Early Mobilization in the ICU: A Multicenter Survey of Clinicians' Knowledge, Attitude and Practices in Resource-Limited Hospital Settings

Background: Prolonged stay in the Intensive Care Unit (ICU) is associated with impaired physical function, low quality of life and increased cost of care. Evidence suggests early mobilization (EM) in the ICU is safe, feasible and results in physiological and functional improvement in critically ill patients. Despite its benefits, EM in the ICU is not a common practice. Factors relating to healthcare provider, such as level of knowledge, attitude and practices may contribute to this trend. As a first step towards adopting routine EM in our ICU, we investigated the current level of knowledge, attitude and practices of care professional about EM. Methods: We conducted a cross-sectional survey to assess level of knowledge, attitude and practices of clinician towards early mobilization in four teaching hospitals in southwestern Nigeria, using a 20-item questionnaire adapted from previous studies. Results: A total of 131 health care providers comprising of 58 (44%) physicians, 34 (26%) physiotherapist and 39 (30%) nurses participated in the study. Most (89%) clinician indicated knowledge about benefits of EM, but only 30% showed adequate knowledge about what constitute EM. 5% of the participants had knowledge about EM guidelines. 45 (80%) reported that the risk associated with early mobilization of patients on mechanical ventilator (MV) outweighs its benefits. While 75% of the respondents indicated they will not ambulate patient on mechanical ventilator or on vasopressor agents, 65% agreed that critically ill patient could be mobilized in the ICU. Most (83%) of the participants did not train or work at an institution where patients are mobilized in the ICU and consequently feel they are not competent to implement EM. More physiotherapist indicated willingness to ambulate patient on mechanical ventilator, while more physicians reported unwillingness to ambulate patients on vasopressor agents (p<0.05). Conclusion: There is good level of knowledge about early mobilization of intensive care patients among participants, but current level of practice are low as most perceive the risks associated with EM outweigh its benefits.