Dose of Early Therapeutic Mobility: Does Frequency or Intensity Matter?

Chris Winkelman, Abdus Sattar, Hasina Momotaz, Kimberly D. Johnson, Peter Morris, James R. Rowbottom, John Daryl Thornton, Sheryl Feeney, Alan Levine

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Objective: Investigate the feasibility of a nurse-led mobility protocol and compare the effects of once- versus twice-daily episodes of early therapeutic mobility (ETM) and low- versus moderate-intensity ETM on serum biomarkers of inflammation and selected outcomes in critically ill adults. Design: Randomized interventional study with repeated measures and blinded assessment of outcomes. Setting: Four adult intensive care units (ICUs) in two academic medical centers. Subjects: Fifty-four patients with > 48 hr of mechanical ventilation (MV). Intervention: Patients were assigned to once- or twice-daily ETM via sealed envelope randomization at enrollment. Intensity of (in-bed vs. out-of-bed) ETM was administered according to protocolized patient assessment. Measurements: Interleukins 6, 10, 8, 15, and tumor necrosis factor-α were collected from serum before and after ETM; change scores were used in the analyses. Manual muscle and handgrip strength, delirium onset, duration of MV, and ICU length of stay (LOS) were evaluated as patient outcomes. Main Results: Hypotheses regarding the inflammatory biomarkers were not supported based on confidence intervals. Twice-daily intervention was associated with reduced ICU LOS. Moderate-intensity (out-of-bed) ETM was associated with greater manual muscle test scores and handgrip strength and reduced occurrence of delirium. Conclusion: Findings from this study suggest that nurses can provide twice-daily mobility interventions that include sitting on the edge of the bed once patients have a stable status without altering a pro-inflammatory serum biomarker profile.

Original languageEnglish
Pages (from-to)522-530
Number of pages9
JournalBiological Research for Nursing
Issue number5
StatePublished - Oct 1 2018

Bibliographical note

Publisher Copyright:
© The Author(s) 2018.


  • ICU
  • cytokines
  • delirium
  • mechanical ventilation
  • mobility
  • muscle strength
  • rehabilitation

ASJC Scopus subject areas

  • Research and Theory


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