Conhecimento e aplicabilidade de escalas funcionais por fisioterapeutas intensivistas / Knowledge and applicability of functional scales by intensive physiotherapists

INTRODUÇÃO: A atuação do fisioterapeuta através da mobilização precoce visa reduzir os efeitos adversos do imobilismo e melhorar a funcionalidade. Nesse sentido, o uso de escalas funcionais é crucial para avaliar a condição funcional do paciente crítico. OBJETIVO: Analisar o conhecimento de fisioterapeutas intensivistas sobre escalas funcionais, conhecer as escalas mais utilizadas e as principais barreiras para aplicabilidade na UTI, além de associar o uso das escalas funcionais com a segurança e a percepção de resultados. METODOLOGIA: Trata-se de um estudo transversal e quantitativo realizado com fisioterapeutas intensivistas na cidade de Fortaleza entre agosto de 2022 a fevereiro de 2023. A coleta de dados ocorreu via questionário online (Google Forms). Os dados foram analisados através do Software Jamovi. Utilizou-se a estatística descritiva e o teste de Qui quadrado. RESULTADOS: Participaram 75 fisioterapeutas, a maioria com tempo de experiência na unidade de terapia intensiva de 1 a 5 anos. A maior parte dos profissionais percebem benefícios na utilização das escalas funcionais e utilizam para prescrição de conduta com segurança em sua aplicabilidade, sendo a escala Intensive Care Unit Mobility Scale a mais utilizada. Quanto às barreiras que mais interferem para utilização das escalas funcionais foram relacionadas a equipe, ao paciente e a instituição. CONCLUSÃO: Percebe-se que a maioria dos fisioterapeutas conhecem os objetivos e benefícios no uso de escalas funcionais, afirmam ter segurança para aplicação em sua conduta, sendo a escala IMS a mais utilizada pelos profissionais. Evidencia-se que a interação do fisioterapeuta com a equipe foi a principal barreira para a aplicação de escalas funcionais na Unidade de Terapia Intensiva.

INTRODUCTION: The role of the physiotherapist through early mobilization aims to reduce the adverse effects of immobility and improve functionality. In this sense, the use of functional scales is crucial to assess the functional condition of critically ill patients. OBJECTIVE: To analyze the knowledge of intensive care physiotherapists about functional scales, to know the most used scales and the main barriers to applicability in the ICU, in addition to associating the use of functional scales with safety and the perception of results. MATERIALS AND METHODS: This is a cross-sectional and quantitative study carried out with intensive care physiotherapists in the city of Fortaleza between August 2022 and February 2023. Data were collected via an online questionnaire (Google Forms). The data were analyzed using the Jamovi Software. Descriptive statistics and the Chi-square test were used. RESULTS: 75 physiotherapists participated, most with 1 to 5 years of experience in the intensive care unit. Most professionals perceive benefits in the use of functional scales and use them to prescribe conduct with safety in its applicability, with the Intensive Care Unit Mobility Scale being the most used. As for the barriers that most interfere with the use of functional scales, they were related to the team, the patient and the institution. CONCLUSION: Many physiotherapists are aware of the objectives and benefits of using functional scales, they say they are confident in applying them in their practice, and the IMS scale is the one most used by professionals. The interaction between the physiotherapist and the team was the main barrier to the application of functional scales in the Intensive Care Unit.

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER. 2 study

Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Qualitative systematic review of the safety and feasibility of early mobilization in critically ill patients with femoral catheters / 中国胸心血管外科临床杂志

@#Objective    To investigate the safety and feasibility of early mobilization in critically ill patients with femoral catheters, and to provide reference for guiding clinical rehabilitation training. Methods    The literature on the safety and feasibility of early mobilization in critically ill patients with femoral catheters included in PubMed, EMbase, OVID, Springer-link, Wiley Online Library, and Web of Science up to June 2021 was searched, and relevant data were extracted for analysis. Results    Seventy-two papers were initially screened, and 12 papers that met the criteria were finally included, covering 1 056 patients, and 489 patients had femoral catheters. Patients underwent 6 495 sessions of physical therapy, and a total of 62 patients had adverse events, including 14 (2.86%, 14/489) patients with catheter-related adverse events. Conclusion    Although early mobilization in critically ill patients with femoral catheters may lead to adverse catheter-related events, the incidence is low. Therefore, the associated risks and benefits should be weighed in clinical practice, and femoral catheter is not recommended as a contraindication for early mobilization in critically ill patients.

Study on the effect of early mobilization in oral cancer patients who have undergone free flap reconstruction / 中国实用护理杂志

Objective:To explore an early mobilization plan for oral cancer patients after free flap reconstruction and evaluate the application effect of the plan.Methods:This study was a prospective randomized controlled trial. A total of 173 patients undergoing free flap reconstruction surgery from December 2018 to December 2021 in the second ward of Peking University School and Hospital of Stomatology were selected. The patients were randomly divided into the control group (87 cases) and the intervention group (86 cases) by cluster randomized grouping. The control group received the routine nursing plan, that was, head immobilization for 4 days after surgery, and patients performed sat up and off-bed activity on the 5th day. The intervention group received the early mobilization plan, that was, patients sat up on the 2nd day after surgery and performed off-bed activity on the 3rd day. The incidence of vascular compromise, postoperative complications, sleep time in the first 5 days after surgery, catheter removal time, hospitalization duration and expenses were compared between the two groups.Results:The incidence of postoperative pulmonary infection, the daily sleep time in the first 5 days after surgery, the time for removing nasogastric tube, trachea cannula, and urinary catheter were 7.0%(6/86), (5.0 ± 1.0) h/d, (11.8 ± 7.3) d, (6.1 ± 3.2) d, (3.6 ± 0.6) d in the intervention group, and 13.8%(12/87), (4.4 ± 1.3) h/d, (14.2 ± 5.8) d, (7.3 ± 1.7) d, (4.0 ± 0.9) d in the control group, all differences were statistically significant ( χ2 = 3.89, t values were -3.57 - -2.44, all P<0.05). There was no significant difference in the incidence of rascular compromise, hospitalization duration and expenses between the two groups (all P>0.05). Conclusions:For patients undergoing free tissue flap reconstruction, it is safe to sit up on the 2nd day and get out of bed on the 3rd day, which can reduce the incidence of pulmonary infection, improve patient sleep, and shorten the indwelling time of nasogastric tube, trachea cannula and urinary catheter.

