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Effect of implementing mobility protocol on selected outcomes among critically ill elderly patients
Abstract
Background
Implementing mobility protocol for critically ill elderly patients may help prevent the sequelae of bed rest and improve patient outcomes.
Aim
To investigate the effect of implementing mobility protocol on selected outcomes among critically ill elderly patients.
Research hypothesis
Elderly critically ill patients who will be exposed to predesigned mobility protocol will have an improvement in their selected outcomes than those who will not.
Design
A quasi-experimental research design was used.
Sample
A purposive sample consisting of 60 critically ill elderly patients was included in this study within a period of 6 months.
Setting
This study was conducted at a medical ICU affiliated to a selected university hospital in Zagazig.
Tools
Two tools were developed, tested for clarity, and feasibility: (a) personal characteristics and medical data, and (b) patient outcome assessment sheet.
Results
Half (50%) of the control group and study group were males and the other half were females. The majority of study group were in the age group of 60 to less than 70 years. Concerning the past medical history, the majority of the control group and study group had a cardiac problem. The two groups were equal according to the presence of medical problems. In pretest, there were insignificant statistical differences ( P >0.05) between the two groups regarding cardiovascular system outcomes. The two groups were equal, except for capillary refill ( χ ² =4.32, P =0.04). Moreover, more than two-thirds (73.3%) of the control group had sluggish capillary refill compared with 93.3% of the study group, and approximately two-thirds (60%) of the control group had nonpitting edema in the right and left upper arms compared with 36.7% of the study group. In posttest, there were significant statistical differences in cardiovascular system outcomes between study group and control group in peripheral pulses ( χ ² =4.32, P =0.04), edema of right upper arm ( χ ² =10.13, P =0.006), edema of left upper arm ( χ ² =10.13, P =0.006), edema of right lower leg ( χ ² =5.96, P =0.03), and edema of left lower leg ( χ ² =4.95, P =0.04).
Conclusion
Early mobilization and rehabilitation of critically ill elderly patients may help prevent the sequelae of bed rest and improve patient outcomes.
Recommendation
Integrating mobility protocol into daily nursing care has shown to be imminent. As well, studying the effect of implanting mobility protocol on selected outcomes of critically ill intubated patients. In addition replication of this study on a larger probability sample from the different geographical locations in Egypt is recommended. Replication of this study on a larger probability sample from different geographical locations in Egypt is recommended.
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Importance:
Strength training exercise is recommended for improving physical function in older adults. However, whether strength training (lifting and lowering weights under control) and power training (PT) (lifting weights fast and lowering under control) are associated with improved physical function in older adults is not clear.
Objective:
To evaluate whether PT vs traditional strength training is associated with physical function improvement in older adults.
Data sources:
Systematic searches of MEDLINE, Embase, Cochrane Central, CINAHL, PsycInfo, PEDro, and SPORTDiscus were conducted from database inception to October 20, 2021.
Study selection:
Randomized clinical trials (RCTs) that compared strength training with instructions to move the weight as fast as possible in the lifting phase with traditional strength training in healthy, community-living older adults (age ≥60 years).
Data extraction and synthesis:
Two authors independently selected trials, extracted data, assessed the risk of bias using the Cochrane risk-of-bias tool 2, and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Summary effect size measures were calculated using a multilevel random-effects model with cluster robust variance estimation and are reported as standardized mean differences (SMDs). Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline.
Main outcomes and measures:
Primary outcomes included physical function and self-reported physical function. Secondary outcomes included power, strength, muscle mass, walk speed, balance, and adverse effects.
Results:
A total of 20 RCTs enrolling 566 community-living older adults (mean [SD] age, 70.1 [4.8] years; 368 [65%] women) were included. For the primary outcomes, PT was associated with an improvement in physical function with low-certainty evidence in 13 RCTs (n = 383) (SMD, 0.30; 95% CI, 0.05-0.54) and self-reported function with low-certainty evidence in 3 RCTs (n = 85) (SMD, 0.38; 95% CI, -0.62 to 1.37). The evidence was downgraded by 2 levels for high risk of bias and imprecision for physical function and very serious imprecision for self-reported physical function.
