | ✓ | |
Needham et al. (2010) [103] USA | Case control | Medical ICU | To evaluate the effect of the quality improvement project on the number of physical and occupational therapy consultations/treatments and length of stay, in comparison with the prior year. | 57 | ✓ | ✓ | ✓ | |
Pohlman et al. (2010) [26] USA | Cohort | Medical ICU | To describe a protocol of a daily sedative interruption and early physical and occupational therapy, including neurocognitive state, potential barriers and adverse events related to this intervention. | 49 | ✓ | ✓ | ✓ | |
Yang et al. (2010) [79] Taiwan | Cohort | Post ICU | To understand the characteristics of ventilator dependence in patients and the potential effects of physical therapy on ventilator weaning and patients’ functional status. | 126 | ✓ | ✓ | ✓ | |
Zanni et al. (2010) [86] USA | Cohort | Medical ICU | To describe the frequency, physiologic effects, safety and patient outcomes associated with traditional rehabilitation therapy. | 32 | ✓ | ✓ | ||
Chen et al. (2011) [72] Taiwan | RCT | Post ICU | To study the outcomes of functional status, survival rate and ventilator-free status for prolonged mechanical ventilation patients 1 year after physical therapy training enrolment. | 34 | ✓ | ✓ | ✓ | |
Clini et al. (2011) [75] Italy | Cohort | Respiratory ICU | To assess changes in functional status and whether the degree of functional recovery after a comprehensive rehabilitation program influenced hospital outcomes in a population of tracheostomised and chronically ventilated patients admitted for weaning. | 77 | ✓ | ✓ | ✓ | |
Nordon-Craft et al. (2011) [97] USA | Case series | N/A | To describe safety and feasibility of participation in physical therapy intervention for individuals with ICU-acquired weakness who required MV for at least 7 days and characterise the examination and intervention procedures with sufficient detail that clinicians can implement a similar strategy. | 19 | ✓ | ✓ | ✓ | |
Chen et al. (2012) [96] Taiwan | RCT | Post ICU | To evaluate the effects of an exercise training program on pulmonary mechanics, physical functional status and hospitalisation outcomes in terms of respiratory care centre stay, mechanical ventilator weaning rate and mortality rate in patients requiring prolonged mechanical ventilation. | 27 | ✓ | |||
Dantas et al. (2012) [46] Brazil | RCT | General ICU | To evaluate the effects of an early mobilisation protocol on respiratory and peripheral muscles. | 59 | ✓ | ✓ | ✓ | ✓ |
Ronnebaum et al. (2012) [102] USA | Case control | General ICU | To compare the effectiveness of two protocols: mobility protocol (MP) and Standard Physical Therapy (SPT) for patients with respiratory failure. | 28 | ✓ | ✓ | ✓ | |
Winkelman et al. (2012) [49] USA | Case control | Medical-Surgical ICUs | To compare standard care versus an early mobility protocol and to examine the effects of exercise on vital signs and inflammatory biomarkers and the effects of the nurse-initiated mobility protocol on outcomes. | 75 | ✓ | ✓ | ✓ | ✓ |
Berney et al. (2013) [57] Australia and New Zealand | Cohort | General ICUs | To document current physiotherapy mobilisation practices and focus specifically on mobilisation practices in patients requiring prolonged mechanical ventilation, defined as more than 48 h. | 498 | ✓ | ✓ | ||
Camargo Pires-Neto et al. (2013) [92] Brazil | Case Series | Medical ICU | To evaluate the hemodynamic, respiratory and metabolic effects of a cycling exercise performed during the first 72 h of mechanical ventilation. | 19 | ✓ | ✓ | ✓ | |
Davis et al. (2013) [36] USA | Cohort | Medical-Surgical ICU | To determine the feasibility of employing a standard early mobilisation protocol, while systematically collecting patient mobility data and short-term functional outcomes from critically ill, mechanically ventilated, older adults. | 15 | ✓ | ✓ | ✓ | ✓ |
Dinglas et al. (2013) [60] USA | Cohort | General ICUs | To evaluate the association of patient, ICU and hospital factors with the time to first occupational therapy intervention in the ICU in a prospective cohort of mechanically ventilated patients with acute lung injury. | 514 | ✓ | ✓ | ✓ | |
