“How should I apply this information?”
This research successfully captures the impact that physical therapist-led early mobilization (EM) practices have on important variables that not only impact child outcomes and influence financial considerations for pediatric institutions. The authors highlight the importance of implementation of EM practices in the pediatric intensive care unit (PICU), which requires consistent staffing and institutional support of rehab programs to meet the specialized needs of critically ill children. With consistently adequate staffing and resources in the PICU, therapists are able to advance rehabilitative practices specific to pediatrics instead of relying on evidence from research with adults. Dedicated therapist engagement from the beginning of a child’s hospital admission allows early rehabilitation from new injuries and prevention of avoidable, secondary impairments from prolonged immobilization and sequelae of critical illness. Additionally, EM protocols allow early engagement in advocacy and care coordination that best supports long term functional outcomes for each child.
“What should I be mindful about when applying this information?”
This article highlights the limited availability of literature that reflects the impact of rehabilitative efforts in the PICU, due in large part to the heterogenous nature of PICU populations, limited research supports, and variable practice guidelines. Additionally, pediatric rehab departments are often faced with the challenge of prioritizing resource management and staffing needs outside of the PICU to facilitate timely discharges in the hospital setting, which can impede the consistency of EM practices. By objectively identifying the financial impacts of physical therapist-led EM interventions, the authors have been able to highlight the importance of institutional investment in establishing, prioritizing, and sustaining EM practices. Advocacy for rehabilitative practices within the PICU supports further research and refinement of therapy practice guidelines and outcome assessments to continue to improve care and clinical practice. This focus on improving care within the first few days of a child’s critical illness can best address the long-term functional impacts of PICU admissions for each child and family.
Katherine Hedden, PT, DPT, PCS, CBIS
Kara Arps, PT, DPT, PCS, ATP
Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
Footnotes
The authors declare no conflicts of interest.