ORCID

Abstract

Background: Early mobilisation of critically ill patients remains variable across practice. This study set out to determine barriers to and facilitators of early mobilisation for patients diagnosed with delirium in the intensive care unit (ICU). Methods: A mixed-methods descriptive systematic review. Electronic databases (AMED, BNI, CINAHL Plus, Cochrane Library, Medline and EMBASE) were searched for publications up to 22nd December 2021. Independent reviewers screened studies and extracted data using Covidence Systematic Review Management software. Data were summarised according to frequency (n/%) of barriers and facilitators. Thematic analysis of qualitative studies was carried out in order to address the secondary aim. Quantitative studies were assessed using the GRADE quality assessment tool. Qualitative studies were analysed according to the GRADE-CERQual quality assessment tool. This study was prospectively registered on PROSPERO (CRD 42021227655). Results: Ten studies met the inclusion criteria. Quantitative findings demonstrated the presence of delirium was the most common reported barrier to early mobilisation. The most common facilitator was ICU staff experience of positive outcomes as a result of early mobilisation interventions. Thematic analysis identified six main themes that may describe potential meanings behind these findings: (1) knowledge, (2) personal preferences, (3) perceived burden of delirium, (4) perceived complexity, (5) decision-making and (6) culture. Conclusion: These findings highlight the reported need to further understand the impact and value of early mobilisation as a non-pharmacological intervention for patients diagnosed with delirium in ICU. Evaluation of early mobilisation interventions involving key stakeholders may address these concerns and provide effective implementation strategies.

Publication Date

2024-03-06

Publication Title

Journal of the Intensive Care Society

Volume

25

Issue

2

ISSN

1751-1437

Acceptance Date

2023-12-03

Deposit Date

2024-06-17

Funding

We would like to thank Professor Richard Atkinson, Population Health Research Institute, St. George\u2019s, University of London, for his support to ensure methodological rigor; Ms Anna El-Jouzi, Liaison Librarian, Faculty of Health and Social Care, St. George\u2019s University of London for providing the peer-review for the search strategy; St. George\u2019s University of London library services and the Royal Free London library services for providing support to identify unpublished studies and full texts of included studies; the public advisory group and public member on our research team (RG) who gave support to ensure the relevance and rigor of this systematic review; Mr Robert Sun (a non-medical unfunded volunteer) supported the translation of texts published in Mandarin. Mr Sun is not responsible for any inaccuracies or misinterpretation. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This systematic review is independent research supported by the National Institute for Health Research HEE/NIHR ICA Programme Pre-doctoral Clinical Academic Fellowship, Miss Jacqueline Bennion, NIHR301174. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This systematic review is independent research supported by the National Institute for Health Research HEE/NIHR ICA Programme Pre-doctoral Clinical Academic Fellowship, Miss Jacqueline Bennion, NIHR301174. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.

Keywords

delirium, Early ambulation, intensive care units

First Page

210

Last Page

222

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