Katina Zheng1,2, Aimee Sarti3, Sama Boles1, Saoirse Cameron4, Robert Carlisi4, Heather Clark1, Adeeb Khawaji1, Saif Awladthani1, Samah Al-Harbi5, Karen Choong1,6. 1. Department of Pediatrics, McMaster University, Hamilton ON, Canada. 2. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 3. Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada. 4. University of Western Ontario, London, ON, Canada. 5. Department of Pediatric, King Abdulaziz University, Jeddah, Saudi Arabia. 6. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Abstract
OBJECTIVES: To understand patient, family caregiver, and clinician impressions of early mobilization, the perceived barriers and facilitators to its implementation, and the use of in-bed cycling as a method of mobilization. DESIGN: A qualitative study, conducted as part of the Early Exercise in Critically ill Youth and Children, a preliminary Evaluation (wEECYCLE) Pilot randomized controlled trial. SETTING: McMaster Children's Hospital PICU, Hamilton, ON, Canada. PARTICIPANTS: Clinicians (i.e., physicians, nurses, and physiotherapists), family caregivers, and capable patients age greater than or equal to 8 years old who were enrolled in a clinical trial of early mobilization in critically ill children (wEECYCLE). INTERVENTION: Semistructured, face-to-face interviews using a customized interview guide for clinicians, caregivers, and patients respectively, conducted after exposure to the early mobilization intervention. MEASUREMENTS AND MAIN RESULTS:Thirty-seven participants were interviewed (19 family caregivers, four patients, and 14 clinicians). Family caregivers and clinicians described similar interrelated themes representing barriers to mobilization, namely low prioritization of mobilization by the medical team, safety concerns, the lack of physiotherapy resources, and low patient motivation. Key facilitators were family trust in the healthcare team, team engagement, an a priori belief that physical activity is important, and participation in research. Increased familiarity and specific features such as the virtual reality component and ability to execute passive and or active mobilization helped to engage critically ill children in in-bed cycling. CONCLUSIONS: Clinicians, patients, and families were highly supportive of mobilization in critically ill children; however, concerns were identified with respect to how and when to execute this practice. Understanding key stakeholder perspectives enables the development of strategies to facilitate the implementation of early mobilization and in-bed cycling, not just in the context of a clinical trial but also within the culture of practice in a PICU.
RCT Entities:
OBJECTIVES: To understand patient, family caregiver, and clinician impressions of early mobilization, the perceived barriers and facilitators to its implementation, and the use of in-bed cycling as a method of mobilization. DESIGN: A qualitative study, conducted as part of the Early Exercise in Critically ill Youth and Children, a preliminary Evaluation (wEECYCLE) Pilot randomized controlled trial. SETTING: McMaster Children's Hospital PICU, Hamilton, ON, Canada. PARTICIPANTS: Clinicians (i.e., physicians, nurses, and physiotherapists), family caregivers, and capable patients age greater than or equal to 8 years old who were enrolled in a clinical trial of early mobilization in critically ill children (wEECYCLE). INTERVENTION: Semistructured, face-to-face interviews using a customized interview guide for clinicians, caregivers, and patients respectively, conducted after exposure to the early mobilization intervention. MEASUREMENTS AND MAIN RESULTS: Thirty-seven participants were interviewed (19 family caregivers, four patients, and 14 clinicians). Family caregivers and clinicians described similar interrelated themes representing barriers to mobilization, namely low prioritization of mobilization by the medical team, safety concerns, the lack of physiotherapy resources, and low patient motivation. Key facilitators were family trust in the healthcare team, team engagement, an a priori belief that physical activity is important, and participation in research. Increased familiarity and specific features such as the virtual reality component and ability to execute passive and or active mobilization helped to engage critically ill children in in-bed cycling. CONCLUSIONS: Clinicians, patients, and families were highly supportive of mobilization in critically ill children; however, concerns were identified with respect to how and when to execute this practice. Understanding key stakeholder perspectives enables the development of strategies to facilitate the implementation of early mobilization and in-bed cycling, not just in the context of a clinical trial but also within the culture of practice in a PICU.
Authors: Robert Tamburro; Ann Pawluszka; Deborah Amey; Elyse Tomanio; R Whitney Coleman; Markita Suttle; Anne Eaton; Sue R Beers; Kevin A Van; Ruth Grosskreuz; Tessie W October; Mary Ann DiLiberto; Randi Willey; Stephanie Bisping; Ericka L Fink Journal: Pediatr Res Date: 2022-06-07 Impact factor: 3.953
Authors: Jacqueline Y Thompson; Julie C Menzies; Joseph C Manning; Jennifer McAnuff; Emily Clare Brush; Francesca Ryde; Tim Rapley; Nazima Pathan; Stephen Brett; David J Moore; Michelle Geary; Gillian A Colville; Kevin P Morris; Roger Charles Parslow; Richard G Feltbower; Sophie Lockley; Fenella J Kirkham; Rob J Forsyth; Barnaby R Scholefield Journal: BMJ Paediatr Open Date: 2022-06
Authors: Katie O'Hearn; Jess Gibson; Karla Krewulak; Rebecca Porteous; Victoria Saigle; Margaret Sampson; Anne Tsampalieros; Nick Barrowman; Saoirse Cameron Journal: Can J Anaesth Date: 2021-12-14 Impact factor: 6.713
Authors: Ruchit V Patel; Juliana Redivo; Archana Nelliot; Michelle N Eakin; Beth Wieczorek; Julie Quinn; Ayse P Gurses; Michele C Balas; Dale M Needham; Sapna R Kudchadkar Journal: Pediatr Crit Care Med Date: 2021-04-01 Impact factor: 3.971