title: Early mobilization of critically ill adults: a survey of knowledge, perceptions and practices of Canadian physicians and physiotherapists.
abstract: BACKGROUND
  The promotion of early mobilization following critical illness is tempered by national reports of patient and institutional barriers to this approach. We carried out a survey to assess current knowledge, perceptions and practices of Canadian physicians and physiotherapists with respect to acquired weakness and early mobilization in adults in the intensive care unit (ICU).
  
  
  METHODS
  We conducted a cross-sectional, self-administered postal survey among critical care physicians and physiotherapists in all 46 academic ICUs in Canada in 2011-2012. To identify all physicians and physiotherapists working in the ICUs, we contacted division heads and senior physiotherapists by telephone or email. We designed, tested and administered a questionnaire with the following domains: knowledge of ICU-acquired weakness and early mobilization; personal views of, perceived barriers to and adequacy of technical skills for early mobilization; assessments for initiation of early mobilization and permissible activity levels by patient physiologic characteristics, diagnoses and therapies; staffing issues; and sedation practices.
  
  
  RESULTS
  The overall response rate was 71.3% (311/436); it was 64.2% (194/302) among physicians and 87.3% (117/134) among physiotherapists. A total of 214 respondents (68.8%) underestimated the incidence of ICU-acquired weakness in the general medical-surgical ICU population, and 186 (59.8%) stated they had insufficient knowledge or skills to mobilize patients receiving mechanical ventilation. Excessive sedation, medical instability, limited staffing, safety concerns, insufficient guidelines and insufficient equipment were common perceived barriers to early mobilization.
  
  
  CONCLUSIONS
  Physicians and physiotherapists in the ICU underestimated the incidence of ICU-acquired weakness and felt inadequately trained to mobilize patients receiving mechanical ventilation. We identified multiple modifiable barriers to early mobilization at the institutional, health care provider and patient levels that need to be addressed when designing mobilization programs for critically ill adults.
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Karen K Y
authors.initials: KK
authors.lastname: Koo
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Karen
authors.initials: K
authors.lastname: Choong
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Margaret
authors.initials: M
authors.lastname: Herridge
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Newman
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Fran
authors.initials: F
authors.lastname: Priestap
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Eileen
authors.initials: E
authors.lastname: Campbell
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Karen E A
authors.initials: KE
authors.lastname: Burns
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: FranÇois
authors.initials: F
authors.lastname: Lamontagne
authors.affiliation: Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade