{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:05:16Z","timestamp":1791399916904,"version":"4.3.3"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T00:00:00Z","timestamp":1645401600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003061","name":"Erasmus Medisch Centrum","doi-asserted-by":"publisher","award":["Evidence Based Care by Nurses (EBCN) \u2010 2016\u201016409"],"award-info":[{"award-number":["Evidence Based Care by Nurses (EBCN) \u2010 2016\u201016409"]}],"id":[{"id":"10.13039\/501100003061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Immobility during hospital stay is associated with muscle weakness, delirium, and delayed neurocognitive recovery. Early mobilisation of critically ill adults improves their physical functioning and shortens the duration of mechanical ventilation. However, comparable research in children is lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To determine the effects of the implementation of an early mobilisation (EM) program on mobility activities for critically ill children and to explore barriers and facilitators and clinical outcomes before and after implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>A prospective single\u2010centre before\u2010and\u2010after study. This study was conducted in a PICU of a large tertiary hospital. Children aged from 3\u00a0months to 18\u2009years, with an expected stay of \u22653\u2009days were eligible to participate. In the \u201cbefore\u201d phase, participants received usual care; in the \u201cafter\u201d phase we implemented a multicomponent, multidisciplinary EM protocol. The primary outcome was a change in the process outcome \u201cmobilisation activities\u201d. Secondary outcomes were PICU staff opinions on mobilisation (survey), safety, process measures, involvement of parents and physical therapist, and clinical outcomes (sedative use and prevalence of delirium).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 113 children were included; 55 before and 58 after, with a median age of 31\u2009months (IQR: 10\u2013103) and 35\u2009months (IQR: 7\u2013152), respectively. The number of mobilisation activities (per patient per day) had significantly increased from 5 (IQR: 2\u20137) to 6 (IQR: 4\u20138) (<jats:italic>U<\/jats:italic>\u00a0=\u00a0272185.0; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). PT consultations for mobilisation had significantly increased from 23.6% (13\/55) to 46.5% (27\/58) (<jats:italic>X<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a06.48; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.011). In both phases, no mobilisation\u2010related adverse events were documented. The survey showed that PICU staff found EM of critically ill children useful and feasible. In the after phase, PICU staff rated the perceived benefit of the support of the physical therapist during mobilisation activities significantly higher than in the before phase (<jats:italic>X<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a034.80; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Implementation of a structured EM program for critically ill children is feasible and safe.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to clinical practice<\/jats:title><jats:p>It is suggested to start the implementation of a structed EM program with the idendentification of local barriers and facilitators by an interdisciplinary PICU team. Further, an increased presence of physiotherapists on the PICU would improve mobilisation levels, and facilitate mobilisation in critically ill children. Also, they can support and advice PICU nurses and parents in mobilising children.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nicc.12761","type":"journal-article","created":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T06:19:18Z","timestamp":1645510758000},"page":"545-553","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Quality improvement intervention to stimulate early mobilisation of critically ill children"],"prefix":"10.1111","volume":"28","author":[{"given":"Tabitha Zanen\u2010van den","family":"Adel","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Section Physical Therapy Erasmus MC, Erasmus University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Intensive Care Unit Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam the Netherlands"},{"name":"Department of Internal Medicine, Section Nursing Science Erasmus MC, Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariska","family":"de Heer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Intensive Care Unit Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjoukje","family":"Hoekstra","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Intensive Care Unit Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Steenhorst","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Intensive Care Unit Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9187-244X","authenticated-orcid":false,"given":"Joost","family":"van Rosmalen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Erasmus MC, Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"},{"name":"Department of Epidemiology Erasmus MC, Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Verbruggen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Intensive Care Unit Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leontien","family":"Toussaint\u2010Duyster","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Section Physical Therapy Erasmus MC, Erasmus University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1257-3108","authenticated-orcid":false,"given":"Erwin","family":"Ista","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Intensive Care Unit Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam the Netherlands"},{"name":"Department of Internal Medicine, Section Nursing Science Erasmus MC, Erasmus University Medical Center Rotterdam  Rotterdam The 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