Functional mobility effects of progressive early mobilization protocol on people with moderate-to-severe traumatic brain injury: A pre-post intervention study
Affiliations: [a] Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| [b] Department of Traumatology, Trauma ICU, National Taiwan University Hospital, Taipei, Taiwan
| [c] School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| [d] Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| [e] Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
Correspondence:
[*]
Correspondence to: Hung-Jui Chuang, MD., Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei 100, Taiwan. E-mails:
rexintwo@gmail.com and hjchuang.ntuh@gmail.com. ORCID: 0000-0003-2921-4347
Abstract: BACKGROUND: Brain plasticity evoked by environmental enrichment through early mobilization may improve sensorimotor functions of patients with moderate-to-severe traumatic brain injury (TBI). Increasing evidence also suggests that early mobilization increases verticalization, which is beneficial to TBI patients in critical care. However, there are limited data on early mobilization interventions provided to patients with moderate-to-severe TBI. OBJECTIVE: We investigated the possible enhancing effects of revised progressive early mobilization on functional mobility and the rate of out-of-bed mobility attained by patients with moderate-to-severe TBI. METHODS: This is a quantitative study with a retrospective and prospective pre–post intervention design. We implemented a revised progressive early mobilization protocol for patients with moderate-to-severe TBI admitted to the trauma intensive care unit (ICU) within the previous seven days. The outcome parameters were the rate of patients attaining early mobilization (sitting on the edge of the bed) and the Perme ICU Mobility Score at discharge from the ICU. The outcome parameters in the intervention cohort were compared with those from a historical control cohort who received standard medical care a year previously. Differences in the Perme ICU Mobility Score between the two cohorts were assessed using univariate analysis of covariance. RESULTS: Forty-two patients were included in the progressive early mobilization program and were compared with 44 patients who underwent standard medical care. In the intervention cohort, 100% and 57.2% of the patients completed early rehabilitation and early mobilization, respectively, compared to 0% in the control cohort. The intervention cohort at ICU discharge showed significantly improved the Perme ICU Mobility Scores. CONCLUSIONS: The implementation of the revised progressive early mobilization program for patients with moderate-to-severe TBI resulted in significantly improved mobility at ICU discharge; however, the length of overall stay in the ICU may be not affected.
Keywords: Traumatic brain injury, intensive care, early mobilization
