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Delphi Study Results
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Delphi Study Results
 

Phase 1: Summary of Comments

Group 3: Rehabilitation



  • Clinical algorithm for the Passive Mobilization of Patients
    • Subject 1 : Importance of an individualized mobility plan
    • Subject 2 : Criteria to determine cardiovascular reserve
    • Subject 3 : Core elements of a mobility plan

Clinical algorithm for the Passive Mobilization of Patients

SUBJECT 1: Comments on the value and importance of the development of an individualized mobility plan in consultation with the interdisciplinary team

AGREEMENT: 5/7
DISAGREEMENT: 0 /7
NO RESPONSE: 2/7

REFER TO REFORMULATION OF EXPERT OPINION

SUBJECT 2: Comments on the criteria to determine cardiovascular reserve for the passive mobilization of patients that are unresponsive
Comments on the criteria to determine cardiovascular reserve for the implementation of the core elements of a mobility plan in patients that have not reached physiological stability to initiate early activity

AGREEMENT: 3/7
DISAGREEMENT: 2/7
NO RESPONSE: 2/7

POSTED COMMENTS:

  • I don't like putting actual figures like MAP >60 as some patients may have a MAP below this as their baseline. That's why I have recommended a change in BP of 20% or more in my work

  • I would also include other factors related to the ventilatory system (level of oxygenation, Fi02
 

SUBJECT 3: Comments on the elements (activities and frequency) included in a mobility plan for unresponsive patients
Comments on the core elements of a mobility plan for patients that have not reached physiological stability to initiate early activity

AGREEMENT: 3/7
DISAGREEMENT: 2/7
NO RESPONSE: 2/7

POSTED COMMENTS:

  • I'm not aware of the evidence to support two hourly turns, particularly if blow up mattresses are being used. I DO agree with nursing patients at least 30 degrees head up to decrease chance of aspiration. I'm not aware of any evidence to support need for once daily ROM exs - data on other patient groups does not support this approach either.

  • See comments earlier. We can probably do more than turning and passive range of motion. There can also be tragets at the level of the muscle. This will need adaptations in terms of duration, intensity and specifity of the training

  • The ‘two-hour’ turning rule has not been supported yet has become a standard. Evidence from kinetic beds shows that with frequent turning, oxygenation can be maximized and complications reduced in patients who are medically unstable and tenuous. We have data (as yet unpublished; remains on my huge pile of manuscripts to complete) to support that more frequent turning can simulate progression to upright and moving by stimulating a gravitational response and fluid shifts, necessary hemodynamic stress. Passive movements may have some role particularly in patients with neuromuscular impairments (spasticity). There is some evidence that passive movements stimulate deeper breaths. This is a minor reflex and should not be relied upon, but may have a role in some patients who are unstable or those with severe head injuries for example (but ICP and CPP would have to be monitored).

  • Does once daily mean that joint is moved once a day one repetition? If so, I suggest that 5 reps of all physiological movements should be done once daily.



REFER TO REFORMULATION OF EXPERT OPINION

 

 
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