Effectiveness of Early Mobilization in Prevention and Rehabilitation of Functional Impairment After Myocardial Revascularization Surgery: A Systematic Review

Abstract Introduction Myocardial revascularization surgery is associated with high morbidity and mortality, due to factors like the general anesthesia and the surgical procedure itself. Physiotherapy, combined with early mobilization (EM), can provide the patient with better functional parameters. Objective To review, identify and describe the effectiveness of EM in the prevention and rehabilitation of functional parameters of coronary artery bypass graft surgery. Methodology This is a systematic review conducted between February 2020 and 2021 of randomized clinical trials (RCTs) published in the Cochrane databases Library, LILACS, Scielo and Medline / PubMed. The Physiotherapy Evidence Database (PEDro) scale was used for assessment of the methodological quality of studies included. Results Four studies were reviewed. Two articles assessed functional capacity, one using the cycle ergometer and one with inspiratory muscle training (IMT) together with active exercises and early walking. One article reported a reduction in the incidence of atelectasis and pleural effusion with EM and one article reported improvements in the alveolus-artery gradient and inspiratory muscle power using an inspiratory muscle trainer combined with EM. Conclusion EM is effective in the prevention and rehabilitation of functional parameters after CABG surgery, by improving functional capacity, respiratory muscle power, quality of life and gas exchange, and reducing the incidence of atelectasis and pleural effusion.

A mobilização precoce está associada à melhor funcionalidade no pós-operatório de cirurgias abdominais? / Is early mobilization associated with better functionality after abdominal surgery? / ¿Se asocia la movilización temprana con una mejor funcionalidad después de las cirugías abdominales?

Introdução: Pacientes submetidos a grandes cirurgias abdominais apresentam riscos de complicações pós-operatórias. A mobilização precoce vem sendo implementada e cada vez mais aplicada, no intuito de prevenir esses eventos. Objetivo: Demonstrar se a mobilização precoce está associada à melhor funcionalidade no pós-operatório de cirurgias abdominais. Métodos: Revisão integrativa de literatura realizada por meio de uma busca bibliográfica junto aos bancos de dados: BVS, Scielo, PedRO e Pubmed por meio dos descritores: mobilização precoce, deambulação precoce, cuidados pós-operatórios, período pós-operatório, estado funcional, exercício físico, reabilitação, funcionalidade e cirurgia abdominal, nos idiomas inglês, português e espanhol. Resultados: A amostra final foi constituída por 08 artigos científicos, que foram estruturados em forma de quadro para apresentação de suas principais características, dos métodos e os principais resultados. Conclusão: A mobilização precoce está associada ao retorno rápido à funcionalidade da linha de base pré- operatória, as atividades de vida diária, independência funcional, além do tempo de internação mais curto e menor duração dos desagradáveis sintomas pós-operatórios.

Introduction: Patients undergoing major abdominal surgery are at risk of postoperative complications. Early mobilization has been implemented and increasingly applied in order to prevent these events. Objective: to demonstrate whether early mobilization is associated with better functionality in the postoperative period of abdominal surgeries. Methods: an integrative literature review carried out through a literature search in the following databases: BVS, Scielo, PedRO and Pubmed using the descriptors: early mobilization, early ambulation, postoperative care, postoperative period, functional status, physical exercise, rehabilitation, functionality and abdominal surgery, in English, Portuguese and Spanish. Results: The final sample consisted of 08 scientific articles, which were structured in the form of a table to present their main characteristics, methods and main results. Conclusion: Early mobilization interferes with the rapid return to preoperative baseline functionality, activities of daily living, functional independence, in addition to a shorter hospital stay and shorter duration of unpleasant postoperative symptoms.

Introducción: Los pacientes sometidos a cirugías abdominales mayores corren el riesgo de sufrir complicaciones postoperatorias. La movilización temprana se ha implementado y aplicado cada vez más para prevenir estos eventos. Objetivo: Demostrar si la movilización temprana se asocia con una mejor funcionalidad después de la cirugía abdominal. Métodos: Revisión bibliográfica integrativa realizada a través de una búsqueda bibliográfica en las siguientes bases de datos: BVS, Scielo, PedRO y Pubmed utilizando los descriptores: early mobilisation, early ambulation, postoperative care, postoperative period, functional status, physical exercise, rehabilitation, functionality and abdominal surgery, en inglés, portugués y español. Resultados: La muestra final consistió en 08 artículos científicos, que se estructuraron en forma de tabla para presentar sus principales características, los métodos y los principales resultados. Conclusión: La movilización temprana se asocia con un rápido retorno a la funcionalidad de base preoperatoria, a las actividades de la vida diaria, a la independencia funcional, así como a una estancia hospitalaria más corta y a una menor duración de los síntomas postoperatorios desagradables.

