Table 1.
Differences between trials of early mobilisation in baseline factors and early mobilisation delivery
| Study | Schweickert Lancet 2009 |
Denehy Crit Care 2013 |
Schaller Lancet 2016 |
Morris JAMA 2016 |
Moss AJRCCM 2016 |
Wright Thorax 2017 |
TEAM NEJM 2022 |
Patel Lancet Resp Med 2023 |
|---|---|---|---|---|---|---|---|---|
| N randomised (intervention/comparison) | 104 (49/55) | 150 (74/76) | 200 (104/96) | 300 (150/150) | 120 (59/61) | 308 (150/158) | 750 (372/378) | 200 (100/100) |
| Location(s) | United States | Australia |
Austria (1), Germany (1), United States (3) |
United States | United States | United Kingdom |
Australia (28), New Zealand (5), United Kingdom (8), Ireland (4), Germany (3), Brazil (1) |
United States |
| Centres | 2 | 1 | 5 | 1 | 5 | 4 | 49 | 1 |
| Cohort | Medical | Mixed | Surgical | Medical | Medical | Mixed | Mixed | Mixed |
| Enrolment dates | 6/2005–10/2007 | 5/2007–8/2009 | 7/2011–11/2015 | 10/2009–5/2014 | 8/2009–10/2014 | 1/2012–12/2014 | 2/2018–11/2021 | 8/2011–10/2019 |
| Age (intervention/comparison) years | 57.7/54.4 | 61.4/60.1 | 66/64 | 55/58 | 61/57 | 60/64 | 60.5/59.5 | 57.9/54.5 |
| Primary admission diagnosis |
Sepsis 16% Acute lung injury 55% |
Pneumonia 23% Cardiac 15.3% |
Sepsis 1% Trauma 26% |
Acute respiratory failure |
ARDS 30% Pneumonia 24% |
Medical 52% Surgical 48% |
Sepsis 66% Trauma 4% |
Acute respiratory failure 44% Sepsis 14% |
| APACHE II (intervention/comparison) | 20/19 | 19/20.7 | 16/17 | 76/75 (APACHE III) | 17.9/17.4 | 19/19 | 18.2/18 | 23/23 |
| RASS target | Goal directed | 1 to + 1 | Goal directed | No sedation protocol | N/A | − 1 to + 1 | Goal directed | Clinician directed |
| Intervention | Exercise and mobilisation at enrolment | Exercise rehabilitation and usual care | Early, goal-directed mobilisation with a facilitator to identify and address barriers | Passive range of motion, physical therapy, progressive resistance | Intensive physical therapy activities | Intensive physical rehabilitation | Sedation minimization and daily highest possible level of mobilisation | Early mobilisation at enrolment |
| Passive/active mobilisation at 1° level/session of the intervention | Passive range of motion | Active bed exercises | Passive range of motion | Passive range of motion | Active bed exercises | Active bed exercises | Active exercises | Passive range of motion |
| Comparison | Standard care, with physical and occupational therapy delivered as ordered by primary care team | Usual care | Individual centres’ practice guidelines | Usual care | Standardised physical therapy activities | Usual care | Usual care mobilisation level | Usual care when ordered by primary team or on extubation |
| Duration of invasive mechanical ventilation, days (intervention/comparison) | 3.4/6.1 | 4.4/ 4.1 | NA | 7/NA | 10/10 | 4/4 | 6/6 | 2.7/3.4 |
| Time to first therapy, days (intervention/comparison) | 1.5/7.4 (from intubation) | On or after day 5 of ICU admission | NA/NA | 3/7 (to physical therapy) | 8/8 (from initiation of mechanical ventilation) | 3/3 (from enrolment; ventilated 4 days pre-randomisation) | 4/7 (from ICU admission) | 1.1/4.7 (from intubation) |
| Proportion of patients mobilised during invasive mechanical ventilation (%) (intervention/comparison) | NA | 42/41 | NA | NA | NA | NA | 74/73 | 94/6 |
| Frequency of mobilization, days per week (intervention/comparison) | Daily, to hospital discharge or return to baseline function/NR | 7/7 | NA | 7 to hospital discharge/5 | 7/3 (up to 28 days) | 5/5 | 7/5 | Daily, to hospital discharge or return to baseline function/NR |
| Duration of mobilisation, minutes per day (intervention/comparison) | 19.2/0 (whilst receiving MV) | ICU: 15–30 min/day: ward: 60 min/day; outpatient 2 × /week (all active)/NR | 21/9 | NA | 39 (ICU 31.3; non-ICU 45.3)/21 (ICU 21; non-ICU 22) | 23/13 (includes passive and active) | 20.8/8.8 (active mobilisation) | NA |
| Median time to mobility milestones, days (intervention/comparison) | From intubation | NA | NA | NA | NA | NA | From randomisation | From intubation |
| Sitting | 1.7/6.6 | 2/4 | 1.1/4.8 | |||||
| Standing | 3.2/6 | 3/5 | 1.3/5 | |||||
| Walking | 3.8/7.3 | 5/7 | 1.7/5.6 |
NA not available