Background: The reduced mobility in critically ill patients is still a reality in many intensive care units. This study aims to investigate if mobility level is associated with extubation outcome in adult patients.Methods: Prospective cohort study which comprised adults who had undergone initial invasive mechanical ventilation for more than 24 hours and were independently mobile before hospitalization. Patient progress was monitored from ICU admission to discharge. Data were collected daily from medical records and multidisciplinary teams, considering variables such as age, sex, BMI, SAPS III score, type of ICU admission, comorbidities, sedation, usage of vasoactive drugs, neuromuscular blockers, duration of mechanical ventilation, and ICU mobility scale (IMS). The primary outcome was the success of extubation.Results: IMS values did not directly associate with extubation outcome. Older patients demonstrated a reduced tendency for high IMS values, as did those on prolonged usage of vasoactive drugs or mechanical ventilation. Patients with higher IMS values achieved successful extubation earlier, suggesting a link between mobility and faster extubation success.Conclusion: The level of mobility assessed 24 hours after extubation was not associated with extubation success. The following characteristics were associated with a lower propensity to present high IMS: older age, greater number of days of use of vasoactive drugs and mechanical ventilation. Patients with higher levels of mobility had a successful extubation event earlier in the ICU. Studies that assess mobility on a continuous basis would be more precise in identifying this association.

BACKGROUND: Despite early mobilization has been proposed as an effective intervention to improve prognosis of patients in intensive care unit and other clinical settings, the benefits of it in patients with atrial fibrillation undergoing catheter ablation is still unknow.
METHODS: 273 geriatric patients with atrial fibrillation underwent catheter ablation in our center were included in this retrospective cohort study, with 137 in early mobilization group and 136 in routine care group.
RESULTS: After in-hospital observation and 90-day follow-up, we found though patients undergoing early mobilization didn\'t suffer more post-procedural complications, early mobilization didn\'t either shorten or extend the length of hospital stay. The average score of EQ-5D visual analogue scale and EHRA symptom scale were significantly improved and less unscheduled outpatient visits were recorded in early mobilization group during 90-day follow-up.
CONCLUSIONS: Early mobilization could be a safe and favorable intervention for patients underwent catheter ablation.

OBJECTIVE: Muscular deficits as part of severe osteoarthritis of the hip may persist for up to two years following total hip arthroplasty (THA). No study has evaluated the mid-term benefit of a modified enhanced-recovery-after-surgery (ERAS) concept on muscular strength of the hip in detail thus far. We (1) investigated if a modified ERAS-concept for primary THA improves the mid-term rehabilitation of muscular strength and (2) compared the clinical outcome using validated clinical scores.
METHODS: In a prospective, single-blinded, randomized controlled trial we compared patients receiving primary THA with a modified ERAS concept (n = 12, ERAS-group) and such receiving conventional THA (n = 12, non-ERAS) at three months and one year postoperatively. For assessment of isokinetic muscular strength, a Biodex-Dynamometer was used (peak-torque, total-work, power). The clinical outcome was evaluated by using clinical scores (Patient-Related-Outcome-Measures (PROMs), WOMAC-index (Western-Ontario-and-McMaster-Universities-Osteoarthritis-Index), HHS (Harris-Hip-Score) and EQ-5D-3L-score.
RESULTS: Three-months postoperatively, isokinetic strength (peak-torque, total-work, power) and active range of motion was significantly better in the modified ERAS group. One year postoperatively, the total work for flexion was significantly higher than in the Non-ERAS group, whilst peak-torque and power did not show significant differences. Evaluation of clinical scores revealed excellent results at both time points in both groups. However, we could not detect any significant differences between both groups in respect of the clinical outcome.
CONCLUSIONS: With regard to muscular strength, this study supports the implementation of an ERAS concept for primary THA. The combination with a modified ERAS concept lead to faster rehabilitation for up to one-year postoperatively, reflected by significant higher muscular strength (peak-torque, total-work, power). Possibly, because common scores are not sensitive enough, the results are not reflected in the clinical outcome. Further larger randomized controlled trials are necessary for long-term evaluation.

Traumatic brain injury (TBI) is a major cause of neurodisability worldwide, with notably high disability rates among moderately severe TBI cases. Extensive previous research emphasizes the critical need for early initiation of rehabilitation interventions for these cases. However, the optimal timing and methodology of early mobilization in TBI remain to be conclusively determined. Therefore, we explored the impact of early progressive mobilization (EPM) protocols on the functional outcomes of ICU-admitted patients with moderate to severe TBI.
This randomized controlled trial was conducted at a trauma ICU of a medical center; 65 patients were randomly assigned to either the EPM group or the early progressive upright positioning (EPUP) group. The EPM group received early out-of-bed mobilization therapy within seven days after injury, while the EPUP group underwent early in-bed upright position rehabilitation. The primary outcome was the Perme ICU Mobility Score and secondary outcomes included Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), the length of stay in the intensive care unit (ICU), and duration of ventilation.
Among 65 randomized patients, 33 were assigned to EPM and 32 to EPUP group. The EPM group significantly outperformed the EPUP group in the Perme ICU Mobility and FIM-motor scores, with a notably shorter ICU stay by 5.9 days (p < 0.001) and ventilation duration by 6.7 days (p = 0.001). However, no significant differences were observed in PhAs.
The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI. Our study\'s results support further investigation of EPM through larger, randomized clinical trials. Clinical trial registration ClinicalTrials.gov NCT04810273 . Registered 13 March 2021.

