Construction and application of a graded early mobility path for critically ill adult patients

doi:10.3761/j.issn.0254-1769.2025.17.009

Abstract

Abstract:

Objective To develop a graded early mobility implementation pathway for critically ill adult patients in tertiary hospitals in Beijing and to preliminarily validate its feasibility and effectiveness. Methods Based on the “goal-directed” early mobility concept，a graded early mobility implementation pathway for critically ill patients was developed through evidence synthesis and the Delphi method，consisting of 3 components：patient inclusion，mobility implementation，and mobility evaluation. Using convenience sampling，patients meeting inclusion criteria in the general ICU of a tertiary hospital in Beijing from October 2024 to January 2025 were selected as participants. Among them，25 patients admitted from December 2024 to January 2025 were assigned to an experimental group and received early mobility interventions following the developed pathway. 25 patients admitted from October to November 2024 served as a control group and received routine ICU mobility care. Outcomes including diaphragm excursion，muscle strength，ICU length of stay，and adverse events were compared between the 2 groups. Results The graded early mobility pathway achieved an implementation rate of 70.05% in the experimental group，significantly higher than it in the control group（P<0.001），without increasing adverse events. Post-intervention diaphragm excursion in the experimental group was significantly greater than that in the control group（P=0.018）. Conclusion The developed graded early mobility implementation pathway for ICU patients demonstrates scientific rigor and clinical practicality. It provides a reference for the widespread and effective implementation of early mobility in ICUs，standardizing its clinical application.

Key words: Intensive Care Units, Delphi Technique, Early Mobility, Rehabilitation Nursing, Breathing Exercises, Limb Movements, Ambulation

摘要：

目的构建ICU患者早期活动分级实施路径，并初步验证其可行性和有效性。方法基于目标导向的早期活动理念，通过证据总结、德尔菲法，构建ICU患者早期活动分级实施路径，包含患者纳入、活动实施及活动评价3个部分。采用便利抽样法，选取2024年10月至2025年1月在北京市某三级甲等医院综合ICU符合标准的患者作为研究对象，其中2024年12月至2025年1月收治的25例患者为试验组，采用构建的ICU患者早期活动分级实施路径进行活动，2024年10—11月收治的25例患者为对照组，执行ICU常规活动。比较两组活动实施率、不良事件发生情况、膈肌移动度、肌力等指标的差异。结果 ICU患者早期活动分级实施路径的应用可使试验组活动实施率达到70.05%，高于对照组（P<0.001），且未增加不良事件的发生。试验组出ICU膈肌移动度高于对照组（P=0.018）。结论构建的ICU患者早期活动分级实施路径具有较好的科学性和实用性，可为ICU患者早期活动在临床广泛、有效开展提供参考，规范早期活动在ICU的落实。

关键词: 重症监护病房, 德尔菲技术, 早期活动, 康复护理, 呼吸锻炼, 肢体运动, 离床活动

LI Bing, TANG Sheng, MA Yanlan, SHEN Lingyu, ZHAO Qinghua, LUO Ping, BI Mengjie. Construction and application of a graded early mobility path for critically ill adult patients[J]. Chinese Journal of Nursing, 2025, 60(17): 2102-2109.

李冰, 唐晟, 马燕兰, 慎玲玉, 赵庆华, 罗萍, 毕梦婕. ICU患者早期活动分级实施路径的构建及初步验证[J]. 中华护理杂志, 2025, 60(17): 2102-2109.

