adjunct to therapy – regularly challenged sitting during the day31

– particularly useful

for those patients where sitting out is more challenging or requires a high number of staff to facilitate the transfer out of bed. Evidence suggests that upright positioning can provide an orthostatic challenge to prevent cardiac function deterioration32

postural hypotension; increase functional residual capacity;33 impairment34

and ensure a better position

for active exercises and intervention within the clinical environment. An early method to support in bed rehabilitation is cycle ergometry, used during the acute phase of illness when out of bed mobility is contraindicated or as an adjunct to progressive mobility to improve strength and cardiorespiratory fitness.35

Electrical muscle

stimulation may also be utilised during acute periods of immobility – although, at present, the effectiveness of this remains inconclusive.36

Pressure ulcer prevention In order to assist the prevention of pressure ulcers developing over body areas such as the face, breast region, genitals, knees and toes when in a prone position, an appropriate pressure redistribution mattress should be used. Consideration could be given to a mattress, which allows carers to deflate individual mattress cells under the patient’s body, providing an adaptable support surface and selective off-loading for the management of highly vulnerable areas.37 Regular repositioning is essential to help prevent the development of pressure ulcers whenever patients are spending extended periods in bed due to excessive loading onto sensitive areas of skin with increased contact directly over bony prominences.38,39


injuries can lead to a protracted hospital stay, patient suffering, possible surgical intervention, and increased costs of care.40 To further support the care of patients in bed, early detection41

using a specialised

scanner can assist clinicians to identify anatomical areas at increased risk of pressure ulcers developing five days earlier than visual inspection alone and potentially reduces the incidence of hospital acquired pressure ulcers by an average of 89% based on an individual care pathway.42


detection provides an opportunity for timely intervention in the management of pressure

and reduce risk of neurological

ulcer prevention and the rehabilitation and recovery process.

VTE prevention Another important area in the care of immobile patients is preventing venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) which can lead to serious and potentially life changing complications, while increasing healthcare cost. Venous stasis is naturally avoided through the biomechanical action of the calf and foot muscle pump, which is why early ambulation / mobilisation is the treatment of choice for patients at lower risk of VTE.43

When walking is not possible,

the benefits of the muscle pump can be simulated by mechanical means. Prevention strategies commonly incorporate the use of pharmacological prophylaxis and/or mechanical methods44

including intermittent

pneumatic compression and passive graduated compression stockings.

Sitting on the edge of the bed The process of sitting a patient on the edge of the bed forms an important part of the patient assessment and subsequent provision of a structured rehabilitation programme

and seating plan. The assessment would consider the body anthropometrics, shape, sitting balance and readiness for sitting out of bed, ensuring the bed height is adjusted so the person’s feet are placed on the floor providing proprioceptive feedback.

Out of bed mobilisation Passive standing: The process of sitting on the edge of the bed can at times be labour intensive, particularly for patients who are obese, of low arousal or with profound ICU- AW.45

In these instances, equipment such as a tilt table, ceiling lift / passive mobile hoist with an ambulation sling, or a multi- positional aid can support patient care in the acute care setting.

Evidence suggests that a multi-positional aid that can support supine, sitting or standing position, early in the rehabilitation process can have positive outcomes to patient care, length of stay and facility costs.46

Active standing: Once the patient is able to maintain their sitting balance with minimal support and move their legs against gravity, they may be ready to progress to stand at the side of the bed.

Using a standing and raising aid is one potential solution for those patients aiming to


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