Verticalization Therapy as an Early Mobilization Intervention in the Critically Ill Population: A Retrospective Record Review

ABSTRACT Background and Purpose: Verticalization therapy (VT) using tilt beds can improve feasibility of early mobility (EM) for critically ill patients. Limited research exists regarding the functional outcomes of patients treated with VT in the intensive care unit (ICU). We reviewed patient records to identify the functional impact of a VT procedure implemented in the ICU. Approach: We conducted a retrospective record review of the medical records of 38 consecutive patients who received VT during their ICU stay. Data included demographics, verticalization and rehabilitation therapy session data, and functional outcomes. We hypothesized that earlier and more consistent verticalization and increased tolerance for verticalization based on physiological responses would yield greater positive changes on the Johns Hopkins Highest Level of Mobility scale. Nonparametric tests investigated hypotheses and group differences. Outcomes: Of the 79% of patients (n = 30) who survived to hospital discharge, 90% (n = 27) stood during their hospital stay and 67% (n = 20) ambulated. Average Johns Hopkins Highest Level of Mobility scale scores increased by 3.14 from the first VT session to hospital discharge. We identified a trend toward improved functional outcomes when VT was initiated within 21 days of hospital admission and a statistically significant inverse relationship between the frequency of minor adverse events during VT sessions and functional improvement (rho = −0.37, P = .028). No major adverse events occurred across 514 VT sessions. Therapists' decisions to adapt, proceed, or terminate VT sessions indicated efforts to overcome barriers to mobility and optimize patient participation. Discussion and Conclusion: VT can support functional recovery in critically ill patients with barriers to traditional early mobility interventions. This study offers guidance for clinical decision making for VT as a component of EM for critically ill patients. More research is needed to determine optimal utilization of VT in the ICU.