Respiratory medicine · 2026
Barriers to early rehabilitation and mobilization in adult ICUs: A multicenter survey in the Eastern region of Saudi Arabia.
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Al Humoud Shoug Yousef, Alasmi Najlaa K, Alquaimi Maher M, Almojaibel Abdullah A, Alhassan Fatima H, Aljouf Maha M, Alsubaiei Mohammed S, Alghamdi Renad A, Raza Saqlain, Alzahrani Yahya H, Alsomali Hana, Al Asmari Mansour A, Alnoaimi Noorah
Аннотация
INTRODUCTION: Prolonged Intensive Care Unit (ICU) immobilization leads to complications such as ICU Acquired Weakness (ICU-AW). While Early Rehabilitation and Mobilization (ERM) is proven to improve functional independence and reduce mechanical ventilation (MV) duration, its implementation remains inconsistent. This study aimed to identify barriers to ERM as perceived by adult ICU healthcare practitioners in the Eastern region of Saudi Arabia.
METHODS: A multicenter, cross-sectional survey using a 21-question adapted self-administered questionnaire was conducted between January and April 2023 through QuestionPro platform. The survey was distributed to critical care practitioners including physicians, nurses, respiratory therapists, physiotherapists, and other allied health staff. Respondents represented three hospital categories in the Eastern region: private, Eastern Health Cluster, and other governmental sector hospitals. Barriers were assessed a priori at three levels: patient, provider, and institutional. Internal consistency of the patient-level barrier scale was assessed using Cronbach's alpha. Chi-square and Fisher-Freeman-Halton exact tests compared ERM protocol availability between hospital sectors and knowledge, practice, and resource variables across professional groups.
RESULTS: Of 137 practitioners who accessed the survey, 121of 137 who accessed the link completed the questionnaire (88%completion rate). Although 66 (55%) rated ERM as very important, only 48 (40%) reported always participating in or observing it in practice. The most frequently endorsed ideal initiation time was within 24 hours of admission (38, 31%), whereas the most commonly reported actual initiation point was when patients were conscious and able to cooperate (28, 23%); only 10 (8%) reported initiation within 24 hours. Patient-level barriers were mainly sedation and physiological instability. Provider-level barriers included safety concerns, limited staffing, and inadequate training. At the institutional level, only 57 (47%) respondents reported the presence of a formal ERM protocol, with a significant difference between private hospitals (36/54, 67%) and government hospitals (21/67, 31%) (χ2 = 13.59 df = 1, p < 0.001; OR 4.38, 95% CI 2.04-9.42). Protocol availability, ERM participation, and physiotherapy access also differed significantly across professional groups, with respiratory therapists consistently reporting the lowest access p = 0.013; p < 0.001; p = 0.038; p < 0.001.
CONCLUSION: Despite high awareness of its benefits, ERM implementation across adult ICUs in the Eastern region remains suboptimal relative to the 72-hour initiation window recommended by current consensus guidance and is delivered reactively rather than proactively. Barriers operate at patient, provider, and institutional levels, and both formal ERM protocol availability and profession-based access to ERM structures differ significantly, with respiratory therapists the most excluded despite managing the highest-risk patients. These findings identify protocol availability and interdisciplinary delivery structures as the principal targets for regional implementation efforts.
METHODS: A multicenter, cross-sectional survey using a 21-question adapted self-administered questionnaire was conducted between January and April 2023 through QuestionPro platform. The survey was distributed to critical care practitioners including physicians, nurses, respiratory therapists, physiotherapists, and other allied health staff. Respondents represented three hospital categories in the Eastern region: private, Eastern Health Cluster, and other governmental sector hospitals. Barriers were assessed a priori at three levels: patient, provider, and institutional. Internal consistency of the patient-level barrier scale was assessed using Cronbach's alpha. Chi-square and Fisher-Freeman-Halton exact tests compared ERM protocol availability between hospital sectors and knowledge, practice, and resource variables across professional groups.
RESULTS: Of 137 practitioners who accessed the survey, 121of 137 who accessed the link completed the questionnaire (88%completion rate). Although 66 (55%) rated ERM as very important, only 48 (40%) reported always participating in or observing it in practice. The most frequently endorsed ideal initiation time was within 24 hours of admission (38, 31%), whereas the most commonly reported actual initiation point was when patients were conscious and able to cooperate (28, 23%); only 10 (8%) reported initiation within 24 hours. Patient-level barriers were mainly sedation and physiological instability. Provider-level barriers included safety concerns, limited staffing, and inadequate training. At the institutional level, only 57 (47%) respondents reported the presence of a formal ERM protocol, with a significant difference between private hospitals (36/54, 67%) and government hospitals (21/67, 31%) (χ2 = 13.59 df = 1, p < 0.001; OR 4.38, 95% CI 2.04-9.42). Protocol availability, ERM participation, and physiotherapy access also differed significantly across professional groups, with respiratory therapists consistently reporting the lowest access p = 0.013; p < 0.001; p = 0.038; p < 0.001.
CONCLUSION: Despite high awareness of its benefits, ERM implementation across adult ICUs in the Eastern region remains suboptimal relative to the 72-hour initiation window recommended by current consensus guidance and is delivered reactively rather than proactively. Barriers operate at patient, provider, and institutional levels, and both formal ERM protocol availability and profession-based access to ERM structures differ significantly, with respiratory therapists the most excluded despite managing the highest-risk patients. These findings identify protocol availability and interdisciplinary delivery structures as the principal targets for regional implementation efforts.