Impact of Early Rehabilitation Initiation on Walking Recovery in Critically Ill Patients

Purpose Predicting walking recovery in critically ill patients, including the timing of early rehabilitation, remains unclear. This study aimed to identify clinical factors, particularly the timing of first sitting on the edge of the bed, that are associated with walking recovery in critically ill patients. Methods We retrospectively analyzed data from mechanically ventilated patients (≥48 hours) admitted to the intensive care unit (ICU) of a tertiary-care hospital. Only patients who survived until hospital discharge were included. Walking recovery was defined as achieving a Functional Ambulation Categories (FAC) score ≥ 3, indicating independent walking on level ground with supervision for safety. Results A total of 121 patients were included. The median age was 73 years, 83 (68.6%) were male, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 18.9 ± 6.5, and the median duration of mechanical ventilation was seven days. Cox proportional-hazards regression identified three independent predictors of walking recovery: younger age (hazard ratio (HR) 0.98; 95% CI 0.97-1.00; p = 0.016), shorter duration of mechanical ventilation (HR 0.97; 95% CI: 0.95-1.00; p = 0.049), and sitting on the edge of the bed within 13 days (HR 0.11; 95% CI 0.52-0.91; p < 0.001). Receiver operating characteristic (ROC) analysis identified day 13 as the optimal cutoff for sitting, with an area under the curve (AUC) of 0.76, sensitivity of 81.6%, and specificity of 67.4% for predicting walking recovery. Gray's test further demonstrated that initiating sitting after 13 days significantly reduced the probability of walking recovery compared to earlier initiation (p < 0.001). Conclusion Achieving a sitting position at the edge of the bed by day 13 may serve as a clinically relevant marker for timely rehabilitation initiation and improved walking recovery in critically ill patients. However, the timing for initiating sitting on the edge of the bed should be validated through future prospective multicenter studies.