Editorial
Reading between the lines, the key to successfully implementing early rehabilitation in critical care

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Current position

Despite the growing evidence base for early rehabilitation, a number of recent point prevalence surveys have demonstrated levels of rehabilitation within critical care to be low, particularly whilst patients are receiving mechanical ventilation. A 3 day point prevalence survey of 38 ICU’s in Australia and New Zealand found no patients requiring mechanical ventilation sitting out of bed or walking on the days in question (Berney et al., 2013). This was also the case in a similar study to assess

Implementing change

A survey of current practice, including over 1500 ICU’s from four countries, demonstrated significant international variation in the delivery of rehabilitation within critical care. Once again barriers found were multifactorial, importantly though common themes were identified amongst those with established early mobility practice. The presence of a dedicated physiotherapist, daily goal setting for rehabilitation and multidisciplinary ward rounds were key factors associated with the presence of

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      This shows a gap between research evidence and clinical practice. The reasons for this low uptake are multifactorial [28,29], and the situation varies in different countries, regions, and even ICUs within the same hospital [28]. The knowledge, attitudes and practices (KAP) Model [30] suggests that people’s practices (behaviors) are determined by people’s attitudes and knowledge.

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      Despite this, current literature suggests that early mobilisation is not widely practiced.10–13 This lack of translation into practice has gained much interest, with some suggesting the causes are multifactorial14 and differences are seen between countries, regions, and even ICUs within the same hospital.14 A survey of current practice that included 951 ICUs from four countries identified significant variation in the delivery of early mobility within critical care.15

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