Factors Associated with Mobility in a Neuroscience Intensive Care Unit

Purpose:
We examined if highest mobility level achieved during the first 12 days of stay in a Neuroscience Intensive Care Unit (NICU) was related to patient characteristics, psychological profile,length of hospital or unit stay, discharge disposition and 30-day mortality.

Background/Significance:
In medical ICU patients, early ambulation was safe, feasible, and associated with short-term benefits; such as fewer complications of bed rest, reduced length of stay, mechanical ventilation weaning, improved functional outcomes and quality of life, and reduced overall hospital costs. Patients in a NICU are often viewed as too sick to tolerate physical activity; thus, little is known about mobility status of patients treated in a NICU.

Methods:
Using a prospective, longitudinal design and survey and medical record review methods, all NICU patients were involved in data collection from July to November, 2011. Daily mobility status was collected via an investigator developed case report form. Medical history, demographics and acuity score were collected by medical record review. Patients completed the Brief Symptom Inventory for depression, anxiety and hostility (BSI-DAH) prior to unit discharge, when able. Descriptive statistics were use to summarize the sample. Comparative statistics were used to determine factors and outcomes associated with mobility.

Results:
Of 248 admissions in 229 patients, median (range) age was 65 (20, 95) years, 65% were Caucasian, and 52% were male. Median stay was 4 (1, 61) days and acuity score was 55.5 (16, 145). Turning, range of motion and head of bed (HOB) >30º were uniformly applied. 39% of patients never progressed; 39% progressed to HOB >45º or dangling; 11% progressed to standing/pivoting to chair and 10% progressed to walking with or without assistance. Of patient characteristics, only ventilator status and higher acuity score were associated with mobility level. Higher mobility was associated with shorter hospital stay, discharge home and less 30-day mortality. Mobility was not related to BSI-DAH (n=64).

Conclusions and Implications for Practice:
In NICU, mobility is not progressive. Ventilator status and higher acuity score limited mobility; however, both factors may be overcome with an early mobility protocol. Since mobility was associated with clinical outcomes, NICU nurses need to assess the effectiveness of an early mobility protocol.