[2026-10-07] Effect of Clinical Practice Guideline for Early Mobilization on Limb Muscle Strength in Critically Ill Patients

Metta Kheiawsawang; Onsuda Sopaporm; Siwakon Sriwicha

doi:10.33165/rmj.2028.e279755

Authors

Metta Kheiawsawang Medical Intensive Care Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0007-5024-7529
Onsuda Sopaporm Medical Intensive Care Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0008-8672-8399
Siwakon Sriwicha Medical Intensive Care Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0001-0146-9965

DOI:

https://doi.org/10.33165/rmj.2028.e279755

Keywords:

Early mobilization, Intensive care unit, Critical care nursing, Muscle strength, Rehabilitation

Abstract

Background: Intensive care unit (ICU)-acquired weakness is a significant complication affecting approximately 34.1% of ICU patients, leading to muscle atrophy, prolonged hospitalization, and increased mortality. Early mobilization (EM) is a critical nursing practice to mitigate these effects. Despite its benefits, standardized guidelines are often underutilized due to safety concerns and the limited availability of clinical protocols.

Objective: To compare muscle strength and mobility levels in critically ill patients before and after the implementation of a structured EM nursing practice guideline.

Methods: This retrospective descriptive study analyzed 35 critically ill patients at Ramathibodi Hospital’s medical ICU (January-December 2024) who received an established EM nursing practice guideline comprising a standardized EM protocol, staff training, and educational media. Outcomes were measured by the Medical Research Council (MRC) sum score and the ICU Mobility Scale (IMS), analyzed via paired t tests and Wilcoxon signed rank tests.

Results: Most participants were aged 70-79 years, with acute respiratory distress syndrome (ARDS) and septic shock as primary diagnoses. Following the 5-day EM protocol, muscle strength significantly improved, with mean (SD) MRC scores increasing from 38.77 (12.46) to 47.26 (11.76) (P < .001). Functional mobility also showed significant gains (P < .001), with 54.3% of patients achieving higher mobility levels and 45.7% remaining stable. Importantly, no decline in mobility level was observed.

Conclusions: This study demonstrated that a structured EM nursing practice guideline is feasible and effective in improving muscle strength and mobility among critically ill patients, supporting its integration into routine ICU nursing care.

References

Fazzini B, Märkl T, Costas C, et al. The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis. Crit Care. 2023;27(1):2. doi:10.1186/s13054-022-04253-0

Wang W, Xu C, Ma X, Zhang X, Xie P. Intensive care unit-acquired weakness: a review of recent progress with a look toward the future. Front Med. 2020;7:559789. doi:10.3389/fmed.2020.559789

Kutsuzawa T, Sato M, Takahashi N, Matsuki H, Inokuchi S. Incidence rate and risk factors for muscle weakness in emergency ICU. J Jpn Soc Intensive Care Med. 2011;18(4):647-650. doi:10.3918/jsicm.18.647

Chen J, Huang M. Intensive care unit-acquired weakness: recent insights. J Intensive Med. 2023;4(1):73-80. doi:10.1016/j.jointm.2023.07.002

Vollman KM. Understanding critically ill patients hemodynamic response to mobilization: using the evidence to make it safe and feasible. Crit Care Nurs Q. 2013;36(1):17-27. doi:10.1097/CNQ.0b013e3182750767

Lacomis D. Neuromuscular disorders in critically ill patients: review and update. J Clin Neuromuscul Dis. 2011;12(4):197-218. doi:10.1097/CND.0b013e3181b5e14d

Kasotakis G, Schmidt U, Perry D, et al. The surgical intensive care unit optimal mobility score predicts mortality and length of stay. Crit Care Med. 2012;40(4):1122-1128. doi:10.1097/CCM.0b013e3182376e6d

Connolly BA, Jones GD, Curtis AA, et al. Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study. Crit Care. 2013;17(5):R229. doi:10.1186/cc13052

Rawal H, Bakhru RN. Early mobilization in the ICU. CHEST Critical Care. 2024;2(1):100038. doi:10.1016/j.chstcc.2023.100038

Hermans G, Van Mechelen H, Clerckx B, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2014;190(4):410-420. doi:10.1164/rccm.201312-2257OC

Bakhru RN, McWilliams DJ, Wiebe DJ, Spuhler VJ, Schweickert WD. Intensive care unit structure variation and implications for early mobilization practices. an international survey. Ann Am Thorac Soc. 2016;13(9):1527-1537. doi:10.1513/AnnalsATS.201601-078OC

Barros-Poblete M, Bernardes Neto SC, Benavides-Cordoba V, et al. Early mobilization in intensive care unit in Latin America: a survey based on clinical practice. Front Med. 2022;9:1005732. doi:10.3389/fmed.2022.1005732

Tadyanemhandu C, van Aswegen H, Ntsiea V. Organizational structures and early mobilization practices in South African public sector intensive care units-a cross-sectional study. J Eval Clin Pract. 2021;27(1):42-52. doi:10.1111/jep.13378

Wang J, Shi C, Xiao Q, Jia Y. ICU nurses' practice and intention to implement early mobilization: a multi-centre cross-sectional survey. Nurs Crit Care. 2024;29(5):1067-1077. doi:10.1111/nicc.13100

Dubb R, Nydahl P, Hermes C, et al. Barriers and strategies for early mobilization of patients in intensive care units. Ann Am Thorac Soc. 2016;13(5):724-730. doi:10.1513/AnnalsATS.201509-586CME

Jaengsook R, Siripitayakunkit A, Duangbubpha S, Chayaratanasin P. A feasibility study of implementing early mobilization nursing practice guidelines for critically ill patients. Thai J Cardio-Thorac Nurs. 2021;32(1):29-43.

Bailey P, Thomsen GE, Spuhler VJ, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139-145. doi:10.1097/01.CCM.0000251130.69568.87

Hashem MD, Nelliot A, Needham DM. Early mobilization and rehabilitation in the ICU: moving back to the future. Respir Care. 2016;61(7):971-979. doi:10.4187/respcare.04741

Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-1882. doi:10.1016/S0140-6736(09)60658-9

TEAM Study Investigators; Hodgson C, Bellomo R, et al. Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care. 2015;19(1):81. doi:10.1186/s13054-015-0765-4

Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017;43(2):171-183. doi:10.1007/s00134-016-4612-0