Effect of progressive and step-up mobilization and exercise training on functional rehabilitation in critically ill patients: a prospective randomized controlled trail

Objective To determine the effect of progressive and step-up mobilization and exercise training on functional rehabilitation in critically ill patients. Methods A total of 60 critically ill patients hospitalized in the Intensive Care Unit and High Dependence Unit of General Hospital of Southern Theater Command during September 1, 2019 and September 1, 2021 were prospectively recruited, and then randomly divided into observation group and control group, with 30 cases in each group. Both groups received routine treatment and nursing care. The patients of the control group received a conventional exercise rehabilitation training for 6 weeks, while those of the observation group underwent a 3-staged (passive, auxiliary, and active) progressive and step-up mobilization and exercise training for 6 weeks. Before and after the 6-week training, Fugl-Meyer Assessment of Lower Extremity (LE-FMA) was used to assess the motor function of the patient, and Modified Barthel Index (MBI) was used to assess their abilities for activities of daily living. Muscle function was assessed by Medical Research Council Scale (MRC) scale and bedside diaphragmatic ultrasonography before and at 2, 4, and 6 weeks after training. Results After 2 weeks of training, the muscle strength and diaphragm excursion were decreased in both groups compared, and the decrease was more obvious in the control group (P < 0.05). After 4 and 6 weeks of training, the muscle strength and diaphragm excursion were improved in both groups (P < 0.05), and the improvement was more significant in the observation group (P < 0.05). At the end of training, the scores of LE-FMA and MBI were improved in the 2 groups when compared with those before training (P < 0.05), and the scores of the observation group were significantly higher than those of the control group (P < 0.05). Conclusion Compared with the conventional exercise rehabilitation training, our progressive and step-up mobilization and exercise training can more significantly promote patient's diaphragm function, upper and lower limb muscle strength and lower limb motor function, and thus improve the quality of life in critically ill patients.