Early ICU Rehabilitation
Early progressive mobility in critically ill patients is safe and
feasible and is shown to reduce functional decline, improve physical
performance and cognitive function, and optimize the quality of life in
critical illness survivors24,25. A review by
Stiller26 provides evidence on the efficacy of early
rehabilitation (ER) on secondary outcomes such as ICU and hospital
length of stay. Findings from previous studies have also shown
short-term improvements in physical-related outcomes such as muscle
strength and a reduction in the incidence of ICU-acquired
weakness27, 28. Delirium, a significant cause of
cognitive impairment, is also effectively combated using early
mobility19.
Unfortunately, several patient-, clinician- and institutional related
barriers have been identified to challenge the implementation of ER for
critically ill patients across different ICUs in
Africa29,30,31. Notable amongst the “modifiable”
barriers includes; lack of expertise on ER amongst acute care
clinicians30, staff
unavailability29, lack of rehabilitation
equipments31 and excessive sedation
practice29,31. Low utilization of rehabilitation
services in Africa32, possibly resulting from these
and many other barriers, has been corroborated by anecdotal reports
during this pandemic33.
This is thus a call to action for critical care centers across Africa to
adopt multi-targeted strategies to (1) address these identified
barriers, (2) facilitate the implementation of ER and (3) maintain an
ICU culture of prioritizing ER. Interestingly, in the case of this
present pandemic, there exist international34 as well
as local guidelines35 to ensure safety and efficiency
in the acute rehabilitation of individuals with severe COVID-19.