Conclusions and relevance:
In this systematic review and meta-analysis, PT was associated with a modest improvement in physical function compared with traditional strength training in healthy, community-living older adults. However, high-quality, larger RCTs are required to draw more definitive conclusions.
Delayed mobilization of cardiac surgical patients (CSPs) postoperatively is a huge challenge for critical care nurses (CCNs). Early ambulation (EA) is a vital task with a significant priority of nursing practice in critical care units (ICUs). CCNs’ awareness of EA value for CSPs’ outcomes is the main concern. The inclusive aim of EA is to sustain hemodynamic stability and adequate organ perfusion. Aim: The current study aimed to examine the effect of EA on hemodynamic and perfusion indices post cardiac surgery. Sample: Sixty adult patients of both sexes undergoing cardiac surgery were involved in this study. Then they assigned randomly into two groups; EA group and hospital care (HC) group. Data collection: Data were collected using one tool which encompasses three parts containing the patient preoperative basic health data, hemodynamic indices record and perfusion indices record. Results: The findings presented that peripheral pulse (PP) and heart rates were decreased tenuously among the EA patients compared with HC patients. However, the systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were increased significantly in EA group than HC group post ambulation compared with preoperative readings. Additionally, perfusion indices were increased among the EA patients and HC patients post mobilization compared with preoperative readings. Conclusion: The current study showed that EA has positive effect on the patients hemodynamic and perfusion indices postoperatively. Thus, CCNs should give a high priority to plan EA schedule when caring for CSPs. Furthermore, there is a need for EA algorithms in ICUs.
Objectives:
The aim was to investigate whether patients who participated in a mobility program in the ICU performed better on functional status, muscle, mobility, and respiratory assessments upon discharge than patients who received conventional physiotherapy.
Design:
Randomized controlled trial.
Setting:
Blind evaluation.
Patients:
Adults with previous functional independence and without contraindications for mobilization were eligible.
Interventions:
The intervention group participated in an early and progressive mobility program with five levels of activity. The control group underwent the conventional treatment without a preestablished routine. We evaluated functional status, level of activity, respiratory status, muscle strength, and mobility at ICU discharge.
Measurements and main results:
We analyzed 49 patients in the control group and 50 patients in the intervention group. Our data showed patients with better functional status and more functionally independent patients in the intervention group compared with those in the control group (96% vs 44%; p < 0.001). The results of the sit-to-stand and 2-minute walk tests, as well as the results of the maximum voluntary ventilation tests, also varied between the groups. The intervention group had shorter ICU stays than the control group. Higher Barthel index scores were associated with the amount of activity and participation in the protocol. The benefits to functional status remained during follow-up.
Conclusions:
Patients who participated in an ICU mobility program had better functional status at discharge from the ICU. The other benefits of the program included better performance in the mobility tests and improved maximum voluntary ventilation performance.
Background
Age has been traditionally considered a risk factor for mortality in elderly patients admitted to intensive care units. The aim of this prospective, observational, multicenter cohort study is to determine the risk factors for mortality in elderly and very elderly critically ill patients with sepsis.
Results
A total of 1490 patients with ≥ 65 years of age were included in the study; most of them 1231 (82.6%) had a cardiovascular failure. The mean age (± SD) was 74.5 (± 5.6) years, and 876 (58.8%) were male. The patients were divided into two cohorts: (1) elderly: 65–79 years and (2) very elderly: ≥ 80 years. The overall hospital mortality was 48.8% (n = 727) and was significantly higher in very elderly compared to elderly patients (54.2% vs. 47.4%; p = 0.02). Factors independently associated with mortality were APACHE II score of the disease, patient location at sepsis diagnosis, development of acute kidney injury, and thrombocytopenia in the group of elderly patients. On the other hand, in the group of very elderly patients, predictors of hospital mortality were age, APACHE II score, and prompt adherence of the resuscitation bundle.
Conclusion
This prospective multicenter study found that patients aged 80 or over had higher hospital mortality compared to patients between 65 and 79 years. Age was found to be an independent risk factor only in the very elderly group, and prompt therapy provided within the first 6 h of resuscitation was associated with a reduction in hospital mortality in the very elderly patients.
Purpose
To describe the association between major complications of immobility (pressure ulcer, pneumonia, deep vein thrombosis and urinary tract infection) during hospitalization and the patients’ health-related quality of life after discharge.
