Nurse‐Led Early Mobility Protocols in the Intensive Care Unit

We read the recent meta-analysis of nurse-led early mobility protocols by Xu et al. (2025). The authors reported on 15 randomised controlled trials (RCTs) of critically ill patients receiving nurse-led early mobility. Their meta-analysis demonstrated a significantly reduced intensive care unit (ICU) length of stay [weighted mean difference (WMD) = −1.81 days (95% CI: −3.07 to −0.56, p = 0.005)] and hospital length of stay (WMD = −2.62 days [95% CI: −5.122 to −0.123, p = 0.040]). However, they did not find significant improvements for observed mobility, body function, muscle strength or mortality. The authors used the PICOS (Population, Intervention, Comparator, Outcomes, Study Design) framework to develop their meta-analysis. Specifically, the authors defined the intervention ‘as structured programs initiated and/or led primarily by nursing staff’ (emphasis added). Upon our review of the 15 RCTs included in the meta-analysis, we noted that 6 (40%) did not include nursing in the RCT's description of the clinicians delivering the study intervention. Across the 15 trials included, we found heterogeneity in the type of clinician(s) delivering the intervention, including nurse only (7%), nurses and physicians only (13%), physical therapists (PT) only (27%) or a multidisciplinary team (53%) (Table 1). In addition, according to their eligibility criteria, the authors intended to include studies that performed the interventions in ‘critical care settings’. However, one of the 15 included trials, Gruther et al. (2017), evaluated the effects of an ‘early rehabilitation program’ that started after patients were discharged from the ICU. Thus, this study did not appear to meet eligibility criteria for the meta-analysis by Xu et al. (2025). Importantly, the recently published focused update to Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility and Sleep Disruption in Adult Patients (PADIS guideline) by the Society of Critical Care Medicine synthesized data from 58 RCTs with 8038 patients. The PADIS meta-analysis highlights the benefits of enhanced mobilisation/rehabilitation on the incidence of ICU-acquired weakness, functional outcomes, quality of life and discharge location (Lewis et al. 2025). Our experience clearly indicates that nurses are integral members of the enhanced mobilisation/rehabilitation team and their involvement can markedly enhance the successful implementation of rehabilitation/mobility. Xu et al. (2025) may wish to clarify their meta-analysis findings of nurse-led mobility protocols in light of these issues raised. Ehizele Iyayi: writing – original draft, investigation. Dale M. Needham: conceptualization, validation, writing – review and editing. Stephanie L. Hiser: writing – review and editing, validation. The authors have nothing to report. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.