Pediatrics and PM&R Experts Publish QI Initiative for Development and Implementation of Pediatric ICU-based Mobility Guidelines

Ericka L. Fink, MD, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, and Maddie Chrisman, DPT, Department of Physical Therapy, UPMC Children's Hospital of Pittsburgh, led the study “Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative.”

Amit Sinha, MD, UPMC Department of Physical Medicine and Rehabilitation, along with several other colleagues from UPMC Children’s Hospital of Pittsburgh and the University of Utah School of Medicine, participated in and published this study in May 2021.

Studies show that critical illness can result in physical impairments which may be mitigated by intensive care unit (ICU)-based early mobility. This initiative aimed to develop and implement ICU-based mobility guidelines for critically ill children.

A multidisciplinary team developed and implemented these ICU-based mobility guidelines. They determined the success of guideline implementation by comparing utilization of physical therapy (PT) and occupational therapy (OT) and changes in functional status scale scores in pre-implementation and postimplementation cohorts. The team also assessed barriers and adverse events.

The research team identified 34 patients pre-implementation and 55 patients postimplementation. PT/OT consultation by 72 hours occurred in 44 (81.5%) patients postimplementation compared to 6 (17%) pre-implementation (P < 0.001). Implementation did not result in more ICU-based therapy sessions or shorter time to active therapies. High deferral rates for PT/OT sessions [PT: n = 72 (46.2%) pre-implementation versus 112 (39.4%) postimplementation; OT: n = 71 (46.1%) pre-implementation versus 134 (41.5%) postimplementation] occurred. They did not identify a difference in new morbidity between cohorts. Barriers to this study included the patient's sedation status, severity of illness, and patient availability.

This study showed that implementation of ICU-based mobility guidelines resulted in a 4-fold increase in PT/OT consultation. They did not result in increased treatment sessions due to frequent deferrals. The research team determined that future pediatric ICU-based mobility guidelines should focus on interventions to address identified barriers to treatment in a critically ill pediatric population.

Dr. Sinha is a pediatric physiatrist and is certified in physical medicine & rehabilitation and pediatric rehabilitation medicine by the American Board of Physical Medicine. He is medical director for the rehabilitation unit at UPMC Children’s Hospital of Pittsburgh and is assistant professor of physical medicine & rehabilitation at the University of Pittsburgh School of Medicine. His clinical interests include neuromuscular rehabilitation, spasticity management, cerebral palsy, brain injury, and spinal cord injury. 

Other study contributors:

Stefanie G. Ames, MD
Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.

Lauren J. Alessi, MD
Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.

Meg Stanger, DPT
Physical Therapy Department, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.

Devin Corboy, CCRN
Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.

View the full study on PubMed.