Methods
The data were obtained from a multi-center study conducted in 2015. Complications of immobility during hospitalization was measured by case report form and quality of life after discharge was measured using the EQ-5D scale by telephone interview. Multilevel mixed-effects models were used to explore the association of complications and responses in the EQ-5D dimensions after controlling for important covariates.
Results
Among the 20,515 bedridden patients, 2,601(12.72%) patients experienced at least one of the major complications of immobility during hospitalization, including pressure ulcer (527, 2.57%), deep vein thrombosis (343, 1.67%), pneumonia (1647, 8.16%), and urinary tract infection (265, 1.29%). Patients with any of the four complications during hospitalization reported more problems in all EQ-5D dimensions except for pain/discomfort, and had lower mean EQ-VAS scores than those without any complications. The four complications all showed significant associations with the proportion of reported problems in certain dimensions after adjustment for confounding variables.
Conclusions
Major complications of immobility were significantly associated with reduced health related quality of life. Prevention of complications is critical to reduce the burden of decreased quality of life for bedridden patients.
Objective:
to describe the deleterious effects of prolonged bed rest on the body systems of the elderly.
Method:
an integrative-narrative review was carried out, with the following research question: What are the effects of prolonged bed rest on the body systems of the elderly? The PubMed and Virtual Health Library databases were searched with the following terms: "bed rest” and "elderly" with the Boolean operator “and”.
Results:
a total of 1,639 articles were found. After application of the established criteria, nine articles remained, and 20 were added to maintain the citation of the primary source, giving a total of 29 articles.
Conclusion:
the immobility associated with prolonged bed rest is detrimental to the health of the elderly, as it affects several systems, such as the cardiovascular, pulmonary, gastrointestinal, musculoskeletal and urinary systems, which may lead to the onset of diseases in addition to those that led to bed rest.
The present study evaluated the effectiveness of a short and versatile daily exercise regime, named locomotion replacement training (LRT), to maintain muscle size, isometric strength, power, and endurance capacity of the leg muscles following 5 days of head-down tilt (HDT) bed rest.
10 male subjects (age 29.4 ± 5.9 years; height 178.8 ± 3.7 cm; body mass 77.7 ± 4.1 kg) performed, in random order, 5 days of 6° head-down tilt bed rest (BR) with no exercise (CON), or BR with daily 25 min of upright standing (STA) or LRT.
Knee extensor and plantar flexor cross-sectional area (CSA) were reduced by 2-3 % following bed rest (P < 0.01) for CON and STA, yet maintained for LRT. Knee extensor isometric strength (MVC) decreased by 8 % for CON (P < 0.05), was maintained for STA, and increased with 12 % for LRT (P < 0.05). Plantar flexor MVC remained unaltered during the study. Maximum jump height declined (~1.5 cm) for all conditions (P < 0.001). Neural activation and knee extensor fatigability did not change with bed rest. Bone resorption increased during BR and neither LRT nor STA was able to prevent or attenuate this increase.
LRT was adequate to maintain muscle size and to even increase knee extensor MVC, but not muscle power and bone integrity, which likely requires more intense and/or longer exercise regimes. However, with only some variables showing significant changes, we conclude that 5 days of BR is an inadequate approach for countermeasure assessments.
Cognitive impairment after critical illness is common and debilitating. We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness.
We randomized 87 medical and surgical ICU patients with respiratory failure and/or shock in a 1:1:2 manner to three groups: usual care, early once-daily physical therapy, or early once-daily physical therapy plus a novel, progressive, twice-daily cognitive therapy protocol. Cognitive therapy included orientation, memory, attention, and problem-solving exercises, and other activities. We assessed feasibility outcomes of the early cognitive plus physical therapy intervention. At 3 months, we also assessed cognitive, functional, and health-related quality of life outcomes. Data are presented as median (interquartile range) or frequency (%).
Early cognitive therapy was a delivered to 41/43 (95 %) of cognitive plus physical therapy patients on 100 % (92-100 %) of study days beginning 1.0 (1.0-1.0) day following enrollment. Physical therapy was received by 17/22 (77 %) of usual care patients, by 21/22 (95 %) of physical therapy only patients, and 42/43 (98 %) of cognitive plus physical therapy patients on 17 % (10-26 %), 67 % (46-87 %), and 75 % (59-88 %) of study days, respectively. Cognitive, functional, and health-related quality of life outcomes did not differ between groups at 3-month follow-up.
