title: A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU.
abstract: OBJECTIVE
  To determine if the early goal-directed mobilization intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared with standard care.
  
  
  METHODS
  A pilot randomized controlled trial.
  
  
  METHODS
  Five ICUs in Australia and New Zealand.
  
  
  METHODS
  Fifty critically ill adults mechanically ventilated for greater than 24 hours.
  
  
  METHODS
  Patients were randomly assigned to either early goal-directed mobilization (intervention) or to standard care (control). Early goal-directed mobilization comprised functional rehabilitation treatment conducted at the highest level of activity possible for that patient assessed by the ICU mobility scale while receiving mechanical ventilation.
  
  
  RESULTS
  The ICU mobility scale, strength, ventilation duration, ICU and hospital length of stay, and total inpatient (acute and rehabilitation) stay as well as 6-month post-ICU discharge health-related quality of life, activities of daily living, and anxiety and depression were recorded. The mean age was 61 years and 60% were men. The highest level of activity (ICU mobility scale) recorded during the ICU stay between the intervention and control groups was mean (95% CI) 7.3 (6.3-8.3) versus 5.9 (4.9-6.9), p = 0.05. The proportion of patients who walked in ICU was almost doubled with early goal-directed mobilization (intervention n = 19 [66%] vs control n = 8 [38%]; p = 0.05). There was no difference in total inpatient stay (d) between the intervention versus control groups (20 [15-35] vs 34 [18-43]; p = 0.37). There were no adverse events.
  
  
  CONCLUSIONS
  Key Practice Points: Delivery of early goal-directed mobilization within a randomized controlled trial was feasible, safe and resulted in increased duration and level of active exercises.
authors.affiliation: 1Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 2Alfred Hospital, Melbourne, VIC, Australia. 3Austin Health, Heidelberg, VIC, Australia. 4The University of Melbourne, Melbourne, VIC, Australia. 5Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 6Monash University, Melbourne, Melbourne, VIC, Australia. 7Curtin University, Bentley, WA, Australia. 8University of Michigan, Ann Arbor, MI. 9Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI. 10St Vincent's Hospital, Melbourne, VIC, Australia. 11Auckland City Hospital/Cardiovascular Intensive Care Unit, Auckland City, New Zealand. 12Fremantle Hospital, Fremantle, WA, Australia. 13Royal Brisbane and Women's Hospital, Herston, QLD, Australia. 14The George Institute for Global Health, Sydney, NSW, Australia. 15Western Hospital, Footscray, VIC, Australia. 16Wellington Hospital, Wellington, New Zealand. 17Royal Perth Hospital, Subiaco WA, Australia.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Hodgson
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Susan
authors.initials: S
authors.lastname: Berney
authors.forename: Heidi
authors.initials: H
authors.lastname: Buhr
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
authors.forename: Belinda
authors.initials: B
authors.lastname: Gabbe
authors.forename: Megan
authors.initials: M
authors.lastname: Harrold
authors.forename: Alisa
authors.initials: A
authors.lastname: Higgins
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
authors.forename: Rebecca
authors.initials: R
authors.lastname: Papworth
authors.forename: Rachael
authors.initials: R
authors.lastname: Parke
authors.forename: Shane
authors.initials: S
authors.lastname: Patman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Presneill
authors.forename: Manoj
authors.initials: M
authors.lastname: Saxena
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Skinner
authors.forename: Claire
authors.initials: C
authors.lastname: Tipping
authors.forename: Paul
authors.initials: P
authors.lastname: Young
authors.forename: Steven
authors.initials: S
authors.lastname: Webb
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001007:Anxiety; D016638:Critical Illness / Q000534:rehabilitation*; D003863:Depression; D004434:Early Ambulation / Q000009:adverse effects; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054792:Muscle, Striated; D010347:Patient Care Planning; D010865:Pilot Projects; D011788:Quality of Life; D012121:Respiration, Artificial; D016138:Walking