Mobilização precoce em unidade de terapia intensiva adulto: revisão de literatura e proposta de protocolo assistencial / Arly mobilization in an adult intensive care unit: literature review and proposal of a care protocol

Introdução: A mobilização precoce impacta diretamente no aumento da sobrevida em pacientes críticos, diminui a chance de complicações pulmonares, reduz o tempo de desmame de ventilação mecânica e impulsiona o processo de recuperação. A justificativa deste estudo reside na ausência de um protocolo de mobilização precoce (PMP) na unidade de terapia intensiva (UTI) em que atuam os autores. Objetivo: Desenvolver um PMP para uma UTI adulto, a partir de uma revisão sobre protocolos disponíveis na literatura. Metodologia: Foi realizada uma revisão da literatura dos últimos 10 anos, utilizando os descritores: mobilização precoce e unidade de terapia intensiva, nas bases de dados Medline/PubMed, Lilacs e Scielo. Resultados: Foram identificados 302 artigos, dos quais foram incluídos cinco ensaios clínicos que aplicaram protocolos de mobilização diversos em relação aos exercícios incluídos, dosimetria das intervenções, tempos de aplicação e características sociodemográficas e clínicas dos pacientes incluídos. Foi verificada homogeneidade nos critérios de progressão das intervenções dos protocolos, sendo o nível de consciência e a força muscular periférica, os critérios mais utilizados. Conclusão: A partir desta revisão, foi desenvolvido um PMP para uma UTI adulta, baseado em níveis de progressão das intervenções, considerando características clínicas como nível de sedação, necessidade de suporte ventilatório invasivo, nível cognitivo e funcionalidade.

Introduction: Early mobilization has a direct impact on the increased survival in critically ill patients, reduces the chance of pulmonary complications, reduces the time to weaning from mechanical ventilation, and boosts the recovery process. This study is necessary since there is an absence of an early mobilization protocol (EMP) in the intensive care unit (ICU) where the authors work. Objective: To develop an EMP for an adult ICU, based on a review of protocols available in the literature. Methodology: A literature review of the last 10 years was performed, using the descriptors: early mobilization and intensive care unit on the Medline/PubMed, Lilacs, and Scielo databases. Results: From a total of 302 articles identified, five clinical trials were included in the analysis. These five trials applied different mobilization protocols regarding the included exercises, intervention dosimetry, application times, and sociodemographic and clinical characteristics of the included pa-tients. Homogeneity was verified in the criteria for the progression of the interventions in the protocols. Also, the level of consciousness and peripheral muscle strength were the most used criteria. Conclusion: From this review, an EMP was developed for an adult ICU based on levels of progression of interventions, based on clinical characteristics such as level of sedation, need for invasive ventilatory support, cognitive level, and functionality.

Evidence summary of early rehabilitation of adults with veno-venous extracorporeal membrane oxygenation / 中华危重病急救医学

Objective:To evaluate and summarize the best evidence for early rehabilitation of adults with veno-venous extracorporeal membrane oxygenation (VV-ECMO).Methods:Evidence on early rehabilitation of adult VV-ECMO patients was searched by computer from 7 English literature databases [PubMed database, cumulative index to nursing and allied health literature (CINAHL), Embase database, Cochrane library database, UpToDate clinical consultant, BMJ best clinical practice, JBI database], 5 Chinese literature databases (China biomedical literature database, China Yimai Tong, China national knowledge infrastructure, Wanfang data, VIP database), 5 guideline networks [National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), China Guide Network] and 2 professional association websites [Extracorporeal Life Support Organization (ELSO), Chinese Association of Rehabilitation Medicine]. The search period is from January 2011 to December 2021. The appraisal of guidelines for research and evaluation Ⅱ (AGREE ) and JBI 2014 quality assessment tools were used to evaluate the quality of inclusion guidelines, systematic reviews, expert consensus and original studies, respectively, and to extract and summarize the best evidence for early rehabilitation of adults with VV-ECMO.Results:A total of 2 guidelines, 2 expert consensuses, 2 systematic reviews and 8 original studies [including 1 randomized controlled trial (RCT), 1 non-randomized controlled study, 3 cohort studies and 3 case reports] were included. The evidence was summarized from 9 aspects including the necessity of early rehabilitation, rehabilitation initiation time, rehabilitation location, pre-rehabilitation preparation, pre-rehabilitation assessment, rehabilitation method, rehabilitation frequency and duration, rehabilitation process monitoring and effect evaluation,and finally 24 pieces of the best evidence were summarized.Conclusion:Early rehabilitation of adults with VV-ECMO is safe and feasible. The summary of the best evidence can provide evidence-based guidance for clinical medical staff to reasonably carry out early rehabilitation.

Impacto da pandemia do SARS-CoV-2 na ocupação e mobilização de pacientes de uma unidade de terapia intensiva cardiovascular / The impact of SARS-CoV-2 pandemic on the occupation and mobilization of patients in a cardiovascular intensive care unit

Introdução: a pandemia do SARS-CoV-2 causou impactos econômicos e sociais em todo o mundo, em especial nos sistemas de saúde, repercutindo no número de admissões hospitalares por outras doenças, na rotina dos cuidados, no acesso aos serviços e nos recursos materiais, humanos e financeiros disponibilizados. Objetivo: Analisar o impacto da pandemia SARS-CoV-2 no número de internamentos e mobilização de pacientes críticos de uma unidade de terapia intensiva cardiovascular. Metodologia: trata-se de um estudo transversal, retrospectivo, realizado na Unidade de Terapia Intensiva Cardiovascular do Hospital Geral Roberto Santos, Salvador-BA. Analisaram-se comparativamente os dados de internamento e mobilização dos pacientes, no período entre março de 2019 e fevereiro de 2020, isto é pré-pandemia, e o primeiro ano de sua ocorrência. Resultados: houve redução (p <0,001) no número de internações no setor, quanto a mobilização, embora impactada nos primeiros meses da pandemia, conseguiu manter dados estáveis, quando avaliada de maneira linear. Discussão: A redução na ocupação coincide com achados de estudos nacionais e internacionais, o que pode ter influência na orientação de distanciamento social e o receio de contágio pelo vírus. Quanto à mobilização, importante instrumento de atuação fisioterapêutica nas UTI, apresentou dados similares (p= 0,8), quando comparados os dois períodos do estudo. Conclusão: notou-se impacto da pandemia no número de internamentos em uma UTI cardiológica durante a pandemia, o que deve ser futuramente estudado para avaliar as reais consequências dessa redução assistencial. Quanto à mobilização, não foi observada alteração significativa na média, antes e após a pandemia.

