A progressive mobility program is a structured and gradual approach designed to increase a patient’s physical activity, particularly in hospital settings like intensive care units (ICUs). This planned series of movements helps individuals regain strength and restore their pre-hospitalization functionality, which can decline significantly during a hospital stay. The program begins at a patient’s current mobility status and systematically advances through various levels of activity.
The Goals of a Progressive Mobility Program
Hospitalization, especially in an ICU, can lead to various complications due to prolonged inactivity. Patients may experience muscle weakness, sometimes termed ICU-acquired weakness, and a loss of muscle mass. Immobility also contributes to respiratory issues like atelectasis and hospital-acquired pneumonia, along with a higher risk of developing deep vein thrombosis (blood clots).
Progressive mobility programs address these challenges by promoting early and sustained movement. This helps prevent muscle deconditioning and reduces complications such as pressure injuries on the skin. Furthermore, these programs decrease the incidence of delirium. Ultimately, implementing a progressive mobility program can shorten a patient’s ICU and overall hospital stay, while also improving their functional status after discharge.
The Stages of Progressive Mobility
A progressive mobility program begins with the most basic movements, often within 48 hours of a patient’s admission to an ICU. The initial stage involves passive range-of-motion exercises, where staff gently move a patient’s limbs, and assisted turning from side to side every two hours to maintain joint flexibility and promote circulation. As the patient’s condition stabilizes, they progress to active bed exercises, performing movements independently while still in bed.
The next steps involve preparing the patient for upright positions. This includes sitting upright in bed, and then dangling their feet over the side of the bed. Dangling helps the patient adjust to changes in body position and can improve their tolerance for standing. Once tolerated, the patient is assisted to stand at the bedside.
Further progression involves transferring from the bed to a chair, allowing for longer periods of sitting out of bed. The final stages of the program introduce ambulation, starting with short walks within the patient’s room. As strength and endurance improve, patients are encouraged to walk longer distances in the hospital hallway. The pace of progression is always tailored to the individual patient’s ability to follow commands and their muscle strength.
Patient Candidacy and Safety
Not every patient is immediately suitable for a progressive mobility program. A thorough assessment by a multidisciplinary healthcare team, including nurses, physical therapists, and physicians, is conducted first. This evaluation checks various physiological parameters like heart rate, blood pressure, and oxygen saturation levels to ensure patient stability before initiating any mobilization.
Beyond vital signs, the healthcare team evaluates the patient’s overall stability, their level of consciousness, and their ability to understand and follow simple commands. Certain conditions can prevent immediate participation in progressive mobility. These contraindications include severe cardiovascular or respiratory instability, specific injuries, active bleeding, or a physician’s order for strict bed rest. Continuous monitoring and staff trained in safe patient handling techniques ensure patient safety throughout the program.
Equipment Used in Progressive Mobility
Several pieces of specialized equipment are routinely used to facilitate progressive mobility safely and effectively. Modern hospital beds are designed with features that aid in patient movement while remaining in bed, including abilities to tilt and convert into a chair position. For transferring patients, overhead ceiling lifts and mobile patient lifts are commonly employed. These devices safely move patients from a bed to a chair or assist with standing, reducing physical strain.
Sit-to-stand aids provide additional support for patients as they transition from a sitting to a standing position, helping to build strength and confidence. Specialized walkers offer enhanced stability and can be equipped to carry medical devices like oxygen tanks or intravenous poles, allowing patients to ambulate with necessary support. Portable vital signs monitors are used to continuously track a patient’s heart rate, blood pressure, and oxygen levels. Slings and wedges also assist in comfortable and secure patient positioning and transfers.