BACKGROUND: Early mobilization is key in neurologically impaired persons, limiting complications and improving long-term recovery. Self-balanced exoskeletons are used in rehabilitation departments to help patients stand and walk. We report the first case series of exoskeleton use in acute neurosurgery and intensive care patients, evaluating safety, clinical feasibility and patients\' satisfaction.
METHODS: We report a retrospective observational study including individuals hospitalized in the neurosurgical intensive care and neurosurgery departments. We included patients with a medical prescription for an exoskeleton session, and who met no contraindication. Patients benefited from standing sessions using a self-balanced exoskeleton (Atalante, Wandercraft, France). Patients and sessions data were collected. Safety, feasibility and adherence were evaluated.
RESULTS: Seventeen patients were scheduled for 70 standing sessions, of which 27 (39%) were completed. They were typically hospitalized for intracranial hemorrhage (74%) and presented with unilateral motor impairments, able to stand but with very insufficient weight shifting to the hemiplegic limb, requiring support (MRC 36.2 ± 3.70, SPB 2.0 ± 1.3, SPD 0.7 ± 0.5). The average duration of standing sessions was 16 ± 9 min. The only side effect was orthostatic hypotension (18.5%), which resolved with returning to seating position. The most frequent reason for not completing a session was understaffing (75%). All patients were satisfied and expressed a desire to repeat it.
CONCLUSIONS: Physiotherapy using the exoskeleton is safe and feasible in the acute neurosurgery setting, although it requires adaptation from the staff to organize the sessions. An efficacy study is ongoing to evaluate the benefits for the patients.

BACKGROUND: An adequate early mobilization followed by an effective and pain-free rehabilitation are critical for clinical and functional recovery after hip and proximal femur fracture. A multimodal approach is always recommended so as to reduce the administered dose of analgesics, drug interactions, and possible side effects. Peripheral nerve blocks should always be considered in addition to spinal or general anesthesia to prolong postoperative analgesia. The pericapsular nerve group (PENG) block appears to be a less invasive and more effective analgesia technique compared to other methods.
METHODS: We conducted multicenter retrospective clinical research, including 98 patients with proximal femur fracture undergoing osteosynthesis surgery within 48 h of occurrence of the fracture. Thirty minutes before performing spinal anesthesia, 49 patients underwent a femoral nerve (FN) block plus a lateral femoral cutaneous nerve (LCFN) block, and the other 49 patients received a PENG block. A non-parametric Wilcoxon-Mann-Whitney (α = 0.05) test was performed to evaluate the difference in resting and dynamic numerical rating scale (NRS) at 30 min, 6 h, 12 h, and 24 h.
RESULTS: the PENG block administration was more effective in reducing pain intensity compared to the FN block in association with the LFCN block, as seen in the resting and dynamic NRS at thirty minutes and 12 h follow-up.
CONCLUSIONS: the PENG block was more effective in reducing pain intensity than the femoral nerve block associated with the lateral femoral cutaneous nerve block in patients with proximal femur fracture undergoing to osteosynthesis.

OBJECTIVE: To understand the status quo of multiprofessional and multidisciplinary collaboration for early mobilization of mechanically ventilated patients in Chinese ICUs and identify any factors that may influence this practice.
METHODS: A multi-centre cross-sectional survey.
METHODS: From October to November 2022, the convenience sampling method was used to select ICU multiprofessional and multidisciplinary early mobility members (including physicians, nurses and physiotherapists) from 27 tertiary general hospitals in 14 provinces, cities and autonomous regions of China. They were asked to complete an author-developed questionnaire on the status of collaboration and the Assessment of Inter-professional Team Collaboration Scale. A multiple linear regression model was used to analyse the factors associated with the level of collaboration.
RESULTS: Physicians, nurses and physiotherapists mostly suffered from the lack of normative protocols, unclear division of responsibilities and unclear multiprofessional and multidisciplinary teams when using a collaborative approach to early activities. Multiple linear regression analysis showed that the number of ICU patients managed, the existence of norms and processes, the attitude of colleagues around them, the establishment of a team, communication methods and activity leaders were significant influences on the level of collaboration among members of the multiprofessional and multidisciplinary early activities.
CONCLUSIONS: The collaboration of multiprofessional and multidisciplinary early activity members for mechanically ventilated patients in the ICU remains unclear, and the collaboration strategy needs to be constructed and improved, taking into account China\'s human resources and each region\'s economic development level.
CONCLUSIONS: This study investigates the collaboration status of multiprofessional and multidisciplinary activity members from the perspective of teamwork, analyses the reasons affecting the level of collaboration and helps to develop better teamwork strategies to facilitate the implementation of early activities.
UNASSIGNED: The participants in this study were multiprofessional and multidisciplinary medical staff who performed early activities for ICU patients.

