Impact of a progressive mobility protocol functionality in patients in the intensive care unit

• Grant number: 13/24245-2
• Support Opportunities: Regular Research Grants
• Start date: March 01, 2014
• End date: February 29, 2016
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Carolina Fu
• Grantee: Carolina Fu
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Critically ill patients admitted to Intensive Care Unit (ICU) present high mortality and morbidity (Douglas SL , 2002; Martin UJ , 2002). Even after the disease and its comorbidities have been stabilized, patients are often bedridden, and present low mobility during hospital stay, which has been associated with adverse events such as deconditioning, loss of physical function and functional impairment (Brown CJ, 2004). Physical activity level reduction causes deterioration of multiple systems. The cardiovascular and musculoskeletal functional capacity are particularly affected. Since they are essential for functional independence, the impairment of these two systems during hospital stay results in considerable morbidity (Topp R, 2002; King L, 2012),After a critical illness episode, the major long term morbidity is the reduced quality of life after hospital discharge, mainly due to low physical domains scores in quality of life questionnaires. This occurs because of physical deconditioning, muscle and nerve disfunction (Hopkins RO, 2005; Dowody DW, 2006). Thus, the main challenge to be faced is to reverse the immobility status that patients may experience during ICU stay, since it will lead to functional decline both in the short and long term. Recent studies have shown that early and progressive activity for ICU patients is safe and feasible, and reduces immobility-related complications (Bailey P, 2007; Morris PE, 2008; Schweickert WD, 2009; Winkelman C,2009)Such studies suggest that therapeutic activity is neither long nor frequent enough (Winkelman C, 2007; Bernhardt J, 2004; Brown JC, 2009; Callen BL, 2004). The implementation of mobility protocols may be an option to ensure that physical activity is appropriately offered to ICU patients.Therefore, the primary objective of the present study is to compare the level of physical activity performed by ICU patients with and without the application of a mobility protocol, and to verify the impact of the protocol implementation on their functional status after ICU discharge. Secondary objectives are to verify the impact of the protocol on muscle strength and on length of ICU stay. Also, to evaluate if the level of physical activity to which patients are submitted is appropriate to their muscle strength score. (AU)