Physical Therapist-Led Therapeutic Exercise and Mobility in Adult Intensive Care Units: A Scoping Review of Operational Definitions, Dose Progression, Safety, and Documentation

초록

Background/Objectives: Intensive care units (ICU) immobility and weakness impair recovery, yet practice for Physical Therapist (PT)-led therapeutic exercise and mobility varies in definitions, dosing, safety, and documentation, which limits comparability and complicates quality assessment. This study aims to integrate adult ICU evidence and present PT-led operational definitions, dose progression principles, safety parameters, outcome measurement, and a documentation minimum dataset. Methods: A scoping review following PRISMA-ScR is used. Eligibility used Population, Concept, and Context: adults in ICU; PT-led therapeutic exercise or mobility; and ICU-initiated or directed care. Primary studies and prespecified quality-improvement reports were included. Data were extracted with a standardized form and summarized descriptively without meta-analysis. Results: Sixty studies were included. Based on the extracted data, this review synthesizes current evidence to propose standardized PT-led operational definitions and a graded progression from in-bed exercise to ambulation. While the individual components are derived from the literature, the conceptual framework for safety parameters and the stop rules were integrated and elaborated to guide clinical decision-making. Adverse events were uncommon and manageable. Outcome measurement centered on validated mobility and function measures at prespecified time points. A concise electronic record minimum dataset specifies provider attribution, timing and duration, activity level with assistance or device, planned and delivered dose with progression, in-session responses, and adverse events, supporting unit-level quality review and comparisons across ICU. Conclusions: A PT-led, graded program that applies shared thresholds, uses validated outcome measures, and employs standardized electronic documentation is feasible and supports safe delivery, clinically meaningful change, and quality improvement across adult ICU.

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