OBJECTIVE: Early mobilization of patients with a major lower extremity amputation (LEA) is often a challenge because of lack of compliance. Therefore, we investigated factors limiting independent mobility and physiotherapy on the first day with physiotherapy (PTDay1) and the following 2 days after LEA.
METHODS: A total of 60 consecutive patients, mean age 73.7 years (SD 12.1 years), undergoing LEA were included over a period of 7 months. The Basic Amputee Mobility Score was used to assess basic mobility. Predefined limitations for not achieving independent mobility or not completing physiotherapy were residual limb pain, pain elsewhere, fear of being mobilized, fatigue, nausea/vomiting, acute cognitive dysfunction or \"other\" factors reported on PTDay1 and the following 2 days after LEA.
RESULTS: Fatigue and fear of being mobilized were the most frequent limitations for not achieving independent mobility on PTDay1 and the following 2 days after LEA. Patients (n = 55) who were not independent in the Basic Amputee Mobility Score activity transferring from bed to chair on PTDay1 were limited by fatigue (44%) and fear of being mobilized (33%). A total of 21 patients did not complete planned physiotherapy on PTDay1, and were limited by fatigue (38%), residual limb pain (24%) and \"other\" factors (24%).
CONCLUSIONS: Fatigue and fear of being mobilized were the most frequent factors that limited independent mobility early after LEA. Fatigue, residual limb pain and \"other\" factors limited completion of physiotherapy. Geriatr Gerontol Int 2024; 24: 470-476.

Approximately one in three survivors of critical illness suffers from intensive-care-unit-acquired weakness, which increases mortality and impairs quality of life. By counteracting immobilization, a known risk factor, active mobilization may mitigate its negative effects on patients. In this single-center trial, the effect of robotic-assisted early mobilization in the intensive care unit (ICU) on patients\' outcomes was investigated.
We enrolled 16 adults scheduled for lung transplantation to receive 20 min of robotic-assisted mobilization and verticalization twice daily during their first week in the ICU (intervention group: IG). A control group (CG) of 13 conventionally mobilized patients after lung transplantation was recruited retrospectively. Outcome measures included the duration of mechanical ventilation, length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months.
During the first week in the ICU, the intervention group received a median of 6 (interquartile range 3-8) robotic-assisted sessions of early mobilization and verticalization. There were no statistically significant differences in the duration of mechanical ventilation (IG: median 126 vs. CG: 78 h), length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months between the IG and CG.
In this study, robotic-assisted mobilization was successfully implemented in the ICU setting. No significant differences in patients\' outcomes were observed between conventional and robotic-assisted mobilization. However, randomized and larger studies are necessary to validate the adequacy of robotic mobilization in other cohorts.
This single-center interventional trial was registered in clinicaltrials.gov as NCT05071248 on 27/08/2021.

BACKGROUND: Early mobilization (EM) within 24 to 72 hours post-stroke may improve patients\' performance and ability. However, after intravenous thrombolysis (IVT) or mechanical thrombectomy (MT), the increased risk of hemorrhagic complications impacts the implementation of early out-of-bed mobilization. Few studies have investigated EM after IVT or MT for acute ischemic stroke (AIS), and its impact in these patients is unknown.
OBJECTIVE: To investigate the effect of EM on AIS treated with IVT or MT.|.
METHODS: We recruited 122 patients with first AIS; 60 patients were treated with IVT, and 62 patients were treated with MT. For each IVT and MT cohort, the control groups received standard early rehabilitation, and the intervention groups received an EM protocol. The training lasted 30 minutes/day, 5 days/week until discharge.
METHODS: The effectiveness of the interventions was evaluated using the motor domain of the Functional Independence Measure (FIM-motor) and the Postural Assessment Scale for Stroke Patients (PASS) at baseline, 2-week, 4-week, and 3-month post-stroke, the Functional Ambulation Category 2-week post-stroke, and the total length of stay at the stroke center.
RESULTS: Both IVT and MT treatment groups showed improved FIM-motor and PASS scores over time; however, only the IVT EM group had significantly improved FIM-motor performance within 1 month after stroke than the control group. Conclusion. An EM protocol with the same intervention time and session frequency per day as in the standard care protocol was effective in improving the functional ability of stroke patients after IVT.