This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy. Future work to determine optimal patient selection, intensity of treatment, and benefits of cognitive therapy in the critically ill is needed.
As technology and medications have improved and increased, survival rates are also increasing in intensive care units (ICUs), so it is now important to focus on improving the patient outcomes and recovery. To do this, ICU patients need to be assessed and started on an early mobility program, if stable. While the early mobilization of the ICU patients is not without risk, the current literature has demonstrated that patients can be safely and feasibly mobilized, even while requiring mechanical ventilation. These patients are at a high risk for muscle deconditioning due to limited mobility from numerous monitoring equipment and multiple medical conditions. Frequently, a critically ill patient only receives movement from nurses; such as, being turned side to side, pulled up in bed, or transferred from bed to a stretcher for a test. The implementation of an early mobility protocol that can be used by critical care nurses is important for positive patient outcomes minimizing the functional decline due to an ICU stay. This paper describes a pilot study to evaluate an early mobilization protocol to test the safety and feasibility for mechanically ventilated patients in a surgical trauma ICU in conjunction with the current unit standards.
The purpose of this review article was to examine the efficacy of an early mobilization protocol in hospitalized medical-surgical inpatient population.
Prolonged immobilization can result in functional decline and heighten the risk for hospital-associated complications such as falls and pressure ulcers. Early mobilization, on the other hand, has been shown to prevent functional decline and hospital-associated complications. However, currently no evidence-based guidelines exist with regard to an early mobilization protocol for the medical-surgical inpatient population. Therefore, the purpose of this review was to provide a thorough analysis of current evidence pertaining to an early mobilization protocol for the medical-surgical inpatient population.
A comprehensive search of the literature was conducted using Ovid, MEDLINE, and PubMed databases using the following search terms: early ambulation, postoperative care, and length of stay.
We found a total of 9 empirical studies that met the inclusion criteria. Studies revealed that using the basic tenets of an early mobilization protocol was associated with improved outcomes for patients with deep vein thrombosis, reduced length of stay in patients with community-acquired pneumonia, and maintained or improved functional status from admission to discharge of hospitalized older adults and patients recovering from major surgery.
Overall, our review found that early mobilization (especially early ambulation) of the medical-surgical inpatient population may improve patient outcomes.
Our review indicated that the greatest impact of early mobilization is through standardized mobility protocols or programs. Clinical nurse specialists are experts in leading and sustaining standardized protocols or programs pertaining to a nurse-sensitive outcome such as mobility.
Background
Trauma and management of injuries can result in reduction or loss of mobility, which can lead to skeletal muscle deconditioning and sustained disability. Prior investigators have examined changes in skeletal muscle due to injury and immobility separately. The muscular consequences of combined immobility and trauma have not been systematically investigated.
Objective
The purpose of this study was to explore the association of time to first ambulation with skeletal muscle size and strength in patients after major trauma.
Methods
Adults ( N = 19) admitted for major trauma (Injury Severity Score [ISS] > 15) provided daily measures of muscle size (ultrasound) and strength (dynamometry) during hospitalization. Participants were grouped based on time to first ambulation. Repeated measures analysis of variance was used to compare muscle measures between the groups across 5 days while controlling for age and gender.
Results
Participants were primarily male (63%) aged 40 ± 17 years with a mean ISS of 21 ± 4. Early ambulation was associated with a 10% increase from baseline in bicep size on Days 3 and 4 and a 15% increase from baseline on Day 5. There were no changes in rectus femoris size in either group. The early ambulation group was significantly stronger than the delayed ambulation group throughout the study in measures taken with the biceps (22%–37%) and quadriceps (26%–46%).
Conclusion
Early ambulation following major trauma was associated with increased bicep size and greater muscle strength in the biceps and quadriceps muscles over time.
Geriatric admissions to the intensive care unit (ICU) are common and require unique considerations for ICU clinicians. Admission to the ICU should be considered on an individual-patient basis. It is reasonable to consider a "trial of critical care" for many patients, even those who have uncertain chances of meaningful recovery. Quality of life and functional independence are especially important to older adults, and these outcomes should be considered when weighing the risks and benefits of admission or continuing ICU care.
