title: Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units.
abstract: Early mobilization of patients in the intensive care unit (ICU) is safe, feasible, and beneficial. However, implementation of early mobility as part of routine clinical care can be challenging. The objective of this review is to identify barriers to early mobilization and discuss strategies to overcome such barriers. Based on a literature search, we synthesize data from 40 studies reporting 28 unique barriers to early mobility, of which 14 (50%) were patient-related, 5 (18%) structural, 5 (18%) ICU cultural, and 4 (14%) process-related barriers. These barriers varied across ICUs and within disciplines, depending on the ICU patient population, setting, attitude, and ICU culture. To overcome the identified barriers, over 70 strategies were reported and are synthesized in this review, including: implementation of safety guidelines; use of mobility protocols; interprofessional training, education, and rounds; and involvement of physician champions. Systematic efforts to change ICU culture to prioritize early mobilization using an interprofessional approach and multiple targeted strategies are important components of successfully implementing early mobility in clinical practice.
authors.affiliation: 1 Department of Continuing Education of Critical Care Nursing, District Hospital of Reutlingen, Reutlingen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Dubb
authors.affiliation: 2 Neurological Intensive Care Unit and Stroke Unit, University Hospital of Schleswig-Holstein, Kiel, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Nydahl
authors.affiliation: 3 Intensive Care Unit, Helios Klinikum Siegburg, Siegburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Hermes
authors.affiliation: 4 Department of Medicine, University Hospital Tübingen, Tübingen, Germany; and.
authors.forename: Norbert
authors.initials: N
authors.lastname: Schwabbauer
authors.affiliation: 5 Physical Medicine and Rehabilitation, Johns Hopkins Hospital.
authors.forename: Amy
authors.initials: A
authors.lastname: Toonstra
authors.affiliation: 6 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Parker
authors.affiliation: 1 Department of Continuing Education of Critical Care Nursing, District Hospital of Reutlingen, Reutlingen, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Kaltwasser
authors.affiliation: 7 Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D003422:Critical Care / Q000379:methods*; D004434:Early Ambulation / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*
keywords: critical care; intensive care; physical therapy; rehabilitation; review