Introduction: SARS-CoV-2 pandemic caused economic and social impacts around the world, especially in health systems, affecting the number of hospital admissions for other diseases, routine care, access to services and material and human resources and financial resources made available. Objective: to analyze the impact of SARS-CoV-2 pandemic on the number of admissions and mobilization of critically ill patients in a cardiovascular intensive care unit. Methodology: this is a cross-sectional, retrospective study carried out at the Cardiovascular Intensive Care Unit of Hospital Geral Roberto Santos, Salvador-BA. Data on hospitalization and patient mobilization between March 2019 and February 2020 (pre-pandemic) and during the first year of its occurrence were comparatively analyzed. Results: there was a reduction (p <0.001) in the number of hospitalizations in the sector and mobilization, although impacted in the first months of the pandemic, managed to maintain stable data when evaluated in a linear fashion. Discussion: the reduction in occupation coincides with findings from national and international studies, which may influence the orientation of social distancing and the fear of contagion by the virus. As for mobilization, an important instrument of physical therapy practice in the ICUs, it presented similar data (p=0.8), when comparing the two periods of the study. Conclusion: the impact of the pandemic was noted on the number of admissions to a cardiology ICU during the pandemic, which should be studied in the future to assess the real consequences of this reduction in care. As for mobilization, there was no significant change in the mean, before and after the pandemic.

Entendimento da equipe multiprofissional sobre a mobilização precoce e a segurança da sua aplicação em neonatos no pós-operatório / Multidisciplinary team perceptions about the implementation and safety of early mobilization for newborns in post-operative care

INTRODUÇÃO: Neonatos no pós-operatório com repouso prolongado no leito estão sujeitos a consequências a longo prazo, sendo a mobilização precoce uma possibilidade de intervenção terapêutica. OBJETIVO: Descrever o entendimento dos profissionais de saúde de uma unidade de terapia intensiva neonatal (UTIN) cirúrgica sobre mobilização precoce e quanto consideram segura a aplicação em neonatos no pós- -operatório. METODOLOGIA: Trata-se de um estudo analítico descritivo de corte transversal, através de uma abordagem quanti-qualitativa, com resposta de questionário semi-estruturado pelos profissionais de saúde da UTIN. RESULTADOS: A amostra foi composta por 31 profissionais. Destes, 64,5% afirmam saber o que é mobilização precoce, sendo que a maioria relacionou sua definição à atividade motora; 83% acredita haver benefícios. Em relação à segurança, 77,4% considera segura a aplicação da mobilização precoce, porém 90% acredita que podem ocorrer eventos adversos, sendo mais citados: perda de dispositivos e descompensação hemodinâmica. A maioria dos profissionais descreveu que não deve ser realizada a mobilização precoce a depender da cirurgia e em instabilidade hemodinâmica. Aproximadamente 71% afirmaram não ter recebido treinamento para a prática de mobilização precoce. CONCLUSÃO: Observou-se necessidade de treinamento da equipe sobre a temática e a instituição de protocolos institucionais.

BACKGROUND: Early mobilization can be a therapeutic intervention that can prevent long-term consequences from prolonged bed rest in post-operative newborns. OBJECTIVE: Describe the knowledge of the healthcare professionals in the Newborn Intensive Care Unit (NICU) about early mobilization and its safety for postoperative infants. METHODS: This research is an analytical descriptive cross-sectional study with mixed methods, performed by analyzing a questionnaire given to NICU health professionals. RESULTS: The sample was composed of 31 professionals, of which 64.5% affirm that they know what early mobilization means, most of whom defined the intervention in terms of motor activity, 83% believe it is beneficial, 77.4% consider early mobilization safe. However, 90% of the professionals showed concerns for possible adverse events, the most cited being device dislodgment and hemodynamic decompensation. The majority stated that early mobilization should be avoided when concerned about hemodynamic instability or the type of surgery. Approximately 71% affirm that they did not receive educational training for implementing early mobilization. CONCLUSION: This study showed the need for more training and education about early mobilization for professionals and the establishment of evidence-based institutional protocols.

Mobilização precoce a prática do fisioterapeuta intensivista: intervenções e barreiras / Early mobilization intensivist physiotherapy practice: interventions and barriers

