The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: Synthesis of evidence and expert opinion and its translation into practice

Hanekom S. ; Gosselink R. ; Dean E. ; Van Aswegen H. ; Roos R. ; Ambrosino N. ; Louw Q. (2011)

Article

Objective: To facilitate knowledge synthesis and implementation of evidence supporting early physical activity and mobilization of adult patients in the intensive care unit and its translation into practice, we developed an evidence-based clinical management algorithm.Methods: Twenty-eight draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n=7) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range <0.5-were collated into the algorithm.Results: The draft algorithm statements were edited and six additional statements were formulated. The 34 statements related to assessment and treatment were grouped into three categories. Category A included statements for unconscious critically ill patients; Category B included statements for stable and cooperative critically ill patients, and Category C included statements related to stable patients with prolonged critical illness. While panellists reached consensus on the ratings of 94% (32/34) of the algorithm statements, only 50% (17/34) of the statements were rated essential.Conclusion: The evidence-based clinical management algorithm developed through an established Delphi process of consensus by an international inter-professional panel provides the clinician with a synthesis of current evidence and clinical expert opinion. This framework can be used to facilitate clinical decision making within the context of a given patient. The next step is to determine the clinical utility of this working algorithm. © 2011 The Author(s).

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