Early mobilisation and rehabilitation in the PICU: a UK survey

Thompson, Jacqueline Y, Menzies, Julie C, Manning, Joseph C, McAnuff, Jennifer, Brush, Emily Clare, Ryde, Francesca, Rapley, Tim, Pathan, Nazima, Brett, Stephen, Moore, David J, Geary, Michelle, Colville, Gillian A, Morris, Kevin P, Parslow, Roger Charles, Feltbower, Richard G, Lockley, Sophie, Kirkham, Fenella J, Forsyth, Rob J, Scholefield, Barnaby R and PERMIT Collaborators, Paediatric Critical Care Society Study- Gr, (2022) Early mobilisation and rehabilitation in the PICU: a UK survey. BMJ Paediatrics Open, 6 (1). e001300. ISSN 2399-9772

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Abstract

Objective To understand the context and professional perspectives of delivering early rehabilitation and mobilisation (ERM) within UK paediatric intensive care units (PICUs).

Design A web-based survey administered from May 2019 to August 2019.

Setting UK PICUs.

Participants A total of 124 staff from 26 PICUs participated, including 22 (18%) doctors, 34 (27%) nurses, 28 (23%) physiotherapists, 19 (15%) occupational therapists and 21 (17%) were other professionals.

Results Key components of participants’ definitions of ERM included tailored, multidisciplinary rehabilitation packages focused on promoting recovery. Multidisciplinary involvement in initiating ERM was commonly reported. Over half of respondents favoured delivering ERM after achieving physiological stability (n=69, 56%). All age groups were considered for ERM by relevant health professionals. However, responses differed concerning the timing of initiation. Interventions considered for ERM were more likely to be delivered to patients when PICU length of stay exceeded 28 days and among patients with acquired brain injury or severe developmental delay. The most commonly identified barriers were physiological instability (81%), limited staffing (79%), sedation requirement (73%), insufficient resources and equipment (69%), lack of recognition of patient readiness (67%), patient suitability (63%), inadequate training (61%) and inadequate funding (60%). Respondents ranked reduction in PICU length of stay (74%) and improvement in psychological outcomes (73%) as the most important benefits of ERM.

Conclusion ERM is gaining familiarity and endorsement in UK PICUs, but significant barriers to implementation due to limited resources and variation in content and delivery of ERM persist. A standardised protocol that sets out defined ERM interventions, along with implementation support to tackle modifiable barriers, is required to ensure the delivery of high-quality ERM.

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