title: Clinical and psychological effects of early mobilization in patients treated in a neurologic ICU: a comparative study.
abstract: OBJECTIVE
  To determine if an early mobilization protocol increased mobility and improved clinical and psychological outcomes. Currently, there is minimal research on the effects of early mobilization in patients with primary neurologic injury.
  
  
  METHODS
  Prospective, two-group pre/post comparative design with data collection 4 months pre- and postintervention with a 4-month run-in period.
  
  
  METHODS
  Twenty-two-bed neurologic ICU in a 1,200-bed urban, quaternary-care, academic hospital in Northeast Ohio.
  
  
  METHODS
  Critically ill patients with primary neurologic injury admitted to the neurologic ICU.
  
  
  METHODS
  An early mobility program included a progressive mobility protocol, written orders, and staff (clinical nurse specialist clinical technician) who advocated for and assisted with mobility. Highest mobility achieved was assessed daily for 13 days, clinical outcomes were retrieved from electronic databases, and psychological profile was collected by valid, reliable questionnaire at/after neurologic ICU discharge. Analyses included comparative statistics and multivariable modeling.
  
  
  RESULTS
  Of 637 patients, 260 were preintervention and 377 were postintervention. Patient characteristics were similar between groups, except postintervention group patients had less history of using walking aids and more gait abnormalities, and were less likely to require mechanical ventilation in the neurologic ICU (all p≤0.006). Compared with preintervention, postintervention patients had higher mobility levels and decreased hospital and neurologic ICU length of stay; were more likely to be discharged home (all p≤0.002); had decreased bloodstream infection, hospital-acquired pressure ulcer, and anxiety rates (all p<0.03); and had no change in mortality, ventilator-associated pneumonia, deep vein thrombosis, depression, and hostility. In multivariable analyses, postintervention patients had higher mobility levels (p<0.001), had shorter mean hospital and neurologic ICU length of stay (both p<0.001), and were more likely to be discharged home (p=0.033) compared with preintervention patients.
  
  
  CONCLUSIONS
  A neurologic ICU early mobility protocol increased highest neurologic ICU mobility and discharge home and decreased length of stay, but did not improve quality metrics or psychological profile.
authors.affiliation: 1Neurological Intensive Care Unit, Cleveland Clinic Foundation, Cleveland, OH. 2Neuroscience Services, Duke University Hospital, Durham, NC. 3Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, OH. 4Nursing Research and Innovation, Cleveland Clinic Health System, Cleveland OH.
authors.forename: Kate
authors.initials: K
authors.lastname: Klein
authors.forename: Malissa
authors.initials: M
authors.lastname: Mulkey
authors.forename: James F
authors.initials: JF
authors.lastname: Bena
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
mesh_terms: D016638:Critical Illness; D004434:Early Ambulation / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000523:psychology* / Q000628:therapy*; D063868:Patient Outcome Assessment; D011446:Prospective Studies