Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
Kadoorie Centre for Critical Care Research, Oxford NIHR Biomedical Research Centre, and Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
Physiotherapy. 2021 Dec;113:131-137. doi: 10.1016/j.physio.2021.03.013. Epub 2021 Mar 24.
Patients discharged to the ward from an intensive care unit (ICU) commonly experience a reduction in mobility but few mobility interventions. Barriers and facilitators for mobilisation on acute wards after discharge from an ICU were explored.
A human factors analysis was undertaken using the Functional Resonance Analysis Method (FRAM) as part of the Recovery Following Intensive Care Treatment (REFLECT) study. A FRAM focus group was formed from members of the ICU and ward multidisciplinary teams from two hospitals, with experience of working in six hospitals. They identified factors influencing mobilisation and the interdependency of these factors.
Patients requiring discharge assessments or on Enhanced Recovery After Surgery (ERAS) pathways compete for priority with post-ICU patients with more urgent rehabilitation needs. Patients unable to stand and step to a chair or requiring mobilisation equipment were deemed particularly susceptible to missing mobilisation interventions. The ability to mobilise was perceived to be highly influenced by multidisciplinary staffing levels and skill mix. These factors are interdependent in facilitating or inhibiting mobilisation.
This human factors analysis of post-ICU mobilisation highlighted several influencing factors and demonstrated their interdependency. Future interventions should focus on mitigating competing priorities to ensure regular mobilisation, target patients unable to stand and step to a chair on discharge from ICU and create robust processes to ensure suitable equipment availability.
ISRCTN14658054.
从重症监护病房（ICU）出院到病房的患者通常会经历活动能力下降，但很少有活动干预措施。本研究旨在探讨 ICU 出院后在急性病房中进行活动的障碍和促进因素。
作为 RECOVERY FOLLOWING INTENSIVE CARE TREATMENT（REFLECT）研究的一部分，采用功能共振分析方法（FRAM）进行了一项人为因素分析。一个 FRAM 焦点小组由来自两家医院的 ICU 和病房多学科团队成员组成，他们在六家医院工作过。他们确定了影响活动的因素以及这些因素的相互依存关系。
需要进行出院评估或增强型术后恢复（ERAS）途径的患者与有更紧急康复需求的 ICU 后患者竞争优先级。无法站立和移步到椅子或需要移动设备的患者被认为特别容易错过活动干预。活动能力被认为受到多学科人员配备水平和技能组合的高度影响。这些因素在促进或抑制活动方面相互依存。
对 ICU 后活动的人为因素分析突出了几个影响因素，并展示了它们的相互依存关系。未来的干预措施应侧重于减轻竞争优先级，以确保定期活动，针对无法站立和移步到椅子的患者在 ICU 出院时进行活动，并创建稳健的流程以确保设备的可用性。
ISRCTN85220026。
