Effect of Enhanced Versus Usual Mobilization Activities in Critically Ill Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Bibliographic record
Abstract
OBJECTIVES: To conduct a systematic review and meta-analysis to capture updated evidence regarding the benefits and harms of enhanced mobilization activities and explore whether specific approaches may be more beneficial than others. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: This study was prospectively registered PROSPERO: CRD42024550360. Parallel group randomized controlled trials (RCTs) that included adult patients (≥ 18 yr old) admitted to the ICU were included. The intervention group was required to receive enhanced mobilization activities above usual care while in the ICU, while the control group received usual care, which was required to include some degree of mobilization. Four databases and two trial registries were searched until May 2024. Review and data extraction of all potentially eligible articles was performed independently and in duplicate. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence for each outcome. DATA SYNTHESIS: Fifty-nine RCTs ( n = 8462) met eligibility criteria. Enhanced mobilization activities may reduce the incidence of ICU-acquired weakness (risk ratio, 0.79; 95% CI, 0.66-0.95; moderate certainty), duration of delirium (mean difference [MD], -1.34 d; 95% CI, -1.85 to -0.83; low certainty), and duration of invasive mechanical ventilation (MD, -1.07 d; 95% CI, -1.64 to -0.50 d; moderate certainty). ICU and hospital length of stay may also be slightly reduced by enhanced mobilization (low certainty). Enhanced mobilization may result in little to no difference in adverse events (low certainty). CONCLUSIONS: This review demonstrates that enhanced mobilization likely reduces the incidence of ICU-acquired weakness and may reduce duration of delirium, while supporting prior findings that there is little to no difference in risk of adverse events. Early mobilization may be the most promising avenue for optimizing mobilization activities and raise the question of whether the key to improving outcomes lies in early exposure to these activities rather than increased intensity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.036 | 0.083 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.030 | 0.045 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".