Development of an early mobilization practice for critically ill patients in intensive care units: a Delphi method study.

Abstract

Objective: To develop a comprehensive and evidence-based early rehabilitation framework for critically ill patients, aiming to establish a systematic and scientifically grounded rehabilitation system.

Methods: A Delphi survey study was conducted, involving two rounds of consultations with 24 experts from critical care medicine, nursing, respiratory therapy, and rehabilitation medicine. Based on evidence from the literature, a draft rehabilitation system was created and evaluated using a Likert 5-point scale. Entries were refined based on expert feedback, with criteria for inclusion being a mean score ≥4, a coefficient of variation <0.25, and agreement (percentage of ratings as "very important" or "important" and "very operative" or "strong operability") ≥75%. Entries were modified or deleted according to expert suggestions.

Results: The survey achieved recall rates of 95.8% (23/24) and 86.9% (20/23) in the first and second rounds, respectively. The experts' judgment basis, familiarity, and authority coefficients were 0.96, 0.94, and 0.95, respectively. Following the initial round, 20 questionnaire entries were amended, 14 new entries were added, and 1 was deleted. The second round of Delphi consultations resulted in an early rehabilitation system consisting of 5 primary indicators, 21 secondary indicators, and 56 tertiary indicators, totaling 82 entries.

Conclusions: This study established the first Chinese early rehabilitation system for critically ill patients based on the scientific Delphi method. It provides a structured framework that can serve as a reference for early rehabilitation practices in settings for critically ill patients.