Figures/Tables 3

References 23

[1]	Xu Q, Tan J, Wang YX, et al. Theory-based and evidence-based nursing interventions for the prevention of ICU-acquired weakness in the intensive care unit:a systematic review[J]. PLoS One, 2024, 19(9):e0308291.
[2]	Anekwe DE, Biswas S, Bussières A, et al. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness:a systematic review and meta-analysis[J]. Physiotherapy, 2020, 107:1-10. DOI PMID
[3]	Liu H, Tian YM, Jiang BT, et al. Early mobilisation practice in intensive care units:a large-scale cross-sectional survey in China[J]. Nurs Crit Care, 2023, 28(4):510-518.
[4]	Sibilla A, Nydahl P, Greco N, et al. Mobilization of mechanically ventilated patients in Switzerland[J]. J Intensive Care Med, 2020, 35(1):55-62. DOI PMID
[5]	Timenetsky KT, Neto AS, Assunção MSC, et al. Mobilization practices in the ICU:a nationwide 1-day point-prevalence study in Brazil[J]. PLoS One, 2020, 15(4):e0230971.
[6]	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[J]. Front Med, 2022, 9:1005732.
[7]	Unoki T, Hayashida K, Kawai Y, et al. Japanese clinical practice guidelines for rehabilitation in critically ill patients 2023 (J-ReCIP 2023)[J]. J Intensive Care, 2023, 11(1):47. DOI PMID
[8]	Schujmann DS, Teixeira Gomes T, Lunardi AC, et al. Impact of a progressive mobility program on the functional status,respiratory,and muscular systems of ICU patients:a randomized and controlled trial[J]. Crit Care Med, 2020, 48(4):491-497. DOI PMID
[9]	Moss M. Early mobilization of critical care patients-still more to learn[J]. N Engl J Med, 2022, 387(19):1807-1808.
[10]	Yu LR, Jia WJ, Tian WM, et al. Optimal timing for early mobilization initiatives in intensive care unit patients:a systematic review and network meta-analysis[J]. Intensive Crit Care Nurs, 2024, 82:103607.
[11]	Lin YJ, Liang T, Zhang X, et al. Early goal-directed mobilization in patients with acute type A aortic dissection:a rando-mized controlled trial[J]. Clin Rehabil, 2023, 37(10):1311-1321.
[12]	胥露, 江智霞, 鲁鑫, 等. 早期功能锻炼预防ICU获得性衰弱的研究进展[J]. 中华护理杂志, 2021, 56(8):1267-1271. DOI
	Xu L, Jiang ZX, Lu X, et al. Early functional exercise to prevent adult ICU acquired weakness:a system review[J]. Chin J Nurs, 2021, 56(8):1267-1271. DOI
[13]	刘秀, 刘滨滨, 权明桃, 等. ICU机械通气患者膈肌锻炼方案的构建及应用研究[J]. 中华护理杂志, 2023, 58(3):261-267. DOI
	Liu X, Liu BB, Quan MT, et al. Construction and application of a diaphragm exercise program in patients with mechanical ventilation in ICU[J]. Chin J Nurs, 2023, 58(3):261-267. DOI
[14]	李冰, 马燕兰, 赵宏宇, 等. 综合监护室重症病人肢体活动分级护理路径的构建及应用[J]. 护理研究, 2025, 39(9):1416-1424.
	Li B, Ma YL, Zhao HY, et al. Construction and application of a graded limb activity nursing path of critically ill patients in comprehensive intensive care unit[J]. Chin Nurs Res, 2025, 39(9):1416-1424.
[15]	Wi S, Shin HI, Hyun SE, et al. Feasibility and safety of in-bed cycling/stepping in critically ill patients:a study protocol for a pilot randomized controlled clinical trial[J]. PLoS One, 2024, 19(5):e0301368.
[16]	Cassidy CE, Harrison MB, Godfrey C, et al. Use and effects of implementation strategies for practice guidelines in nursing:a systematic review[J]. Implement Sci, 2021, 16(1):102.
[17]	Heinzmann J, Baumgartner C, Liechti FD. Goal-directed mobility of medical inpatients-a mini review of the literature[J]. Front Med, 2022, 9:878031.
[18]	Yabe Y, Komori A, Iriyama H, et al. Association between the development of intensive care unit-acquired weakness and body composition at intensive care unit admission:a descriptive study[J]. J Crit Care, 2025, 85:154933.
[19]	Renner C, Jeitziner MM, Albert M, et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome[J]. Crit Care, 2023, 27(1):301.
[20]	Nydahl P, Günther U, Diers A, et al. PROtocol-based MObi-lizaTION on intensive care units:stepped-wedge,cluster-randomized pilot study(Pro-Motion)[J]. Nurs Crit Care, 2020, 25(6):368-375.
[21]	Yeung MT, Tan NK, Lee GZ, et al. Perceived barriers to mo-bility in the intensive care units of Singapore:The Patient Mobilisation Attitudes and Beliefs Survey for the intensive care units[J]. J Intensive Care Soc, 2023, 24(1):32-39.
[22]	Rosa D, Negro A, Marcomini I, et al. The effects of early mobilization on acquired weakness in intensive care units:a literature review[J]. Dimens Crit Care Nurs, 2023, 42(3):146-152.
[23]	Popoola M, Dingle M, MacLaren J, et al. What are the barriers to nurses mobilising adult patients in intensive care units? An integrative review[J]. Aust Crit Care, 2022, 35(5):595-603.