Mobility for critically ill patients has been found to be safe, beneficial, and feasible, although a culture of immobility prevails in many adult intensive care units (ICU) because of staffing challenges and lack of physical therapy and occupational therapy involvement. Clinical practice guidelines recommended early mobility for ICU patients to improve long- and short-term outcomes. Addition of a mobility team to the licensed physical therapy and occupational therapy staff and interprofessional ICU team improved patient outcomes and staff satisfaction, and reduced facility cost related to employee injuries.
Purpose:
To investigate the predictive value of in-hospital posture and ambulatory activity for 30-d following discharge on functional status in older patients with heart failure.
Methods:
Prospective observational pilot study of 27 patients (78 ± 9.8yrs; 51.8% female) admitted with heart failure. Participants wore two inclinometric accelerometers to record posture in-hospital, and an ankle accelerometer to record ambulatory activity in-hospital and 30 days after discharge. Function was assessed the day after discharge (Timed Up and Go [TUG], Short Physical Performance Battery [SPPB], hand grip strength) and at 30-d post-discharge.
Results:
Length of stay was 5.1 ± 3.9 days. Participants spent 63.0 ± 19.2% of their hospital time lying, 30.2 ± 18.7% sitting, 5.3 ± 4.2% standing, and 1.9 ± 8.6% ambulating. Thirty-day mean post-discharge stepping was 4890 ± 2285 steps/day. Each 10% increase in hospital lying time was associated with 0.7 sec longer TUG time (95% CI, 0.2-1.9) at 30-d. Each 1000 additional daily steps in the post-discharge period was associated with a 0.8-point higher SPPB score (95% CI, 0.1-1.0) at 30-d. Handgrip strength was unchanged.
Conclusions:
Older patients with heart failure were sedentary during hospitalization which may contribute to decreased functional performance. Physical activity post-discharge may minimize this negative effect.
Prevalence of pre-existing frailty in patients admitted to the intensive care unit (ICU) is increasing. Critical illness leads to a catabolic state that further diminishes body reserves and contributes to frailty independent of age and prehospital functional status. Because early mobilization of patients in the ICU results in accelerated recovery and improvement in functional status and quality of life, frailty can severely affect the mobility of patients in ICU ultimately prolonging recovery. Understanding the concept of frailty and the association of frailty and its impact on mobility in the ICU, identifying patients, and timely resource allocation helps in optimum care and improves clinical outcomes.
Immobility in the intensive care unit (ICU) is associated with neuromuscular weakness, post-intensive care syndrome, functional limitations, and high costs. Early mobility-based rehabilitation in the ICU is feasible and safe. Mobility-based rehabilitation varied widely across 5 ICUs in 1 health care system, suggesting a need for continuous training and evaluation to maintain a strong mobility-based rehabilitation program. Early mobility-based rehabilitation shortens ICU and hospital stays, reduces delirium, and increases muscle strength and the ability to ambulate. Long-term effects include increased ability for self-care, faster return to independent functioning, improved physical function, and reduced hospital readmission and death. Factors that influence early mobility-based rehabilitation include having an interdisciplinary team; strong unit leadership; access to physical, occupational, and respiratory therapists; a culture focused on patient safety and quality improvement; a champion of early mobility; and a focus on measuring performance and outcomes.
Neuromuscular disorders are increasingly recognized as a cause of both short and long-term physical morbidity in survivors of critical illness. This recognition has given rise to research aimed at better understanding the risk factors and mechanisms associated with neuromuscular dysfunction and physical impairment associated with critical illness, as well as possible interventions to prevent or treat these issues. Among potential risk factors, bed rest is an important modifiable risk factor. Early mobilization and rehabilitation of critically ill patients may help prevent or mitigate the sequelae of bed rest and improve patient outcomes. Recent research studies and quality improvement projects have demonstrated that early mobilization and rehabilitation is safe and feasible in critically ill patients, with potential benefits including improved physical functioning and decreased duration of mechanical ventilation, intensive care and hospital stay. Despite these findings, early mobilization and rehabilitation is still uncommon in routine clinical practice, with many perceived barriers. This review 1) summarizes potential risk factors for neuromuscular dysfunction and physical impairment associated with critical illness, 2) highlights the potential role of early mobilization and rehabilitation in improving patient outcomes, and 3) discusses some of the commonly perceived barriers to early mobilization and strategies for overcoming them.