Harrold (2013) [35] Australia | Case control | General ICU | To implement a system change that supported safe increases in mobilisation rates of all intensive care patients who were mechanically ventilated for three or more calendar days. | 412 | ✓ | ✓ | ✓ | ✓ |
Li et al. (2013) [59] China | Systematic review | N/A | To investigate the effectiveness and safety of active mobilisation on improving physical function and hospital outcomes in patients undergoing mechanical ventilation for more than 24 h. | 17 | ✓ | ✓ | ✓ | ✓ |
Mendez-Tellez et al. (2013) [106] USA | Cohort | General ICUs | To evaluate the association of patient, ICU and hospital factors with the time to starting physical therapy in a prospective cohort of mechanically ventilated patients with acute lung injury. | 503 | ✓ | ✓ | ✓ | |
Williams and Flynn, (2013) [99] United Kingdom | Qualitative | N/A | To explore the physiotherapists understanding and experience of implementing early rehabilitation in critically ill patients. | 6 | ✓ | |||
Dinglas et al. (2014) [58] USA | Case control | Medical ICU | To evaluate the sustained effect of a quality improvement project on the timing of initiation of active physical therapy intervention in patients with acute lung injury. | 243 | ✓ | ✓ | ✓ | ✓ |
Dong et al. (2014) [67] China | RCT | General ICU | To investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation. | 60 | ✓ | ✓ | ✓ | |
Jolley et al. (2014) [43] USA | Cohort | Medical ICU | To assess clinician knowledge regarding early mobilisation and identify barriers to its provision. | 120 | ✓ | ✓ | ||
Nydahl et al. (2014) [65] Germany | Cohort | General ICUs | To undertake a 1-day point-prevalence study of mobilisation of mechanically ventilated patients in ICUs across Germany, including evaluating associations with perceived barriers to mobilisation and complications during mobilisation. | 116 | ✓ | ✓ | ||
Patel et al. (2014) [45] USA | Cohort | Medical ICU | To determine if early mobilisation affects glycaemic control and, in turn, exogenous insulin requirements in critical illness. | 104 | ✓ | ✓ | ||
Bakhru et al. (2015) [41] USA | Cohort | General ICUs | To evaluate the current level of diffusion of early mobilisation practice and examine environmental factors that may influence its practice. | 500 | ✓ | ✓ | ✓ | |
Barber et al. (2015) [88] Australia | Qualitative | General ICU | To determine the barriers and facilitators of early mobilisation in the ICU. | 25 | ✓ | |||
Berney et al. (2015) [76] Australia | Cohort | General ICU | To measure patterns of physical activity in a group of critically ill patients. | 41 | ✓ | ✓ | ✓ | |
Collings and Cusack (2015) [85] United Kingdom | RCT | General ICU | To quantify and compare the acute physiological response of critically ill patients during a passive chair transfer or a sitting on the edge of the bed. | 10 | ✓ | ✓ | ✓ | |
Eakin et al. (2015) [116] USA | Qualitative | Medical ICU | To describe a multidisciplinary team perspective regarding how to implement and sustain a successful early rehabilitation programme. | 20 | ✓ | |||
Harrold et al. (2015) [52] Australia and United Kingdom | Cohort | General ICUs | To evaluate baseline practise and the perceived barriers to early mobilisation in ICU across multiple sites in two different countries with different systems of health care delivery. | 830 | ✓ | ✓ | ✓ | |
Holdsworth et al. (2015) [61] Australia | Qualitative | General ICU | To elicit attitudinal, normative, and control beliefs towards mobilising ventilated patients in the ICU to generate items for a second-phase questionnaire and inform the development of a tailored implementation intervention. | 22 | ✓ | ✓ | ✓ | ✓ |
Jolley et al. (2015) [100] USA | Cohort | General ICUs | To determine what proportion of hospitals caring for mechanically ventilated patients across Washington State use physical activity in the ICU and to identify process of care factors associated with reported activity delivery. | 47 | ✓ | ✓ | ✓ | |
Kayambu et al. (2015) [95] Australia | RCT | General ICU | To determine whether early physical rehabilitation improves physical function and associated outcomes in patients with sepsis. | 50 | ✓ | ✓ | ✓ | |
