Early Mobilization and Rehabilitation in Critical Care

Early mobilization and rehabilitation in critical care encompass a suite of interventions aimed at initiating physical activity—ranging from passive range of motion to active ambulation—within the first days of intensive care unit admission. These approaches seek to interrupt the cascade of muscle wasting, neuromuscular dysfunction and cognitive decline that often accompany prolonged bed rest and mechanical ventilation. By engaging multidisciplinary teams of physicians, physiotherapists, nursing staff and occupational therapists, early mobilisation protocols tailor the frequency, intensity and progression of rehabilitation to each patient’s physiological reserve and medical stability. Evidence indicates that such interventions can attenuate intensive care unit–acquired weakness, reduce the duration of delirium, shorten ventilator dependence and enhance the likelihood of discharge to home. To achieve optimal outcomes, safety criteria for cardiovascular, respiratory and neurological parameters are rigorously applied, while technological innovations—such as cycle ergometry and robotic assistance—offer new avenues to deliver consistent and measurable rehabilitation doses. Despite demonstrated feasibility and patient and staff acceptability, barriers persist in the form of sedation practices, staffing constraints and heterogeneity of protocols. Ongoing research seeks to refine individualised rehabilitation prescriptions and to extend the benefits of early mobilisation beyond the intensive care stay into the post-discharge period.

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Early Mobilization and Rehabilitation in Critical Care publication trend

The graph below shows the total number of articles in early mobilization and rehabilitation in critical care across all publications each year (not limited to Nature Index journals).

Technical terms

ICU-acquired weakness (ICUAW): Symmetrical muscle weakness arising during critical illness due to a combination of neuropathy and myopathy.

Early mobilization: The initiation of physical activity—such as sitting, standing or walking—within the first 48–72 hours of intensive care unit admission.

Delirium: An acute disturbance of attention and cognition frequently observed in critically ill patients, often exacerbated by immobility and sedation.

Rehabilitation dose: Quantifiable parameters of mobilisation, including frequency, duration and intensity of activity sessions.

References

1. Mobilisation in the EveNing to prevent and TreAt deLirium (MENTAL): a mixed-methods, randomised controlled feasibility trial. EClinicalMedicine (2023).
2. Clustering of critically ill patients using an individualized learning approach enables dose optimization of mobilization in the ICU. Critical Care (2023).
3. Robot-assisted early mobilization for intensive care unit patients: Feasibility and first-time clinical use. International Journal of Nursing Studies (2024).
4. Clinical review: intensive care unit acquired weakness. Critical Care (2015).
5. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care (2014).
6. Clinical review: Early patient mobilization in the ICU. Critical Care (2012).