Influence of the initial level of consciousness on early, goal-directed mobilization: a post hoc analysis

Stefan J. Schaller, Flora T. Scheffenbichler, Somnath Bose, Nicole Mazwi, Hao Deng, Franziska Krebs, Christian L. Seifert, George Kasotakis, Stephanie D. Grabitz, Nicola Latronico, Timothy Houle, Manfred Blobner, Matthias Eikermann

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Purpose: Early mobilization within 72 h of intensive care unit (ICU) admission improves functional status at hospital discharge. We aimed to assess the effectiveness of early, goal-directed mobilization in critically ill patients across a broad spectrum of initial consciousness levels. Methods: Post hoc analysis of the international, randomized, controlled, outcome-assessor blinded SOMS trial conducted 2011–2015. Randomization was stratified according to the immediate post-injury Glasgow Coma Scale (GCS) (≤ 8 or > 8). Patients received either SOMS-guided mobility treatment with a facilitator or standard care. We used general linear models to test the hypothesis that immediate post-randomization GCS modulates the intervention effects on functional independence at hospital discharge. Results: Two hundred patients were included in the intention-to-treat analysis. The significant effect of early, goal-directed mobilization was consistent across levels of GCS without evidence of effect modification, for the primary outcome functional independence at hospital discharge (p = 0.53 for interaction), as well as average achieved mobility level during ICU stay (mean achieved SOMS level) and functional status at hospital discharge measured with the functional independence measure. In patients with low GCS, delay to first mobilization therapy was longer (0.7 ± 0.2 days vs. 0.2 ± 0.1 days, p = 0.008), but early, goal-directed mobilization compared with standard care significantly increased functional independence at hospital discharge in this subgroup of patients with immediate post-randomization GCS ≤ 8 (OR 3.67; 95% CI 1.02–13.14; p = 0.046). Conclusion: This post hoc analysis of a randomized controlled trial suggests that early, goal-directed mobilization in patients with an impaired initial conscious state (GCS ≤ 8) is not harmful but effective.

Original languageEnglish (US)
Pages (from-to)201-210
Number of pages10
JournalIntensive Care Medicine
Volume45
Issue number2
DOIs
StatePublished - Feb 27 2019
Externally publishedYes

Keywords

  • Consciousness
  • Critical care
  • Delirium
  • Early mobilization
  • Early rehabilitation
  • Functional status
  • Neurocritical care

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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