{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T03:06:22Z","timestamp":1790046382604,"version":"4.0.1"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The Coronavirus Disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. Data on the mobility level of patients with COVID-19 in the intensive care unit (ICU) are needed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To describe the mobility level of patients with COVID-19 admitted to the ICU and to address factors associated with mobility level at the time of ICU discharge.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Single center, retrospective cohort study. Consecutive patients admitted to the ICU with confirmed COVID-19 infection were analyzed. The mobility status was assessed by the Perme Score at admission and discharge from ICU with higher scores indicating higher mobility level. The Perme Mobility Index (PMI) was calculated [PMI = \u0394Perme Score (<jats:italic>ICU discharge<\/jats:italic>\u2013<jats:italic>ICU admission<\/jats:italic>)\/ICU length of stay]. Based on the PMI, patients were divided into two groups: \u201cImproved\u201d (PMI &gt; 0) and \u201cNot improved\u201d (PMI \u2264 0).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 136 patients were included in this analysis. The hospital mortality rate was 16.2%. The Perme Score improved significantly when comparing ICU discharge with ICU admission [20.0 (7\u201328) points versus 7.0 (0\u201316) points; <jats:italic>P<\/jats:italic> &lt; 0.001]. A total of 88 patients (64.7%) improved their mobility level during ICU stay, and the median PMI of these patients was 1.5 (0.6\u20133.4). Patients in the improved group had a lower duration of mechanical ventilation [10 (5\u201314) days versus 15 (8\u201324) days; <jats:italic>P<\/jats:italic> = 0.021], lower hospital length of stay [25 (12\u201337) days versus 30 (11\u201348) days; <jats:italic>P<\/jats:italic> &lt; 0.001], and lower ICU and hospital mortality rate. Independent predictors for mobility level were lower age, lower Charlson Comorbidity Index, and not having received renal replacement therapy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Patients\u2019 mobility level was low at ICU admission; however, most patients improved their mobility level during ICU stay. Risk factors associated with the mobility level were age, comorbidities, and use of renal replacement therapy.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250180","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T22:16:59Z","timestamp":1619043419000},"page":"e0250180","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["The Perme Mobility Index: A new concept to assess mobility level in patients with coronavirus (COVID-19) infection"],"prefix":"10.1371","volume":"16","author":[{"given":"Karina Tavares","family":"Timenetsky","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ary","family":"Serpa Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Carolina","family":"Lazarin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreia","family":"Pardini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Regina Sousa","family":"Moreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago Domingos","family":"Corr\u00eaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel Afonso","family":"Caserta Eid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0852-7013","authenticated-orcid":true,"given":"Ricardo Kenji","family":"Nawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,21]]},"reference":[{"key":"pone.0250180.ref001","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A novel coronavirus from patients with pneumonia in China, 2019","volume":"382","author":"N Zhu","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0250180.ref002","unstructured":"WHO. Coronavirus disease 2019 (COVID-19): situation report; [revised 2020 July; Accessed 2020 July 24]. Available from: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019."},{"key":"pone.0250180.ref003","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention","volume":"323","author":"Z Wu","year":"2020","journal-title":"JAMA"},{"key":"pone.0250180.ref004","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"C Huang","year":"2020","journal-title":"Lancet"},{"key":"pone.0250180.ref005","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1186\/s13054-020-02939-x","article-title":"Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study","volume":"24","author":"Y Yu","year":"2020","journal-title":"Crit Care"},{"key":"pone.0250180.ref006","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1016\/S0140-6736(20)31189-2","article-title":"Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York city: a prospective cohort study","volume":"395","author":"MJ Cummings","year":"2020","journal-title":"Lancet"},{"key":"pone.0250180.ref007","doi-asserted-by":"crossref","first-page":"545","DOI":"10.15585\/mmwr.mm6918e1","article-title":"Characteristics and clinical outcomes of adult patients hospitalized with COVID-19 \u2013Georgia, March 2020","volume":"69","author":"JAW Gold","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0250180.ref008","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1001\/jama.2020.5394","article-title":"Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy","volume":"323","author":"G Grasselli","year":"2020","journal-title":"JAMA"},{"key":"pone.0250180.ref009","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1164\/rccm.201607-1516CI","article-title":"On the neuroendocrinopathy of critical illness. Perspectives for feeding and novel treatments","volume":"194","author":"G Van den Berghe","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0250180.ref010","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1001\/jama.2013.278481","article-title":"Acute skeletal muscle wasting