OBJECTIVE: To investigate the effectiveness and safety of active mobilization on improving physical function and hospital outcomes inpatients undergoing mechanical ventilation for more than 24 hours. DATA SOURCES: PubMed, Embase, CINAHL, CENTRAL, PEDro, SinoMed and ISI Web of Knowledge were searched for randomized controlled trials (RCTs), quasi-RCTs, other comparative studies and case series with 10 or more consecutive cases. Additional studies were identified through references, citation tracking and by contacting the authors of eligible studies. STUDY SELECTION: Two reviewers independently selected potential studies according to the inclusion criteria. DATA EXTRACTION: Two reviewers independently extracted data and assessed the methodological quality. DATA SYNTHESIS: A narrative form was used to summarize study characteristics and outcomes because the substantial heterogeneity between the individual studies precluded formal meta-analyses. Among the 17 eligible studies, 7 RCTs, 1 quasi-RCT, 1 prospective cohort study and 1 history controlled study were used to examine the effectiveness and 2 RCTs, 1 prospective cohort study and 7 case series were used to examine the safety of active mobilization in patients receiving mechanical ventilation for more than 24 hours. We found that active mobilization may improve muscle strength, functional independence and the ability to wean from ventilation and may decrease the length of stay in the intensive care unit (ICU) and hospital. However, only one study reported that active mobilization reduced the 1-yr mortality rate. No serious adverse events were reported among included studies. CONCLUSIONS: Active mobilization appears to have a positive effect on physical function and hospital outcomes in mechanical ventilation patients. Early active mobilization protocols may be initiated safely in the ICU setting and continued in post-ICU settings. However, the current available studies have great heterogeneity and limited methodological quality. Further research is needed to provide more robust evidence to support the effectiveness and safety of active mobilization.

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