Effect of Enhanced Versus Usual Mobilization Activities in Critically Ill Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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.