A qualitative study of the perceived barriers and facilitators to early mobilization of critically ill children
CCCF ePoster library. Zheng K. Oct 31, 2016; 150910; 32 Disclosure(s): Funded by the Regional Medical Association Resident Research grant Conducted on behalf of the Canadian Critical Care Trials group (CCTG) Cycle provided by Restorative Therapies
Ms. Katina Zheng
Ms. Katina Zheng
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Topic: Survey or Interview (quantitative or qualitative)

A qualitative study of the perceived barriers and facilitators to early mobilization of critically ill children

Zheng, Katina1; Sarti, Aimee2; Simpson, Racquel1; Cameron, Saoirse3; Khawaji, Adeeb1; Awladthani, Saif1; Choong, Karen1

1Pediatric Intensive Care Unit, McMaster University, Hamilton, Canada; 2Critical Care Medicine, University of Ottawa, Ottawa, Canada; 3Children Health Research Institute, University of Western Ontario, London, Canada

Grant acknowledgements:
RMA (Regional Medical Associates) Resident Research GrantRT300 supplied for purposes of the study by Restorative Therapies Inc. This study is conducted on behalf of the Canadian Critical Care Trials Group.


Critically ill children, like adults, are at risk intensive care unit (ICU) acquired morbidities from bed rest and prolonged immobilization. While there is accumulating adult evidence that early mobilization (EM) may prevent these morbidities and improve functional outcomes, this has not been well studied in the pediatric population to date.
The objective of this study is to understand the perspectives of patients, caregivers and healthcare providers regarding early mobilization in critically ill children through usual care physiotherapy or with an in-bed cycle ergometer as an adjunct.
Consecutive primary caregivers and healthcare providers of children who were enrolled into either the cycling or the usual care physiotherapy arms of the wEECYCLE Pilot RCT were approached to participate in a face-to-face, semi-structured, audiotaped interview following the completion of the study period. The interviews were transcribed verbatim and anonymized. Inductive coding techniques were applied independently by two investigators, using a code book developed iteratively by the research team.
A total of 21 patients have been enrolled between September 2015 and July 2016: 7 into the control, and 14 into the cycling arm. To date, 27 interviews have been conducted (6 control, 21 cycling). Interviews are ongoing and will continue until saturation is reached. Emerging themes suggest unique facilitators and barriers to EM for healthcare providers and caregivers. For caregivers, facilitators include trust in healthcare providers ('I just thought, well these people, this is their job, this is what they do') and a collaborative interdisciplinary environment ('A positive environment over there, and everybody really wanting to motivate her and do her best definitely had an effect on her'). Caregivers also expressed emotional and psychological benefits of EM using in-bed cycling. For healthcare providers, a key facilitator to EM is the emerging paradigm shift in the PICU towards an acceptance of early mobilization as a key component of care. For both groups, lack of comfort was a barrier ('you worry about like the fact that like, is it going to be too much, stimulate them too much…'), along with inconsistency in how much early mobilization is prioritized ('I wasn’t worried about physiotherapy at that time, I was just worried about him and getting back to normal…').
The results of this study will enable us to better understand important facilitators and barriers to executing EM in this population, that may not be possible through quantitative methods. This data will not only inform the design of a future planned multi-centered trial, but also important considerations when implementing EM in critically ill children. Potential effects of emotional and psychological benefits on functional recovery should be considered as a patient-centered outcome, should this theme continue to emerge. 


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