title: The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice.
abstract: OBJECTIVE
  To facilitate knowledge synthesis and implementation of evidence supporting early physical activity and mobilization of adult patients in the intensive care unit and its translation into practice, we developed an evidence-based clinical management algorithm.
  
  
  METHODS
  Twenty-eight draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n = 7) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus - semi-interquartile range <0.5 - were collated into the algorithm.
  
  
  RESULTS
  The draft algorithm statements were edited and six additional statements were formulated. The 34 statements related to assessment and treatment were grouped into three categories. Category A included statements for unconscious critically ill patients; Category B included statements for stable and cooperative critically ill patients, and Category C included statements related to stable patients with prolonged critical illness. While panellists reached consensus on the ratings of 94% (32/34) of the algorithm statements, only 50% (17/34) of the statements were rated essential.
  
  
  CONCLUSIONS
  The evidence-based clinical management algorithm developed through an established Delphi process of consensus by an international inter-professional panel provides the clinician with a synthesis of current evidence and clinical expert opinion. This framework can be used to facilitate clinical decision making within the context of a given patient. The next step is to determine the clinical utility of this working algorithm.
authors.affiliation: Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. sdh@sun.ac.za
authors.forename: Susan
authors.initials: S
authors.lastname: Hanekom
authors.forename: Rik
authors.initials: R
authors.lastname: Gosselink
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dean
authors.forename: Helena
authors.initials: H
authors.lastname: van Aswegen
authors.forename: Ronel
authors.initials: R
authors.lastname: Roos
authors.forename: Nicolino
authors.initials: N
authors.lastname: Ambrosino
authors.forename: Quinette
authors.initials: Q
authors.lastname: Louw
mesh_terms: D000328:Adult; D000465:Algorithms; D032921:Consensus; D016638:Critical Illness / Q000145:classification / Q000534:rehabilitation*; D003697:Delphi Technique; D004434:Early Ambulation; D055317:Evidence-Based Practice; D005081:Exercise Therapy / Q000379:methods / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D009043:Motor Activity