McWilliams et al. (2015) [66] United Kingdom | Case control | General ICU | To evaluate the impact of an early and enhanced rehabilitation programme for mechanically ventilated patients in a large tertiary referral mixed-population ICU. | 582 | ✓ | ✓ | ✓ | |
Ota et al. (2015) [47] Japan | Case control | General ICU | To clarify the benefits of early mobilisation for mechanically ventilated patients for their survival to discharge to home from the hospital. | 108 | ✓ | ✓ | ✓ | ✓ |
Camargo Pires-Neto et al. (2015) [68] Brazil | Cohort | Medical ICU | To characterise the provision of early mobilisation therapy in critically ill patients in a Brazilian medical ICU and to investigate the relationship between physical activity level and clinical outcomes. | 120 | ✓ | ✓ | ✓ | |
Skinner et al. (2015) [69] Australia | Cohort | General ICU | To report the incidence of usual care physiotherapy, specifically treatment and modalities used, in a sample of subjects admitted to a single tertiary Australian ICU. | 100 | ✓ | ✓ | ✓ | |
The TEAM Study Investigators (2015) [48] Australia and New Zealand | Cohort | General ICUs | To investigate current mobilisation practice, strength at ICU discharge and functional recovery at 6 months among mechanically ventilated patients. | 192 | ✓ | ✓ | ✓ | ✓ |
Toccolini et al. (2015) [70] Brazil | Cohort | General ICU | To assess the effects of passive orthostatism on various clinicophysiologic parameters of adult ICU patients, by daily placement on a tilt table. | 23 | ✓ | ✓ | ||
Witcher et al. (2015) [71] USA | Case control | Neurological ICU | To examine the effect of an early mobilisation protocol on sedation practices of critically ill, mechanically ventilated patients. | 68 | ✓ | ✓ | ✓ | |
Bakhru et al. (2016) [56] France, Germany, United Kingdom and USA | Cohort | General ICUs | To evaluate organisational characteristics that enable early mobilisation practice. | 951 | ✓ | ✓ | ✓ | |
Dong et al. (2016) [93] China | RCT | General ICU | To evaluate the influence of early rehabilitation therapy on patients with more than 72 h of prolonged mechanical ventilation after coronary artery bypass surgery. | 106 | ✓ | ✓ | ✓ | |
Hickmann et al. (2016) [42] Belgium | Cohort | General ICU | To demonstrate that early mobilisation performed within the first 24 h of ICU admission proves to be feasible and well tolerated in the vast majority of clinically ill patients. | 171 | ✓ | ✓ | ✓ | ✓ |
Hodgson et al. (2016) [37] Australia and New Zealand | RCT | General ICUs | To determine if the early goal-directed mobilisation intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared with standard care. | 50 | ✓ | ✓ | ✓ | ✓ |
Morris et al. (2016) [84] USA | RCT | Medical ICU | To compare standardised rehabilitation therapy to usual ICU care in acute respiratory failure | 300 | ✓ | ✓ | ✓ | |
Schaller et al. (2016) [101] Austria, Germany and USA | RCT | Surgical ICUs | To test if early, goal-directed mobilisation, using a strict mobilisation algorithm combined with facilitated inter-professional communication leads to improved mobility during admission, decreased length of stay, and increased functional independence at hospital discharge. | 200 | ✓ | ✓ | ✓ | |
Curtis and Irwin (2017) [50] United Kingdom | Qualitative | N/A | To increase understanding of nurses’ perspectives on ambulating mechanically ventilated patients, and to determine why this is not a routine part of ICU patient care. | 8 | ✓ | ✓ | ✓ | |
Dunn et al. (2017) [62] USA | Systematic review | N/A | To evaluate the strength of existing publications to determine if active mobilisation interventions in prolonged mechanical ventilation patients improves physical function, ventilator weaning rates, pulmonary mechanics, and clinical hospital outcomes such as length of stay and mortality. | 8 | ✓ | |||
Jolley et al. (2017) [77] USA | Cohort | General ICU | To determine the prevalence and character of mobility for ICU patients with acute respiratory failure. | 42 | ✓ | ✓ | ✓ | |
