Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
PM R. 2011 Apr;3(4):307-13. doi: 10.1016/j.pmrj.2010.12.022.
To evaluate whether the level of mobilization achieved and the barriers for progressing to the next mobilization level differ between nurses and physical therapists.
Prospective, observational study.
Twenty-bed surgical intensive care unit (SICU) of the Massachusetts General Hospital.
Sixty-three critically ill patients.
Physical therapists and nurses performed 179 mobilization therapies with 63 patients.
Mobilization was defined as the process of enhancing mobility in the SICU, including bed mobility, edge of bed activities, transfers out of bed to a chair, and gait training; the mobilization level was measured on the SICU optimal mobilization scale, a 5-point (0-4) numerical rating scale.
Patients' level of mobilization achieved by physical therapists was significantly higher compared with that achieved by nurses (2.3 ± 1.2 mean ± SD versus 1.2 ± 1.2, respectively P < .0001). Different barriers for mobilization were identified by physical therapists and nurses: hemodynamic instability (26% versus 12%, P = .03) and renal replacement therapy (12% versus 1%, P = .03) were barriers rated higher by nurses, whereas neurologic impairment was rated higher by physical therapists providers (18% versus 38%, P = .002). No mobilization-associated adverse events were observed in this study.
This study showed that physical therapists mobilize their critically ill patients to higher levels compared with nurses. Nurse and physical therapists identify different barriers for mobilization. Routine involvement of physical therapists in directing mobilization treatment may promote early mobilization of critically ill patients.
评估护士和物理治疗师在达到的动员水平和推进到下一个动员水平的障碍方面是否存在差异。
前瞻性、观察性研究。
马萨诸塞州综合医院的 20 床外科重症监护病房（SICU）。
63 名危重病患者。
物理治疗师和护士对 63 名患者进行了 179 次动员治疗。
动员定义为在 SICU 中增强活动能力的过程，包括床上活动、床边活动、从床上转移到椅子上以及步态训练；动员水平通过 SICU 最佳动员量表进行测量，这是一个 5 点（0-4）数字评分量表。
物理治疗师所达到的患者动员水平明显高于护士（分别为 2.3 ± 1.2 均值 ± 标准差与 1.2 ± 1.2，P <.0001）。物理治疗师和护士确定了不同的动员障碍：血流动力学不稳定（26%比 12%，P =.03）和肾脏替代治疗（12%比 1%，P =.03）是护士评估更高的障碍，而神经功能障碍则是物理治疗师评估更高的障碍（18%比 38%，P =.002）。在本研究中未观察到与动员相关的不良事件。
本研究表明，与护士相比，物理治疗师使他们的危重病患者达到更高的动员水平。护士和物理治疗师确定了不同的动员障碍。常规让物理治疗师参与指导动员治疗可能会促进危重病患者的早期动员。
