Impressions of Early Mobilization of Critically Ill Children—Clinician, Patient, and Family Perspectives

Objectives: To understand patient, family caregiver, and clinician impressions of early mobilization, the perceived barriers and facilitators to its implementation, and the use of in-bed cycling as a method of mobilization. Design: A qualitative study, conducted as part of the Early Exercise in Critically ill Youth and Children, a preliminary Evaluation (wEECYCLE) Pilot randomized controlled trial. Setting: McMaster Children’s Hospital PICU, Hamilton, ON, Canada. Participants: Clinicians (i.e., physicians, nurses, and physiotherapists), family caregivers, and capable patients age greater than or equal to 8 years old who were enrolled in a clinical trial of early mobilization in critically ill children (wEECYCLE). Intervention: Semistructured, face-to-face interviews using a customized interview guide for clinicians, caregivers, and patients respectively, conducted after exposure to the early mobilization intervention. Measurements and Main Results: Thirty-seven participants were interviewed (19 family caregivers, four patients, and 14 clinicians). Family caregivers and clinicians described similar interrelated themes representing barriers to mobilization, namely low prioritization of mobilization by the medical team, safety concerns, the lack of physiotherapy resources, and low patient motivation. Key facilitators were family trust in the healthcare team, team engagement, an a priori belief that physical activity is important, and participation in research. Increased familiarity and specific features such as the virtual reality component and ability to execute passive and or active mobilization helped to engage critically ill children in in-bed cycling. Conclusions: Clinicians, patients, and families were highly supportive of mobilization in critically ill children; however, concerns were identified with respect to how and when to execute this practice. Understanding key stakeholder perspectives enables the development of strategies to facilitate the implementation of early mobilization and in-bed cycling, not just in the context of a clinical trial but also within the culture of practice in a PICU. This work was performed at McMaster Children’s Hospital, Hamilton, ON, Canada. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Supported, in part, by the Regional Medical Associations Resident Research Grant. The cycle ergometer was provided by Restorative Therapies. Restorative Therapies did not have any contribution to the design, conduct, analysis, or interpretation of the results of our study. Ms. Zheng, Ms. Boles, Ms. Cameron, and Dr. Choong disclosed that Restorative Therapies, Baltimore, MD, supplied the RT300 pediatric version for this study. The remaining authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Karen Choong, MB, Department of Pediatrics, McMaster University, 1280 Main St West, HSC 3E-20, Hamilton, ON, Canada. E-mail: choongk@mcmaster.ca ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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