INTRODUÇÃO: Pacientes em Unidade de Terapia Intensiva (UTI) requerem longos períodos de internação, estando submetidos ao imobilismo, que resulta em perda significativa de massa muscular. A mobilização precoce é uma terapêutica realizada no ambiente de UTI e tem como objetivo diminuir o comprometimento funcional decorrente do período de internação. OBJETIVO: Analisar a prática de mobilização precoce realizada pelo fisioterapeuta intensivista, identificar as principais intervenções utilizadas por esses profissionais e descrever as barreiras encontradas que inviabilizam a prática da mobilização precoce, em pacientes internados em unidades de terapia intensiva. METODOLOGIA: Estudo de campo, quantitativo e transversal, realizado entre fevereiro e maio de 2020, com fisioterapeutas intensivistas de três hospitais na cidade de Fortaleza, a saber dois deles são da rede pública (um municipal e outro estadual) e o outro de rede privada. Foram inclusos no estudo fisioterapeutas intensivistas atuantes nos hospitais mencionados e que possuam vínculo com a instituição. Foram excluídos os fisioterapeutas na função de residentes, estagiários e preceptores presentes. Para coleta de dados foi utilizado o formulário eletrônico on-line viabilizada por meio do aplicativo Google Forms. Os dados foram analisados e tabulados através do Software Statistical Package for the Social Sciences (SPSS) versão 20.0. A estatística descritiva, com frequências absolutas e relativas foi utilizada para caracterizar o perfil da amostra estudada. Os testes estatísticos aplicados foram o Qui-Quadrado para determinar diferenças nas respostas dos critérios de segurança e barreiras para implementação da mobilização precoce e o tempo de experiência em unidade de terapia intensiva e o Kruskal-Wallis para comparar as intervenções de mobilização precoce entre grupos de Fisioterapeutas dos três hospitais. RESULTADOS: Participaram da pesquisa 68 fisioterapeutas, a maioria (36,8%) com tempo de atuação na terapia intensiva de 6 a 10 anos. O gerenciamento da mobilização precoce é realizado em sua maioria apenas pelo fisioterapeuta. Acerca da utilização de escalas funcionais utilizadas em UTI, a Medical Research Council (MRC) foi a mais citada pelos profissionais com (67,7%). A estratégia de mobilização mais utilizada foi a sedestação (91,2%). O desconforto respiratório foi a situação clínica mais citada para a interrupção da mobilização precoce (83,8%). CONCLUSÃO: As intervenções mais frequentes foram a sedestação, uso do cicloergômetro e transferências leito poltrona. As barreiras relacionadas ao paciente foram a instabilidade hemodinâmica, uso de drogas sedativas e analgésicas.

INTRODUCTION: Patients in the Intensive Care Unit (ICU) require long periods of hospitalization, being subjected to immobilization, which results in significant loss of muscle mass. Early mobilization is a therapy performed in the ICU environment and aims to reduce functional impairment resulting from hospitalization. OBJECTIVE: To analyze the practice of early mobilization performed by the intensive care physiotherapist, identify the main interventions used by these professionals, and describe the barriers found that make early mobilization unfeasible in patients admitted to intensive care units. METHODOLOGY: Field study, quantitative and transversal, carried out between February and May 2020, with intensive care physiotherapists from three hospitals in the city of Fortaleza, namely two of them are from the public network (one municipal and the other state) and the other from the private network. Intensive care physiotherapists working in the mentioned hospitals and who have a link with the institution were included in the study. Physiotherapists in the role of residents, interns, and preceptors present were excluded. For data collection, the online electronic form was made possible through the Google Forms application. The data were analyzed and tabulated using the Statistical Package for the Social Sciences (SPSS) version 20.0. The chi-square statistical tests were to determine differences in the responses of the safety criteria and barriers to the implementation of early mobilization and the length of experience in the intensive care unit and Kruskal-Wallis to compare early mobilization interventions between groups of physiotherapists from the three hospitals. RESULTS: 68 physiotherapists participated in the research, the majority (36.8%) having worked in intensive care for 6 to 10 years. The management of early mobilization is performed mostly by the physiotherapist. Regarding functional scales used in the ICU, the Medical Research Council (MRC) was the most cited by professionals with (67.7%). The most used mobilization strategy was sedestation (91.2%). Respiratory distress was the most frequently cited clinical situation for interrupting early mobilization (83.8%). CONCLUSION: The most frequent interventions were sedation, the cycle ergometer, and transfers from an armchair bed. The patient-related barriers were hemodynamic instability, use of sedative and analgesic drugs.

Descripción de la rehabilitación física en terapias intensivas de Argentina, práctica habitual y durante la pandemia COVID-19. Encuesta tipo online / Description of physical rehabilitation in intensive care units in Argentina: usual practice and during the COVID-19 pandemic. Online survey

RESUMEN Objetivo: Describir la práctica habitual de asistencia kinésica motora en la unidad de cuidados intensivos de adultos, tanto en pacientes con y sin COVID-19. Métodos: Estudio observacional transversal de tipo encuesta online. Se incluyeron kinesiólogos que trabajan en unidades de cuidados intensivos de adultos en Argentina. Se realizaron 16 preguntas de respuesta múltiple o simple agrupadas en 3 apartados. El primero caracterizado por datos personales, profesionales o del ámbito laboral. El segundo, destinado a conocer el accionar habitual y un tercero enfocado en las prácticas bajo la pandemia COVID-19. Resultados: Sobre 351 kinesiólogos, el 76.1% reportó que la movilización de los pacientes estaba a cargo exclusivamente de ellos. El objetivo máximo a alcanzar desde el aspecto motor fue variable según cuatro escenarios: Pacientes en ventilación mecánica, desvinculados de la ventilación mecánica, los que nunca estuvieron asociados a la ventilación mecánica y con COVID-19 en ventilación mecánica. En el primer y último escenario el objetivo máximo fue optimizar valores de fuerza muscular. En los restantes fue realizar actividades de la vida diaria. Por último, la mayor limitante en el abordaje de pacientes con COVID-19 fue el aislamiento respiratorio y/o de contacto. Conclusión: Los kinesiólogos en Argentina reportaron encargarse de la movilización de los pacientes en la unidad de cuidados intensivos. Los objetivos máximos desde el aspecto motor para cuatro escenarios clásicos en el área cerrada podrían estar determinado por la asociación con la ventilación mecánica. La mayor limitación a la hora de movilizar a pacientes con COVID-19 fue el aislamiento respiratorio y de contacto.

