Early Mobilization and Rehabilitation Practices of Adult Patients Admitted to the ICU in Japan: A 1-Day Multicenter Point-Prevalence Study.

Abstract

Importance: Early mobilization (EM) in the ICU mitigates post-intensive care syndrome (PICS) and improves functional outcomes. However, comprehensive national data on mobilization practices and patient-level barriers in Japan's super-aged society remain limited.

Objectives: To describe current mobilization and rehabilitation practices, the prevalence of EM, and factors associated with remaining in bed among adult ICU patients in Japan.

Design, setting, and participants: This nationwide, multicenter, cross-sectional, 1-day point-prevalence study was conducted on February 20, 2024, across ICUs in Japan. All adult patients (18 yr or older) physically present in the ICU between 00:00 and 14:00 were included.

Main outcomes and measures: The highest mobilization level was assessed using the ICU Mobility Scale (IMS). Out-of-bed mobilization was defined as IMS greater than or equal to 3, and EM as IMS greater than or equal to 3 within 48 hours of ICU admission. Patient characteristics, treatments, and perceived barriers were extracted from medical records. Multivariable logistic regression was performed to identify factors independently associated with remaining in bed.

Results: Data were collected from 81 ICUs in 72 hospitals, and 693 patients were included in the analysis (median age, 72 yr; 68% 65 yr or older). Of these, 269 patients (38.8%) were receiving mechanical ventilation. Out-of-bed mobilization occurred in 42.6% of patients overall and in 17.8% of mechanically ventilated patients. EM within two days of ICU admission was achieved in 44.7% of patients overall and in 13.6% of mechanically ventilated patients. Multivariable analysis demonstrated that mechanical devices, particularly mechanical ventilation with an endotracheal tube, vasopressor use, sedative and analgesic administration, and coma were independently associated with a higher likelihood of remaining in bed. Conversely, the presence of delirium and higher nutritional intake were associated with a higher likelihood of achieving out-of-bed mobilization. Subjective assessments identified pathologic and psychoneurological factors as the predominant barriers.

Conclusions and relevance: Despite advanced patient age, mobilization and EM rates in Japanese ICUs were comparable to those reported internationally. However, patients at the highest risk for PICS, particularly those requiring advanced organ support or intensive sedation, were the least likely to achieve out-of-bed mobilization. These findings highlight a persistent clinical dilemma and suggest the need for tailored strategies to safely expand mobilization among the most vulnerable ICU populations in super-aged societies.