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01-02-2019 | Care | Original

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

Authors: 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

Published in: Intensive Care Medicine | Issue 2/2019

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.

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Title: Influence of the initial level of consciousness on early, goal-directed mobilization: a post hoc analysis
Authors: 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
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Keyword: Care
Published in: Intensive Care Medicine / Issue 2/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05528-x

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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