Abstract Objective: To describe the usual practice of mobility therapy in the adult intensive care unit for patients with and without COVID-19. Methods: Online survey in which physical therapists working in an adult intensive care unit in Argentina participated. Sixteen multiple-choice or single-response questions grouped into three sections were asked. The first section addressed personal, professional and work environment data. The second section presented questions regarding usual care, and the third focused on practices under COVID-19 pandemic conditions. Results: Of 351 physical therapists, 76.1% answer that they were exclusively responsible for patient mobility. The highest motor-based goal varied according to four patient scenarios: Mechanically ventilated patients, patients weaned from mechanical ventilation, patients who had never required mechanical ventilation, and patients with COVID-19 under mechanical ventilation. In the first and last scenarios, the highest goal was to optimize muscle strength, while for the other two, it was to perform activities of daily living. Finally, the greatest limitation in working with patients with COVID-19 was respiratory and/or contact isolation. Conclusion: Physical therapists in Argentina reported being responsible for the mobility of patients in the intensive care unit. The highest motor-based therapeutic goals for four classic scenarios in the closed area were limited by the need for mechanical ventilation. The greatest limitation when mobilizing patients with COVID-19 was respiratory and contact isolation.

Movilización temprana en la Unidad de Cuidados Intensivos / Early mobilization in the Intensive Care Unit / Mobilização precoce na Unidade de Terapia Intensiva

Resumen: La movilización temprana (MT) es la implementación de ejercicio físico en los pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) observándose beneficios importantes como reducción de neumonías asociadas con ventilación mecánica (NAVM), trombosis venosa profunda, úlceras por presión, debilidad adquirida en la UCI (DAUCI). Además, tiene un impacto financiero al reducir los días de estancia hospitalaria y en la UCI. Cabe mencionar que la MT impacta en el desenlace posterior al alta hospitalaria reduciendo la aparición de síndrome postcuidados intensivos (PICS).

Abstract: Early mobilization (EM) is the implementation of physical exercise in patients admitted to the Intensive Care Unit (ICU), with important benefits being observed such as reduction of ventilator-associated pneumonia, deep vein thrombosis, pressure ulcers and ICU-acquired weakness (ICU-AW). It also has a financial impact by reducing hospital length of stay and in the ICU. Also, EM has an important role in the outcome once the patient leaves the hospital reducing the post-intensive care syndrome (PICS).

Resumo: A mobilização precoce (MP) é a implementação de exercícios físicos em pacientes internados em Unidade de Terapia Intensiva (UTI), observando benefícios importantes como redução da pneumonia associada à ventilação mecânica (PAV), trombose venosa profunda, úlceras por pressão, fraqueza adquirida no UTI (DAUCI). Além disso, tem impacto financeiro ao reduzir os dias de internação e internação na UTI. Vale ressaltar que a MT tem impacto no desfecho após a alta hospitalar por reduzir o aparecimento da Síndrome de Terapia Pós-Intensiva (PICS).

Barriers to implement early mobilization by nursing in adult ICUs:A systematic review and summary analysis / 中国实用护理杂志

Objective:To systematically review the barriers encountered by nursing staff in the implementation of early activities in adult ICU units.Methods:A systematic search was conducted on CNKI, Wanfang Database, VIP Database, China Biomedical Database, PumMed, Web of Science, Cochrane Library and EMBASE for the research on the obstacles of early activity nursing implementation in adult ICU from the establishment of the database to July 2020, and the final integrated analysis of the included literature was carried out.Results:A total of 26 articles were included, and 59 obstacles in 5 categories were integrated, including 6 kinds of technical level, 13 kinds of organizational culture level, 7 kinds of personnel level, 4 kinds of structural level, and 29 kinds of 6 sub categories of patients level. The most frequent obstacles were unstable condition of patients, sedation or continuous deep sedation, low staffing level, disturbance of consciousness of patients, insufficient equipment related to early activities, and low willingness or compliance of patients to participate.Conclusion:The nursing staff are facing with many obstacles in guiding and assisting ICU adult patients to carry out early activities. It is necessary to formulate modified policies aiming at changeable factors in order to promote the application of early activities in adult ICU units.

Application progress of early mobilization of lung cancer patients based on the concept of enhanced recovery after surgery / 中国实用护理杂志

Early mobilization plays a vital role in the recovery of patients after lung cancer surgery. From the perspective of enhanced recovery after surgery, this paper summarized the mobilization program, effect evaluation and expanded application of early getting out of bed in lung cancer patients, in order to provide reference for medical staff to formulate early mobilization programs.

Rehabilitation of mechanically ventilated elderly patient with COVID-19 of a dedicated COVID tertiary hospital: a case report

Corona virus disease 2019 (COVID-19), a highly communicable disease caused by severe acute respiratory syndrome-corona virus 2 (SARS-CoV2) which originated in Wuhan, China has affected 213 countries worldwide and has caused an economic crisis. As of August10, 2020, India’s recovery rate is 63%. Most of the critical cases requiring intensive care unit (ICU) management are elderly patients with co-morbidities. The case report is of an elderly, comorbid patient who was intubated and put on a mechanical ventilator. At a time when critical patients on mechanical ventilator hardly survived, this patient survived and was successfully weaned from the ventilator and extubated. The case report emphasizes physical therapy management along with medical management for an elderly SARS CoV2 survivor with co-morbidities, and his journey from the onset of symptoms to being mechanically ventilated to performing his daily activities with minimal discomfort.

Confiabilidade e validade concorrente da Escala de Mobilidade Hospitalar em pacientes após acidente vascular cerebral / Reliability and concurrent validity of the Hospital Mobility Scale in acute stroke patients

