DOSE-RESPONSE OF EARLY MOBILIZATION IN THE INITIATION TIME AND PHYSICAL-FUNCTIONAL STATUS OF CRITICAL PATIENTS: A SYSTEMATIC REVIEW AND METHANALYSIS
Intensive Care Units.Physicalexercise.Earlymobilization
The increase in the rate of survival after critical care in the Intensive Care Unit (ICU) has been related by comorbidities that persist for up to five years after discharge. Among the main outcomes after discharge from critical patients are pulmonary complications, muscle weakness acquired in the ICU and decreased of physical and functional capacities. Higher levels of intra-hospital activity lead to less functional decline and early mobilization emerges as an effective intervention in preventing these declines. The methodological variability and lack of comparison between early mobilization’ protocols become standardization difficult. This systematic review aims to: quantify the dose-response relationship of early mobilization in hospitalization time and physical and functional status, to describe early mobilization protocols, regarding duration, frequency and intensity, modality and number of exercises per session, series, repetitions, loads and materials used, and to describe the physical-functional status of hospitalized patients. The recommendations Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) will be respected. The search strategy will be created using the Medical Subject Headings (MeSH) descriptors with combined concepts: adults, critical ill, critically ill, intensive care unit, AND mobilization, early mobilization, active mobilization, early ambulation, exercise, exercise therapy, rehabilitation. The synonyms will be combined in Boolean operators and adapted for each database,Medical Literature Analysis and Retrieval System Online (Medline), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Scopus, during February 2019. The interventions will include early mobilization’s protocols, physical therapy intervention, and rehabilitation performed by any member of the health team. Dose will be considered like duration of a session, duration of interventions in weeks, frequency of exercises per day, per week and per month, intensity, exercises’ modalities, number of exercises per session, loads and progression. The primary outcomes will be length of hospital stay, hospital discharge,mortality, time of use of mechanical ventilation, weaning time, extubation failures and adverse events. The secondary outcomes will be variation in muscle strength and functional capacity assessed before and after early mobilization. After the search and identification of the studies in the databases, two independent reviewers will carry out the selection through the titles and abstracts, those included will be obtained in their full version, and once the two reviewers will make the selection following the criteria established in the protocol for completing the research form. The Physical Therapy Evidence Database (PEDro) scale will be used for quality assessment of clinical trials and the Downs and Black instrument will be used for non-randomized studies. Meta-analysis will be performed using Review Manager Software, version 5.0 (Copenhagen, The Nordic Cochrane Center, The Cochrane Collaboration, 2008).