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R EHABI L I TATION


Mobilisation of patients recovering from COVID


Patients that have been admitted to the ICU, due to serious COVID complications, require effective strategies for early mobilisation and rehabilitation as they recover. Mary Muir and Mark Pinder offer an insight into best practice and the technologies that can assist, to ensure the best possible patient outcomes.


During the initial phases of the COVID-19 pandemic, the focus was on managing hospital admissions, expanding intensive care and ensuring that there was capacity to manage high acuity patients. With thousands hospitalised because of the pandemic, the role of early mobilisation and rehabilitation to aid patient recovery and advance care had never been more important1


as patients


exhibited signs of physical and psychological dysfunction,2


impairments, deconditioning and muscle weakness.3


which included severe physical


For example, it is recognised that excessive immobility has profound effects on key body systems during hospitalisation – lasting for months or years after discharge.4 Loss of muscle mass (up to 20% per week), and nerve dysfunction or damage leading to ICU acquired weakness appears to start within the first few days of critical illness.5-6 Muscle loss in the large lower extremity muscle groups will affect standing and walking ability.


Early mobilisation and rehabilitation requires a multidisciplinary team approach that considers the prevention of hospital- acquired conditions, increasing patient comfort, well-being and recovery from illness. Evidence shows that physical


and occupational therapy approaches are a fundamental component of the care pathway.7


The World Health Organization has called for a coordinated approach and investment to raise the profile of rehabilitation as a health strategy relevant to all people across their life and care continuum.8


It states that “rehabilitation is a set


of interventions needed when a person is experiencing or is likely to experience limitations in everyday functioning due to ageing or a health condition, including chronic diseases or disorders, injuries or traumas.”9


Rehabilitation facilitates


individuals to maintain or return to their prior level of functional independence, activities of daily living and aims to maximise their well-being without additional support or care. Early and ongoing rehabilitation throughout the patient’s episode of care is critical to maintaining the flow in a care facility, aiming to safely discharge home, thereby, freeing up beds and capacity to treat more patients. As hospitals increase their activities, rehabilitation will be central to their operations to avoid costly hospitalisation, a reduction in length of stay and prevent re-admissions soon after


discharge from the acute setting.10 The increased physical demand placed on healthcare professionals is apparent in all care environments; availability of appropriate equipment based on individual need can help in the rehabilitation process, supporting caregivers to achieve successful clinical outcomes.


The Mobility Gallery11 is an internationally


recognised assessment and communication tool based on different levels of functional mobility; from mobile and independent; to fully dependent requiring all care as illustrated in Figure 1. Clinicians recognise that undertaking a functional mobility assessment is central to ensuring patient safety, maximising the physical and cognitive performance. Stimulating mobility and ultimately respecting passivity is crucial from a quality of care perspective.12 In addition, the Positive Eight philosophy13


as illustrated in Figure 2


highlights the potential positive effects arising from maintaining or improving a person’s mobility by supporting care facilities with the right prerequisites: l Use of the work environment to enable efficient care processes.


l Provision of equipment to support patient


Figure 1. SEPTEMBER 2020 WWW.CLINICALSERVICESJOURNAL.COM l 43





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