Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Crit Care Med. 2013 Jul;41(7):1745-53. doi: 10.1097/CCM.0b013e318287f592.
While early mobilization is safe and enhances functional recovery in critically ill adults, rehabilitation practices in critically ill children are not well characterized. The objective of this study was to evaluate the knowledge, perceptions, and stated practices of early mobilization among physicians and physiotherapists practicing in Canadian pediatric critical care units.
A self-administered survey was mailed to 102 physicians and 35 physiotherapists. Survey domains included barriers to early mobilization, the timing, nature and thresholds for rehabilitation, and staffing workload. We assessed for associations using chi-square tests.
The overall response rate was 64.2% (88 of 137), representing 59.8% (61 of 102) physicians and 77.1% (27 of 35) physiotherapists, respectively. Key institutional barriers to early mobilization included a lack of practice guidelines (75.4% physician, 48.1% physiotherapist respondents; p = 0.01) and the need for physician orders prior to initiating physiotherapy (26.2% physician vs 55.6% physiotherapist, p = 0.008). Only 3.4% of respondents reported having local guidelines for early mobilization. Conflicting perceptions regarding the clinical thresholds for early mobilization and the safety of early mobilization were the most commonly reported patient-level barriers. Increasing illness severity was associated with decreased clinician comfort with early mobilization. Respiratory physiotherapy and passive range of motion were the most frequently applied rehabilitation interventions (77.8%), while pregait physiotherapy and ambulation were only sometimes or infrequently (70.4%) used. The type and extent of physiotherapy varied depending on the time of day and week.
There are numerous perceived institutional, patient- and provider-level barriers to early mobilization in Canadian pediatric critical care units, and diverse opinions on the appropriateness of early mobilization. Limited awareness of existing literature and the lack of practice guidelines on early mobilization are not surprising in light of the paucity of pediatric-specific evidence. These results strongly support the need for further research, evaluating the feasibility, safety, and efficacy of early mobilization in critically ill children.
尽管早期活动在危重病成人中是安全的，并能促进功能恢复，但危重病儿童的康复实践并未得到很好的描述。本研究的目的是评估在加拿大儿科重症监护病房工作的医生和物理治疗师对早期活动的知识、看法和既定实践。
向 102 名医生和 35 名物理治疗师邮寄了一份自我管理的调查问卷。调查领域包括早期活动的障碍、康复的时机、性质和阈值以及人员配备工作量。我们使用卡方检验评估关联。
总的回复率为 64.2%（137 人中的 88 人），分别代表 59.8%（102 人中的 61 人）的医生和 77.1%（35 人中的 27 人）的物理治疗师。早期活动的主要机构障碍包括缺乏实践指南（75.4%的医生和 48.1%的物理治疗师受访者；p=0.01）和在开始物理治疗前需要医生医嘱（26.2%的医生和 55.6%的物理治疗师，p=0.008）。只有 3.4%的受访者报告有早期活动的本地指南。关于早期活动的临床阈值和早期活动安全性的冲突看法是最常见的患者层面障碍。疾病严重程度的增加与临床医生对早期活动的舒适度降低有关。呼吸物理治疗和被动关节活动度是最常应用的康复干预措施（77.8%），而预步态物理治疗和行走仅偶尔或很少使用（70.4%）。物理治疗的类型和程度取决于一天中的时间和一周中的时间。
加拿大儿科重症监护病房存在许多早期活动的机构、患者和提供者层面的感知障碍，以及对早期活动的适宜性的不同看法。鉴于儿科特定证据的缺乏，对现有文献的认识有限以及缺乏早期活动的实践指南并不奇怪。这些结果强烈支持进一步研究的必要性，以评估早期活动在危重病儿童中的可行性、安全性和疗效。
