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.