in critical illness","volume":"310","author":"ZA Puthucheary","year":"2013","journal-title":"JAMA"},{"key":"pone.0250180.ref011","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1136\/bjsports-2020-102596","article-title":"The Stanford Hall consensus statement for post-COVID-19 rehabilitation","volume":"54","author":"RM Barker-Davies","year":"2020","journal-title":"Br J Sports Med"},{"key":"pone.0250180.ref012","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1080\/09593985.2020.1766181","article-title":"Consideration of prevention and management of long-term consequences of post-acute respiratory distress syndrome in patients with COVID-19","volume":"36","author":"SA Candan","year":"2020","journal-title":"Physiother Theory Pract"},{"key":"pone.0250180.ref013","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1007\/s00134-015-3672-x","article-title":"Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties","volume":"41","author":"SM Parry","year":"2015","journal-title":"Intensive Care Med"},{"issue":"1","key":"pone.0250180.ref014","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.physio.2012.01.003","article-title":"The Chelsea critical care physical assessment tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study","volume":"99","author":"EJ Corner","year":"2013","journal-title":"Physiotherapy"},{"issue":"12","key":"pone.0250180.ref015","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.2522\/ptj.20120310","article-title":"A physical function test for use in the intensive care unit: validity, responsiveness, and predictive utility of the physical function ICU test (scored).","volume":"93","author":"L Denehy","year":"2013","journal-title":"Phys Ther"},{"key":"pone.0250180.ref016","doi-asserted-by":"crossref","first-page":"41","DOI":"10.14797\/mdcj-10-1-41","article-title":"A tool to assess mobility status in critically ill patients: the Perme Intensive Care Unit Mobility Score","volume":"10","author":"C Perme","year":"2014","journal-title":"Methodist Debakey Cardiovasc J"},{"issue":"1","key":"pone.0250180.ref017","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.hrtlng.2013.11.003","article-title":"Feasibility and inter-rater reliability of the ICU Mobility Scale","volume":"43","author":"C Hodgson","year":"2014","journal-title":"Heart Lung"},{"issue":"4","key":"pone.0250180.ref018","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1097\/CCM.0b013e3182376e6d","article-title":"The surgical intensive care unit optimal mobility score predicts mortality and length of stay.","volume":"40","author":"G Kasotakis","year":"2012","journal-title":"Crit Care Med"},{"issue":"2","key":"pone.0250180.ref019","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jcrc.2009.10.010","article-title":"Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project","volume":"25","author":"JM Zanni","year":"2010","journal-title":"J Crit Care"},{"key":"pone.0250180.ref020","doi-asserted-by":"crossref","first-page":"e1875","DOI":"10.1002\/pri.1875","article-title":"Spanish version of the Perme Intensive Care Unit Mobility Score: Minimal detectable change and responsiveness","volume":"26","author":"EC Wilches Luna","year":"2021","journal-title":"Physiother Res Int"},{"issue":"2","key":"pone.0250180.ref021","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.burns.2014.12.002","article-title":"The responsiveness of the Chelsea Critical Care Physical Assessment tool in measuring functional recovery in the burns critical care population: an observational study","volume":"41","author":"EJ Corner","year":"2015","journal-title":"Burns"},{"issue":"12","key":"pone.0250180.ref022","doi-asserted-by":"crossref","first-page":"e1155","DOI":"10.1097\/CCM.0000000000001949","article-title":"Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference","volume":"44","author":"M Huang","year":"2016","journal-title":"Crit Care Med"},{"issue":"7","key":"pone.0250180.ref023","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1164\/rccm.201512-2343OC","article-title":"The RECOVER Program: Disability Risk Groups and 1-Year Outcome after 7 or More Days of Mechanical Ventilation","volume":"194","author":"MS Herridge","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"pone.0250180.ref024","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1164\/rccm.201206-1138ED","article-title":"Trajectories of recovery and dysfunction after acute illness, with implications for clinical trial design","volume":"186","author":"TJ Iwashyna","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"issue":"7","key":"pone.0250180.ref025","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/S2213-2600(16)30098-4","article-title":"Timing of onset and burden of persistent critical illness in Australia and New Zealand: a retrospective population based observational study","volume":"4","author":"T Iwashyna","year":"2016","journal-title":"Lancet Respir Med"},{"key":"pone.0250180.ref026","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"E von Elm","year":"2007","journal-title":"Lancet"},{"key":"pone.0250180.ref027","first-page":"418","article-title":"intensive care unit patients in Brazil. Epimed Monitor ICU Database\u00ae: um registro nacional baseado na nuvem, para pacientes adultos internados em unidades de terapia intensiva do Brasil","volume":"29","author":"FG Zampieri","year":"2017","journal-title":"The Epimed Monitor ICU Databasev Bras Ter Intensiva"},{"key":"pone.0250180.ref028","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1007\/s00134-005-2763-5","article-title":"SAPS 3\u2013From evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission","volume":"31","author":"RP Moreno","year":"2005","journal-title":"Intensive Care Med"},{"key":"pone.0250180.ref029","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine","volume":"22","author":"JL