title: Physical rehabilitation of the critically ill trauma patient in the ICU.
abstract: OBJECTIVE
  To 1) review the existing evidence for early mobilization of the critically ill patients in the ICU with polytrauma; 2) provide intensivists with an introduction to the biomechanics, physiology, and nomenclature of injuries; 3) summarize the evidence for early mobilization in each anatomic area; and 4) provide recommendations for the mobilization of these patients.
  
  
  METHODS
  A literature search of the MEDLINE and EMBASE databases for articles published in English between 1980 and 2011.
  
  
  METHODS
  Studies pertaining to physical therapy and rehabilitation in trauma patients were selected. Articles were excluded if they dealt with pediatrics, geriatrics, burn injuries, isolated hand injuries, chronic (i.e., not acute) injuries, nontraumatic conditions, and pressure/decubitus ulcers, were in a language other than English, were published only in abstract form, were letters to the editor, were case reports, or were published prior to 1980.
  
  
  METHODS
  Reviewers extracted data and summarized results according to anatomical areas.
  
  
  RESULTS
  Of 1,411 titles and abstracts, 103 met inclusion criteria. We found no articles specifically addressing the rehabilitation of polytrauma patients in the ICU setting or patients with polytrauma in general. We summarized the articles addressing the role of mobilization for specific injuries and treatments. We used this evidence, in combination with biologic rationale and physician and surgeon experience and expertise, to summarize the important considerations when providing physical therapy to these patients in the ICU setting.
  
  
  CONCLUSIONS
  There is a paucity of evidence addressing the role of early mobilization of ICU patients with polytrauma and patients with polytrauma in general. Evidence for the beneficial role of early mobilization of specific injuries exists. Important considerations when applying a strategy of early physical therapy and mobilization to this distinctive patient group are summarized.
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. pengels@ualberta.ca
authors.forename: Paul T
authors.initials: PT
authors.lastname: Engels
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Beckett
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.forename: Hans
authors.initials: H
authors.lastname: Kreder
authors.forename: Joel A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Leodante
authors.initials: L
authors.lastname: da Costa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Papia
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
authors.forename: Homer C
authors.initials: HC
authors.lastname: Tien
mesh_terms: D016638:Critical Illness / Q000534:rehabilitation*; D004434:Early Ambulation / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D013997:Time Factors; D014947:Wounds and Injuries / Q000534:rehabilitation*