患者层面的早期活动障碍及促进因素，及其与重症监护后身体残疾的关系：从世界卫生组织国际功能、残疾和健康分类的角度对综合评价的第 2 部分。
Patient-Level Barriers and Facilitators to Early Mobilization and the Relationship With Physical Disability Post-Intensive Care: Part 2 of an Integrative Review Through the Lens of the World Health Organization International Classification of Functioning, Disability, and Health.
出版信息
Dimens Crit Care Nurs. 2021;40(3):164-173. doi: 10.1097/DCC.0000000000000470.
BACKGROUND
Early mobilization (EM) is associated with reduced physical disability post-intensive care (PD PIC). Yet, contextual factors facilitate or impede delivery of EM in the intensive care unit (ICU). Only 45% of ICUs in the United States routinely practice EM despite its recognized benefits.
OBJECTIVES
To analyze the evidence on the relationship between critical care EM, PD PIC, and personal (patient-level) factors, using the theoretical lens of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF).
METHOD
The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the World Health Organization ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized.
RESULTS
Early mobilization delivery was influenced by personal factors. Deeper sedation level, the presence of delirium, higher patient acuity, the presence of medical devices, and patient weight were identified barriers to EM delivery. Patient engagement in EM was associated with improved delivery. Patients who enjoyed rehabilitation were more likely to demonstrate improvement in functional impairment than those who did not enjoy rehabilitation.
DISCUSSION
Early mobilization is associated with reduced PD PIC, yet numerous contextual factors affect the delivery of EM in the ICU. Further study of patient-level factors and EM must explore the relationship between patient engagement, baseline demographics, and functional status at ICU admission, patient-level considerations for decisions to mobilize, and EM in the ICU. This research is critical to improving the delivery of EM in the ICU and reducing PD PIC.
背景
早期活动（EM）与重症监护后身体残疾（PD PIC）减少有关。然而，在重症监护病房（ICU）中，有一些情境因素会促进或阻碍 EM 的实施。尽管 EM 已被证实有益，但美国仅有 45%的 ICU 常规实施 EM。
目的
使用世界卫生组织国际功能、残疾和健康分类（ICF）的理论视角，分析重症监护 EM、PD PIC 与个人（患者层面）因素之间的关系。
方法
遵循 Whittemore 和 Knafl 综合评价方法和 PRISMA（系统评价和荟萃分析的首选报告项目）报告指南。纳入了评估 EM 和 1 个或多个世界卫生组织 ICF 领域的定性、定量和混合方法研究（n = 38）。使用混合方法评估工具评估质量。评估研究特征，确定共同主题和关系。综合与每个研究相关的 ICF 领域和子领域。
结果
EM 的实施受到个人因素的影响。更深的镇静水平、存在谵妄、更高的患者严重程度、存在医疗设备和患者体重被确定为 EM 实施的障碍。患者参与 EM 与改善 EM 实施相关。与不喜欢康复的患者相比，喜欢康复的患者在功能障碍方面的改善更明显。
讨论
EM 与 PD PIC 减少有关，但在 ICU 中，许多情境因素会影响 EM 的实施。对患者层面因素和 EM 的进一步研究必须探索患者参与度、ICU 入院时的基线人口统计学和功能状态、考虑患者移动的因素以及 ICU 中的 EM 之间的关系。这项研究对于提高 ICU 中 EM 的实施率和降低 PD PIC 至关重要。
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