A Escala de Mobilidade Hospitalar (EMH) avalia de forma específica a mobilidade de pacientes após AVC no ambiente hospitalar e em estudo prévio foi demonstrada a sua concordância interexaminadores, validade preditiva e a responsividade a mudanças na fase aguda. OBJETIVO: Avaliar a validade concorrente da EMH e a sua confiabilidade ao ser aplicada através de entrevista. MATERIAIS E MÉTODOS: Trata-se de um estudo de validação, desenvolvido com pacientes internados em uma Unidade de AVC na cidade de Salvador-Bahia. Para avaliar a validade concorrente da EMH comparamos o seu escore com a pontuação da Escala de Rankin modificada (ERm) utilizando o teste de Spearman. Ambas escalas foram aplicadas no quinto dia após o AVC pelo mesmo pesquisador, previamente treinado. Para avaliação da confiabilidade da EMH quando aplicada através de entrevista, a escala foi aplicada por dois examinadores em turnos diferentes, no mesmo dia. O primeiro examinador aplicou a escala através da observação do desempenho e o segundo examinador através de entrevista. Utilizamos para esta análise o Coeficiente de Correlação Intraclasse (CCI). RESULTADOS: A pontuação total da EMH apresentou uma correlação positiva muito forte com a ERm (r=0,90) e também foi encontrada uma correlação significativa entre os subitens da EMH e a ERm. Ao comparar a aplicação da EMH através da observação do desempenho e aplicação por entrevista, observamos uma excelente concordância interexaminadores (CCI > 0,90). CONCLUSÃO: A Escala de Mobilidade Hospitalar, projetada especificamente para pacientes após AVC, mostrou um alto grau de validade concorrente e se mostrou confiável quando aplicada através de entrevista.

The Hospital Mobility Scale (HMS) evaluates the mobility of stroke patients in the hospital environment and in a previous study showed its inter-examiner agreement, predictive validity and responsiveness to changes in the acute phase. OBJECTIVE: To evaluate the concurrent validity of HMS and its reliability when applied by interview. METHODS: This is a validation study, that was developed with patients admitted in a stroke unit, in the city of Salvador, Bahia, Brazil. In order to assess the concurrent validity of the HMS, we compared its score with the modified Rankin Scale (mRS) score by using the spearman test. The same researcher applied both scales on the fifth day after stroke. To assess the reliability of HMS when applied by interview, two examiners applied the scale in different shifts, on the same day. The first evaluation was face-to-face and the second was performed by interview. For this analysis, we used the intraclass correlation coefficient (ICC). RESULTS: The HMS showed a very strong positive correlation with the mRS (r = 0.90) and a significant correlation was also found between the sub-items of the HMS and the mRS. We found excellent inter-examiner agreement between face-to-face and interview assessment (ICC>0.90). CONCLUSION: The hospital mobility scale, that was developed specifically for stroke patients, showed a high degree of concurrent validity and was reliable when applied by interview.

Mobility and clinical outcome of patients admitted to an intensive care unit / Mobilidade e desfecho clínico de pacientes admitidos em unidade de terapia intensiva

Abstract Introduction: The hospital environment exacerbates the effects of immobility due to several exposure factors, and the functional assessment of individuals using reliable instruments is vital. Objective: To determine the relationship between functional mobility and the clinical outcome of patients admitted to an intensive care unit. Method: This is a prospective quantitative longitudinal study, approved by the institutional research ethics committee, carried out in the intensive care unit of a University Hospital. Clinical data and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were collected 24 hours after admission. The Perne Score was used to analyze patient mobility. Results: 33 patients participated, 63% female. With respect to mobility and transfers, 69.7% required total assistance from the supine to the sitting position and 70% to maintain balance, 9.1% needed minimum assistance from sitting to standing, and 100% total assistance for walking and endurance exercises. The main barriers to mobility were invasive ventilation (60%), assistive devices and intravenous infusion (100%). The following Perne Score domains were significantly associated with the outcome: mental status (p = 0.040), barriers to mobility (p = 0.016), strength (p = 0.010), mobility in bed (p = 0.024) and the total Perme Score ( p = 0.002). There were also significant associations between invasive ventilation and low Perme Scores (p = 0.000), and the Richmond Agitation-Sedation Scale (RASS) (-5 and -4) and death in 66.7% of patients (p = 0.011). The Perme Score and RASS (R = 0.745) were moderately correlated and APACHE II and Perme Score inversely moderately correlated (R = -0.526). Conclusion: Mobility assessed by the Perme Score was related to the clinical outcome and strongly associated with sedation level and patient severity.

Resumo Introdução: O ambiente hospitalar potencializa os prejuízos da imobilidade por diversos fatores de exposição, sendo imprescindível a avaliação funcional do indivíduo por meio de instrumentos fidedignos. Objetivo: Verificar a relação entre mobilidade funcional e desfecho clínico de pacientes admitidos em uma unidade de terapia intensiva. Método: Estudo longitudinal prospectivo e quantitativo, aprovado pelo comitê de ética em pesquisa, realizado na unidade de terapia intensiva de um Hospital Universitário. Após 24h da admissão foram coletados dados clínicos e o escore The Acute Physiology and Chronic Health Evaluation (APACHE II). Para análise da mobilidade dos pacientes utilizou-se o Escore Perme. Resultados: Participaram 33 pacientes, 63% do sexo feminino. Relativo a mobilidade e transferências, 69,7% necessitavam de assistência total de supino para sentado e 70% para manter equilíbrio, 9,1% mínima assistência de sentado para em pé, 100% assistência total para marcha e endurance. As principais barreiras à mobilidade, foram ventilação invasiva (60%), dispositivos e infusão endovenosa (100%). Associando os domínios do Escore Perme com desfecho, houve significância para estado mental (p=0,040),barreiras a mobilidade (p=0,016), força (p=0,010), mobilidade no leito (p= 0,024) e pontuação do Escore Perme (p=0,002). Associações significativas entre ventilação invasiva e baixas pontuações no Escore Perme (p=0,000), associação entre Richmond Agitation-Sedation Scale (RASS) (-5 e -4) com óbito em 66,7% dos pacientes (p=0,011).Correlação positiva moderada entre o Escore Perme e RASS (R=0,745) e inversa moderada entre APACHE II e Escore Perme (R=-0,526). Conclusão: A mobilidade avaliada pelo Escore Perme apresentou relação com o desfecho clínico, e boa associação com o nível de sedação e gravidade dos pacientes.

