Delayed active standing and mobility decline in adult survivors of critical illness: a single-center retrospective cohort study

BACKGROUND: Patients with critical illness frequently experience mobility decline, which has been associated with adverse clinical outcomes. However, the factors associated with this decline are not fully understood, and available evidence remains limited and inconsistent. OBJECTIVE: To investigate factors associated with mobility decline in adults who survived an intensive care unit (ICU) stay. METHODS: This retrospective study included adults who survived an ICU stay in a public hospital in Brazil. The ICU Mobility Scale (IMS) was used to assess mobility prior to hospitalization and at ICU discharge. The primary outcome was mobility decline, defined as a clinically important decrease of at least 1 point in the IMS (IMS at ICU discharge - IMS pre-hospitalization). Secondary outcomes were ICU readmission and hospital length of stay. RESULTS: Among the 178 patients included, 49% experienced mobility decline. After multivariate analysis, mobility decline was associated with older age (OR 1.49 per 10-year increase; 95% CI, 1.15-1.95) and delayed active standing (OR 4.95; 95% CI, 2.06-11.88). Compared with patients who preserved mobility, those who experienced mobility decline had a lower probability of hospital discharge within 7 days after ICU liberation (HR 0.65; 95% CI, 0.44-0.97), with no differences in ICU readmission rates. CONCLUSION: Older age and delayed active standing were independently associated with mobility decline in adults who survived critical illness. Early mobilization and rehabilitation strategies focusing on postural progression may improve mobility outcomes and reduce hospital length of stay.