Does Early Out-Of-Bed Mobilization Improve Outcomes in Traumatic Brain Injury?

In a randomized controlled trial, researchers evaluated the effects of early progressive mobilization (EPM) on the functional outcomes of patients with moderate-to-severe traumatic brain injury (TBI) in an intensive care unit (ICU) setting. The study compared the outcomes of patients receiving early out-of-bed mobilization with those undergoing early in-bed upright positioning (EPUP). The findings indicate that early out-of-bed mobilization can potentially improve both mobility and functional independence while reducing ICU length of stay and ventilation duration, compared with early in-bed positioning.

TBI is a leading cause of long-term neurodisability, particularly among patients with moderate to severe injuries. Despite the benefits of early rehabilitation interventions, the optimal approach to early mobilization in patients with TBI remains uncertain. The current study addresses this gap by assessing the efficacy of early progressive mobilization in comparison with an upright positioning strategy.

The trial was conducted in a trauma ICU and involved 65 patients with moderate to severe TBI who were randomly assigned to either the EPM group (n = 33) or the EPUP group (n = 32). Patients in the EPM group received early out-of-bed mobilization therapy within 7 days of injury, while those in the EPUP group underwent EPUP rehabilitation. The primary outcome measure was the Perme ICU Mobility Score, while secondary outcomes included the Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), ICU length of stay, and duration of mechanical ventilation.

Patients in the EPM group demonstrated better functional outcomes compared with the EPUP group. The EPM group had higher Perme ICU Mobility Scores and FIM-motor scores. Notably, the duration of ICU stay was reduced by 5.9 days (P < .001) in the EPM group, and the duration of mechanical ventilation was shortened by 6.7 days (P = .001). However, there were no significant differences between the groups in terms of PhA, indicating no measurable improvement in muscle quality or cellular health.

The current study had several limitations. For example, the sample size was relatively small, and the trial was conducted at a single medical center. Additionally, long-term outcomes beyond ICU discharge were not assessed.

 “The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI,” the authors concluded. “Our study's results support further investigation of EPM through larger, randomized clinical trials.”

Reference:

Yen HC, Chuang HJ, Hsiao WL, et al. Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury. Crit Care. 2024;28(1):172. doi:10.1186/s13054-024-04940-0.