Comportamiento hemodinámico y respiratorio durante la movilización temprana de pacientes sometidos a cirugía cardíaca: Experiencia en un Hospital Público / Hemodynamic and respiratory changes during early mobilization of patients undergoing cardiac surgery: experience in a public hospital

Abstract: Objective: To describe the hemodynamic and respiratory changes during early mobilization (EM) after cardiac surgery. Methods: An analytical observational retrospective cohort study was performed in a Coronary Care Unit of a tertiary hospital. 75 patients submitted to cardiac surgery (From March 2017 up to July 2017) were included. Inclusion criteria were hemodynamic and respiratory stability before starting EM. Hemodynamic and respiratory behavior during EM were evaluated. EM was performed in 3 steps: supine, seated at the edge of the bed (SEB) and biped (BIP). Heart rate (HR), breathing rate (BR), mean arterial pressure (MAP), oxygen saturation (O2Sat) and Borg and Pain scales were evaluated. Results: Six patients, (8%) could not complete the mobilization satisfactorily, which was significantly associated to greater extracorporeal circulation time (ECC T) (p= 0.02). HR, BR, MAP Borg and Pain scales, that were significantly changed during EM, returned fully after the procedure. O2Sat was significantly increased at the end of EM (p=0.000). Prolonged ECC time predicted a 4.6 fold risk for inability to perform EM for 48 hours. Conclusion: EM of patients undergoing cardiac surgery is a safe and feasible intervention. In addition, the prolonged ECC T was observed to be a risk factor for delayed mobilization in this type of patients.

Os efeitos da eletroestimulação transcutânea em pacientes na unidade de terapia intensiva / The effects of transcutaneous electrostimulation in patients in the intensive care unit

INTRODUÇÃO: A fraqueza muscular adquirida em internações prolongadas é comum em cerca de 50 -80% dos pacientes onde apresentam evidências eletrofisiológicas de disfunção neuromuscular. A mobilização e a reabilitação precoce têm demonstrado melhorar os resultados funcionais e a qualidade de vida e neste contexto, a estimulação elétrica neuromuscular (NMS) tem positivas evidências auxiliando na preservação da síntese proteica e na prevenção de atrofia muscular durante o período de imobilização. OBJETIVO: Analisar os benefícios proporcionados pela eletroestimulação em pacientes internados na unidade de terapia intensiva. METODOLOGIA: Para realizar esta revisão, foi realizada uma busca nas seguintes bases de dados: SciELO, Medline, Lilacs, PEDro, PubMed e Cochrane, no período de junho a dezembro de 2018. Foram encontrados 106 artigos e 99 excluídos por não estarem de acordo com nossos descritores. No final, 7 artigos se enquadram nos critérios para a análise final. Os estudos foram selecionados primeiro pelo título, resumos e metodologias. Os critérios de inclusão dos estudos foram: comparador (es): parâmetros da EENM utilizados, força muscular e tempo de terapia por sessão, indivíduos maiores de 18 anos, homens e mulheres, necessitando de ventilação mecânica invasiva por mais de 24 horas. Estudos: Ensaios clínicos, coorte transversal, coorte longitudinal com esse tema. Não foram selecionados estudos de caso, artigos de revisão sistemática, resumos de congressos sobre o assunto, estudos fora do intervalo de tempo escolhido e outras técnicas de mobilização precoce. RESULTADOS: O número total de participantes incluídos nos estudos foi de 594 adultos, 323 em grupos experimentais e 271 em grupos controle, e todos os estudos investigaram os efeitos da NMS em pacientes críticos. Os estudos foram em adultos com diversos diagnósticos, houve grande variabilidade entre os protocolos NMS, número e tempo de sessão realizada. CONCLUSÃO: O NMS tem resultados significativos no aumento da força muscular, melhora a independência funcional, encurta o tempo de internação hospitalar, o tempo do uso de ventilação mecânica invasiva e níveis mais baixos de sedação. No entanto, ainda há necessidade de mais estudos com uma metodologia mais bem descrita para realmente investigar com mais precisão sobre o efeito isolado de NMS em pacientes críticos.

INTRODUCTION: Acquired muscle weakness in prolonged hospitalizations is common in approximately 50 -80% of hospitalized patients where all present electrophysiological evidence of neuromuscular dysfunction. Mobilization and early rehabilitation have been shown to improve functional results and quality of life and in this context, neuromuscular electrical stimulation (NMS) has positive evidences aiding in the preservation of protein synthesis and in the prevention of muscle atrophy during the immobilization period. OBJECTIVE: To analyze the benefits of electrostimulation in patients in the intensive care unit. METHODOLOGY: To carry out this review a search was performed in the following databases: SciELO, Medline, Lilacs, PEDro, PubMed and Cochrane, in the period from June to December 2018. 106 articles were found and 99 were excluded because they were not in accordance with our descriptors. In the end, 7 articles fit the criteria for the final analysis. The studies were selected first by the title, abstracts and methodologies. The criteria for inclusion of the studies were: comparator (es): NMS parameters used, muscle strength and therapy time per session, individuals over 18 years old, male and female, requiring invasive mechanical ventilation for more than 24 hours. Studies: Clinical trials, cross-sectional cohort, longitudinal cohort with this theme. No case studies, Systematic review articles, congress summaries on the subject, studies outside the chosen time interval, and other early mobilization techniques were selected. RESULTS: The total number of participants included in the studies was 594 adults, 323 in experimental groups and 271 in control groups, and all studies investigated the effects of NMS in critical patients. The studies were in adults with diverse diagnoses, there was great variability between the NMS protocols, number and time of session performed. CONCLUSION: The NMS has significant results in the increase of muscle strength, Improves functional independence, shortens hospital admission time, shortens time for invasive mechanical ventilation and lower levels of sedation. However, there is still a need for further studies with a better described methodology to actually investigate more accurately about the isolated effect of NMS in critical patients.