The effect of increased mobility on morbidity in the neurointensive care unit

J Neurosurg. 2012 Jun;116(6):1379-88. doi: 10.3171/2012.2.JNS111881. Epub 2012 Mar 30.


Object: The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population. This study was a single-institution prospective intervention trial to investigate the effectiveness of increased mobility among neurointensive care unit patients.

Methods: All patients admitted to the neurointensive care unit of a tertiary care center over a 16-month period (April 2010 through July 2011) were evaluated. The study consisted of a 10-month (8025 patient days) preintervention observation period followed by a 6-month (4455 patient days) postintervention period. The intervention was a comprehensive mobility initiative utilizing the Progressive Upright Mobility Protocol (PUMP) Plus.

Results: Implementation of the PUMP Plus increased mobility among neurointensive care unit patients by 300% (p < 0.0001). Initiation of this protocol also correlated with a reduction in neurointensive care unit length of stay (LOS; p < 0.004), hospital LOS (p < 0.004), hospital-acquired infections (p < 0.05), and ventilator-associated pneumonias (p < 0.001), and decreased the number of patient days in restraints (p < 0.05). Additionally, increased mobility did not lead to increases in adverse events as measured by falls or inadvertent line disconnections.

Conclusions: Among neurointensive care unit patients, increased mobility can be achieved quickly and safely with associated reductions in LOS and hospital-acquired infections using the PUMP Plus program.

MeSH terms

  • Academic Medical Centers
  • Algorithms
  • Cooperative Behavior
  • Cross Infection / prevention & control
  • Early Ambulation*
  • Feasibility Studies
  • Female
  • Florida
  • Follow-Up Studies
  • Guideline Adherence
  • Humans
  • Intensive Care Units*
  • Interdisciplinary Communication
  • Length of Stay
  • Male
  • Middle Aged
  • Nervous System Diseases / rehabilitation*
  • Occupational Therapy
  • Physical Therapy Modalities
  • Pneumonia, Ventilator-Associated / prevention & control
  • Prospective Studies
  • Restraint, Physical
  • Urinary Tract Infections / prevention & control