{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:45:32Z","timestamp":1769150732269,"version":"3.49.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003593","name":"National Council for Scientific and Technological Development","doi-asserted-by":"publisher","award":["402698\/2020-7"],"award-info":[{"award-number":["402698\/2020-7"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>In patients who are critically ill, functional dependence and muscle weakness may be influenced by side effects related to the timing of out-of-bed mobilization, but there is a knowledge gap regarding the impact of exercise prescriptions in specific intensive care unit (ICU) populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study was to determine clinical reference values for the time to start out-of-bed mobilization of patients in the ICU to avoid functional dependence and muscle weakness at ICU discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This study was a secondary analysis of a prospective multicenter cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The settings were the ICUs of 5 Brazilian hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The participants were adult patients with COVID-19, an ICU stay of \u22654\u00a0days, and prior functional independence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Time for out-of-bed mobilization was the first day the patient was mobilized to higher postures, provided there were no contraindications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes and measures<\/jats:title>\n                    <jats:p>Functional status (Barthel Index [BI]) and muscle strength (Medical Research Council Scale [MRC]) were assessed within 2\u00a0days of ICU discharge. Receiver operating characteristic analysis identified clinical thresholds for days to initiate out-of-bed mobilization in association with 2 levels of functional dependence and muscle weakness. Optimal cutoffs were based on sensitivity, specificity, and area under the curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 339 patients (58\u00a0years old [SD\u2009=\u200946-66\u00a0years old]; Simplified Acute Physiology Score III\u2009=\u200951.3 [SD\u2009=\u200916.5]; 36% women; 53% on mechanical ventilation) were analyzed. Days to start out-of-bed mobilization for each outcome were as follows: 3\u00a0days for a BI of &amp;lt;85 points (sensitivity\u2009=\u200967%, specificity\u2009=\u200965%, AUC\u2009=\u20090.68 [95% CI\u2009=\u20090.63-0.74]); 4\u00a0days for a BI of &amp;lt;60 points (sensitivity\u2009=\u200960%, specificity\u2009=\u200965%, AUC\u2009=\u20090.66 [95% CI\u2009=\u20090.59-0.73]); 5\u00a0days for an MRC score of &amp;lt;48 points (sensitivity\u2009=\u200954%, specificity\u2009=\u200973%, AUC\u2009=\u20090.66 [95% CI\u2009=\u20090.59-0.73]); and 5\u00a0days for an MRC score of &amp;lt;36 points (sensitivity\u2009=\u200969%, specificity\u2009=\u200967%, AUC\u2009=\u20090.67 [95% CI\u2009=\u20090.49-0.85]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early out-of-bed mobilization, initiated within 3 to 5\u00a0days of physiological readiness, may differentiate patients who develop functional dependence or ICU-acquired weakness at ICU discharge from those who do not. However, since discrimination ranged from 66% to 68%, with a narrow margin for worse outcomes, this recommendation should be interpreted within context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance<\/jats:title>\n                    <jats:p>Knowing clinical reference points for days to initiate out-of-bed exercises may help minimize poor physical outcomes at ICU discharge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ptj\/pzaf141","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T13:07:20Z","timestamp":1764162440000},"source":"Crossref","is-referenced-by-count":0,"title":["Association Between Timing of Out-of-Bed Mobilization and Functional Outcomes at Intensive Care Unit Discharge in Patients With COVID-19: An Analysis of Potential Clinical Reference 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