To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness.
We searched PubMed, CINAHL, Web of Science and Google Scholar for studies reporting disability outcomes (i.e., activities of daily living, instrumental activities of daily living, and mobility activities) and/or cognitive outcomes among patients treated in an ICU who were 65 years or older. We also reviewed the bibliographies of relevant citations to identify additional citations.
We identified 19 studies evaluating disability outcomes in critically ill patients who were 65 years and older.
Descriptive epidemiologic data on disability after critical illness.
Newly acquired disability in activities of daily living, instrumental activities of daily living, and mobility activities was commonplace among older adults who survived a critical illness. Incident dementia and less severe cognitive impairment were also highly prevalent. Factors related to the acute critical illness, ICU practices, such as heavy sedation, physical restraints, and immobility, as well as aging physiology, and coexisting geriatric conditions can combine to result in these poor outcomes.
Older adults who survive critical illness have physical and cognitive declines resulting in disability at greater rates than hospitalized, noncritically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs.
Background: Exposure to microgravity causes functional and structural impairment of skeletal muscle. Current exercise regimens are time-consuming and insufficiently effective; an integrated countermeasure is needed that addresses musculoskeletal along with cardiovascular health. High-intensity, short-duration rowing ergometry and supplemental resistive strength exercise may achieve these goals. Methods: 27 healthy volunteers completed 5 weeks of head down tilt bed rest; 18 were randomized to exercise, 9 remained sedentary. Exercise consisted of rowing ergometry 6d/week including interval training, and supplemental strength training 2d/week. Measurements before and after bed rest, and following reambulation included assessment of strength, skeletal muscle volume (MRI), and muscle metabolism (MRS); quadriceps muscle biopsies were obtained to assess muscle fiber types, capillarization and oxidative capacity. Results: Sedentary bed rest (BR) led to decreased muscle volume (quadriceps: -9±4%, p<0.001; plantarflexors: -19±6%, p<0.001). Exercise (ExBR) reduced atrophy in the quadriceps (-5±4%, interaction p=0.018) and calf muscle, though to a lesser degree (-14±6%, interaction p=0.076). Knee extensor and plantarflexor strength was impaired by BR (-14±15%, p=0.014 and -22±7%, p=0.001) but preserved by ExBR (-4±13%, p=0.238 and +13±28%, p=0.011). Metabolic capacity as assessed by VO2max, (31)P-MRS and oxidative chain enzyme activity was impaired in BR but stable or improved in ExBR. Reambulation reversed the negative impact of bed rest. Conclusions: High-intensity, short-duration rowing and supplemental strength training effectively preserved skeletal muscle function and structure while partially preventing atrophy in key antigravity muscles. Due to its integrated cardiovascular benefits, rowing ergometry could be a primary component of exercise prescriptions for astronauts or patients suffering from severe deconditioning.
: The Agency for Healthcare Research and Quality has defined pressure ulcers (PUs) an important patient safety indicator (#3). Despite the existence of evidence-based guidelines for PU prevention and treatment from the United States Department of Health and Human Services, the sustained success in reducing the development of PUs is elusive in many acute care hospitals.
: The specific aim of the study was to determine whether the implementation of an early standardized process for mobility could reduce or eliminate the development of PUs in a surgical intensive care unit.
: Patient data were collected pre- and postimplementation of the early mobility protocol.
: The mobility compliance for patients postimplementation was 71.30% (SD = 12.73), with a range of 25% to 100%. A χ test for independence (with Yates continuity correction) indicated a significant association between unit-acquired PUs and the pre- and postimplementation mobility groups (χ1,1051 = 6.86, P = .009). Specifically, patients in the intervention group had significantly more unit-acquired PUs than the control group. No significant differences were identified between the 2 groups. IMPLICATIONS/CONCLUSIONS:: Despite implementation of the early mobility protocol, we did not see an improvement in the PU rate overall or with time as protocol compliance improved.
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