Title: Behavior Change Strategies used to Implement Early Mobility Programs in the Intensive Care Unit: A Systematic Review

Authors:
Todd Jarzenski, OTR/L
Carson Becker, OTR/L
Erin King, OTR/L
Samantha Cooper, OTS
Carissa Montague, OTS
Hannah Mulhausen, OTS
Q. Eileen Wafford MSt, MLIS
Kevin Pritchard, OTR/L

JACOT Volume 2, Issue 2

Abstract

The aim of the study was to identify and categorize behavior change strategies used when implementing early mobility in the ICU. Search strategies incorporated a combination of controlled vocabulary and text words for intensive care units, health personnel, and mobility. Inclusion criteria included (a) publication in a peer-reviewed journal (b) description of interventions to improve early mobility implementation in at least one adult ICU setting (c) reporting of ICU-specific data on early mobility outcomes. Exclusion criteria: studies (a) not available in English (b) in pediatric settings. Interventions used to facilitate early mobility behavior change were extracted utilizing the 9 strategies described in the Behavior Change Wheel (BCW) (Michie et al., 2011). Each article was appraised using the Modified Downs and Black checklist for measuring study quality of healthcare interventions (Downs & Black, 1998). Additional data recorded included: level of evidence, study design, professionals participating in intervention. Frequency of strategies utilized: education (89%), enablement (84%), training (63%), restriction (57%), persuasion (42%), environmental restructuring (42%), modeling (42%), incentivisation (31%), coercion (0%). Interventions most utilized for behavior change focused on positive reinforcement such as education, enablement and training while interventions used the least on the BCW were incentivisation and coercion. Review of behavior change strategies utilized by others can assist in the creation of programs designed to implement and improve early mobility in the intensive care unit.