Lai et al. (2017) [87] Taiwan | Case control | Medical ICU | To evaluate the effects of a quality improvement programme to introduce early mobilisation on the outcomes of patients with mechanical ventilation in the ICU. | 153 | ✓ | ✓ | ✓ | |
McWilliams et al. (2017) [39] United Kingdom | Case control | General ICUs | To investigate whether the Sara Combilizer® could facilitate safe and early mobilisation of critically ill patients at high risk of ICU-acquired weakness who would otherwise be unable to get out of bed, thereby reducing time to first mobilisation. | 63 | ✓ | ✓ | ✓ | ✓ |
Parry et al. (2017) [98] Australia | Qualitative | General ICU | To identify the barriers and enablers that influence clinicians’ implementation of early rehabilitation in critical care. | 26 | ✓ | ✓ | ✓ | |
Sibilla et al. (2017) [78] Switzerland | Cohort | General ICUs | To characterise the highest level of mobilisation achieved in mechanically ventilated patients as defined by the valid and reliable ICU Mobility Scale and to characterise the potential safety events related to mobilisation and perceived barriers to mobilisation. | 161 | ✓ | ✓ | ✓ | |
Weeks et al. (2017) [44] USA | Cohort | Medical-Surgical ICU | To investigate the feasibility of early mobilisation and describe the rehabilitation interventions and functional discharge outcomes in critically ill patients with cancer. | 42 | ✓ | ✓ | ✓ | ✓ |
de Queiroz et al. (2018) [63] Brazil | Systematic review | N/A | To evaluate of the description of the active mobilisation protocols in patients on invasive mechanical ventilation at ICUs. | 17 | ✓ | ✓ | ✓ | |
Goddard et al. (2018) [81] Canada and USA | Qualitative | N/A | To explore barriers and facilitators to early rehabilitation for critically ill patients receiving invasive mechanical ventilation. | 40 | ✓ | |||
Liu et al. (2018) [83] Japan | Cohort | General ICU | To investigate the safety of early mobilisation according to the Maebashi Early Mobilisation protocol conducted by ICU physicians. | 72 | ✓ | ✓ | ✓ | |
McWilliams et al. (2018) [40] United Kingdom | RCT | N/A | To explore the feasibility of earlier and enhanced rehabilitation for patients mechanically ventilated for ≥5 days and to assess the impact on possible long-term outcome measures for use in a definitive trial. | 102 | ✓ | ✓ | ✓ | ✓ |
Medrinal et al. (2018) [90] France | RCT | N/A | To compare the physiological effects of four common types of bed exercise in intubated, sedated patients confined to bed in the ICU, in order to determine which was the most intensive. | 19 | ✓ | ✓ | ✓ | |
Phelan et al. (2018) [55] Australia | Systematic review | N/A | To identify the key factors that underpin successful implementation and sustainability of early mobilisation in adult intensive care units. | 13 | ✓ | ✓ | ✓ | |
Ringdal et al. (2018) [91] Sweden | Qualitative | General ICUs | To explore patient recollections and experiences of early mobilisation, including in-bed cycling. | 11 | ✓ | ✓ | ✓ | |
Sarfati et al. (2018) [80] France | RCT | Surgical ICU | To investigate whether cardiothoracic surgery patients expected to require prolonged ICU management benefited from the addition of daily tilting to an early mobilisation program. | 125 | ✓ | ✓ | ✓ | |
Taito et al. (2018) [54] Japan | Cohort | General ICUs | To clarify intensive care unit-level factors facilitating out-of-bed mobilisation in mechanically ventilated patients with orotracheal tubes. | 168 | ✓ | ✓ | ✓ | |
Verceles et al. (2018) [53] USA | RCT | Post ICU | To compare the effects of adding a progressive multimodal rehabilitation program to usual care. | 32 | ✓ | ✓ | ✓ | ✓ |
Winkelman et al. (2018) [94] USA | RCT | General ICUs | To examine whether the delivered intervention influenced inflammatory serum markers and to explore whether the dose of the delivered intervention influenced patient outcomes. | 54 | ✓ | ✓ | ✓ | |
Wright et al. (2018) [82] United Kingdom | RCT | Medical-surgical ICU | To evaluate the effects of two different intensities of early rehabilitation therapy - intensive versus standard - on the recovery of physical health-related quality of life at 6 months. | 308 | ✓ | ✓ | ✓ | |