Vincent","year":"1996","journal-title":"Intensive Care Med"},{"key":"pone.0250180.ref030","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"ME Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"pone.0250180.ref031","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1007\/s00134-018-5342-2","article-title":"Association of frailty with short-term outcomes, organ support and resource use in critically ill patients","volume":"44","author":"FG Zampieri","year":"2018","journal-title":"Intensive Care Med"},{"key":"pone.0250180.ref032","doi-asserted-by":"crossref","first-page":"4391","DOI":"10.1002\/sim.7501","article-title":"Practical recommendations for reporting Fine-Gray model analyses for competing risk data","volume":"36","author":"PC Austin","year":"2017","journal-title":"Stat Med"},{"key":"pone.0250180.ref033","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2019"},{"issue":"7","key":"pone.0250180.ref034","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jclinepi.2010.02.006","article-title":"The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes","volume":"63","author":"LB Mokkink","year":"2010","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"pone.0250180.ref035","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jclinepi.2006.03.012","article-title":"Quality criteria were proposed for measurement properties of health status questionnaires","volume":"60","author":"CB Terwee","year":"2007","journal-title":"J Clin Epidemiol"},{"key":"pone.0250180.ref036","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1097\/CCM.0000000000001480","article-title":"Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors.","volume":"44","author":"VK Moitra","year":"2016","journal-title":"Crit Care Med"},{"key":"pone.0250180.ref037","doi-asserted-by":"crossref","first-page":"2000547","DOI":"10.1183\/13993003.00547-2020","article-title":"Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis","volume":"55","author":"WJ Guan","year":"2020","journal-title":"Eur Respir J"},{"key":"pone.0250180.ref038","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1161\/HYPERTENSIONAHA.120.15324","article-title":"Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension","volume":"76","author":"G Iaccarino","year":"2020","journal-title":"Hypertension"},{"key":"pone.0250180.ref039","doi-asserted-by":"crossref","first-page":"e020633","DOI":"10.1136\/bmjopen-2017-020633","article-title":"Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis","volume":"9","author":"J Pu","year":"2019","journal-title":"BMJ Open"},{"key":"pone.0250180.ref040","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1159\/000368722","article-title":"Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis","volume":"40","author":"K Sheng","year":"2014","journal-title":"Am J Nephrol"},{"key":"pone.0250180.ref041","doi-asserted-by":"crossref","first-page":"535.e9","DOI":"10.1016\/j.jcrc.2013.01.006","article-title":"Safety and feasibility of femoral catheters during physical rehabilitation in the intensive care unit","volume":"28","author":"A Damluji","year":"2013","journal-title":"J Crit Care"},{"key":"pone.0250180.ref042","first-page":"2494","article-title":"Risk Factors for Muscle Loss in Hemodialysis Patients with High Comorbidity","volume":"12","author":"WJ Visser","journal-title":"Nutrients 2020"},{"key":"pone.0250180.ref043","doi-asserted-by":"crossref","first-page":"276","DOI":"10.14740\/jocmr4160","article-title":"COVID-19 and Renal Failure: Challenges in the Delivery of Renal Replacement Therapy","volume":"12","author":"S Adapa","year":"2020","journal-title":"J Clin Med Res"},{"key":"pone.0250180.ref044","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00134-020-05944-4","article-title":"ICU-acquired weakness","volume":"46","author":"I Vanhorebeek","year":"2020","journal-title":"Intensive Care Med"},{"key":"pone.0250180.ref045","doi-asserted-by":"crossref","first-page":"3047","DOI":"10.1097\/CCM.0b013e3181b027e9","article-title":"Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality","volume":"37","author":"T Sharshar","year":"2009","journal-title":"Crit Care Med"},{"key":"pone.0250180.ref046","article-title":"Post-intensive care syndrome and COVID-19\u2014Implications post pandemic","author":"M Biehl","journal-title":"Cleve Clin J Med"},{"key":"pone.0250180.ref047","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/CCM.0000000000001531","article-title":"Postintensive Care Syndrome: Right Care, Right Now\u2026and Later","volume":"44","author":"MA Harvey","year":"2016","journal-title":"Crit Care Med"},{"key":"pone.0250180.ref048","doi-asserted-by":"crossref","first-page":"R100","DOI":"10.1186\/cc12745","article-title":"An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 21-month follow-up study","volume":"17","author":"J Griffiths","year":"2013","journal-title":"Crit Care"},{"key":"pone.0250180.ref049","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1513\/AnnalsATS.201509-586CME","article-title":"Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units","volume":"13","author":"R Dubb","year":"2016","journal-title":"Ann Am Thorac Soc"},{"key":"pone.0250180.ref050","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1186\/s12889-020-09743-w","article-title":"Covid-19 effects on the workload of Iranian healthcare workers","volume":"20","author":"E Shoja","year":"2020","journal-title":"BMC Public Health"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250180","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T22:17:47Z","timestamp":1619043467000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250180"}},"subtitle":[],"editor":[{"given":"Aleksandar R.","family":"Zivkovic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,21]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250180","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,21]]}}}