title: Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession.
abstract: OBJECTIVE
  To evaluate whether the level of mobilization achieved and the barriers for progressing to the next mobilization level differ between nurses and physical therapists.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Twenty-bed surgical intensive care unit (SICU) of the Massachusetts General Hospital.
  
  
  METHODS
  Sixty-three critically ill patients.
  
  
  METHODS
  Physical therapists and nurses performed 179 mobilization therapies with 63 patients.
  
  
  METHODS
  Mobilization was defined as the process of enhancing mobility in the SICU, including bed mobility, edge of bed activities, transfers out of bed to a chair, and gait training; the mobilization level was measured on the SICU optimal mobilization scale, a 5-point (0-4) numerical rating scale.
  
  
  RESULTS
  Patients' level of mobilization achieved by physical therapists was significantly higher compared with that achieved by nurses (2.3 ± 1.2 mean ± SD versus 1.2 ± 1.2, respectively P < .0001). Different barriers for mobilization were identified by physical therapists and nurses: hemodynamic instability (26% versus 12%, P = .03) and renal replacement therapy (12% versus 1%, P = .03) were barriers rated higher by nurses, whereas neurologic impairment was rated higher by physical therapists providers (18% versus 38%, P = .002). No mobilization-associated adverse events were observed in this study.
  
  
  CONCLUSIONS
  This study showed that physical therapists mobilize their critically ill patients to higher levels compared with nurses. Nurse and physical therapists identify different barriers for mobilization. Routine involvement of physical therapists in directing mobilization treatment may promote early mobilization of critically ill patients.
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Garzon-Serrano
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ryan
authors.forename: Karen
authors.initials: K
authors.lastname: Waak
authors.forename: Ronald
authors.initials: R
authors.lastname: Hirschberg
authors.forename: Susan
authors.initials: S
authors.lastname: Tully
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Chipman
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schmidt
authors.forename: Georgios
authors.initials: G
authors.lastname: Kasotakis
authors.forename: John
authors.initials: J
authors.lastname: Benjamin
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
mesh_terms: D016638:Critical Illness / Q000534:rehabilitation*; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D006282:Health Personnel / Q000592:standards*; D006769:Hospitals, General / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013531:Surgicenters / Q000458:organization & administration; D013997:Time Factors