Effect of a generalized early mobilization and rehabilitation protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective pre–post study

Ichikawa, T; Tsuchiya, A; Tsutsumi, Y; Okawa, T; Kubo, D; Horimizu, Y; Tsutsui, R; Shukumine, H; Noda, K; Mizuno, K

doi:10.1186/s13054-025-05570-w

Trauma & major bleeding

Effect of a generalized early mobilization and rehabilitation protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective pre–post study

Crit CarePublished 30 Jul 2025Retrospective pre-post study

Main finding · Home dischargeResultDifference 11.0% 95% CI 1.7–20.2%

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Authors' conclusion

Compared with pre-EMRP implementation, EMRP for adult trauma patients was associated with a higher proportion of home discharge, an improved Barthel Index score at hospital discharge, and a shorter LOS in the ICU.

Study context

Population: Adult trauma patients with Injury Severity Score ≥ 9 admitted to the intensive care unit (ICU) of a university hospitaleligible
Participants: 552 patients

Exposure: Post-EMRP vs pre-EMRP implementation
post-EMRPn = 298
pre-EMRPn = 254reference
Outcome: Proportion of home discharge

Methodological detailspropensity score matching, single university hospital

Propensity score matching
Single university hospital

Main finding

Home discharge

Difference

11.0%

95% CI 1.7–20.2%

By group

post-EMRP52.1%

pre-EMRP41.1%

post-EMRP vs pre-EMRP

difference 11.0% (95% CI 1.7–20.2%)

As reported in the abstract

Observational data: associations, not effects.

Secondary outcomes

ICU LOS · shorter in post-EMRP · propensity score-matched cohort

P = 0.03

post-EMRP5.0 (bracketed spread 3.0–11.0) daysas printed

pre-EMRP7.0 (bracketed spread 4.0–11.0) daysas printed

Patients reaching ICU Mobility Scale (IMS) levels ≥ 3, ≥ 4 and ≥ 7 · within 28 days after ICU admission

	← Lower risk ←→ Higher risk →	Estimate
EMRP	0.512	HR (IMS level ≥ 3) 1.29 (95% CI 1.06–1.57)
EMRP	0.512	HR (IMS level ≥ 4) 1.27 (95% CI 1.03–1.56)
EMRP	0.512	HR (IMS level ≥ 7) 1.36 (95% CI 1.08–1.70)
	0.512Ratio (log scale)

Outcome	post-EMRP	pre-EMRP	P value
Barthel Index score at hospital dischargeHigher in post-EMRP · propensity score-matched cohort	95.0 (bracketed spread (as printed) 55.0–100.0)	80.0 (bracketed spread (as printed) 40.0–100.0)	P = 0.007

Original publication

Effect of a generalized early mobilization and rehabilitation protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective pre–post study. Crit Care. Published 30 July 2025. doi:10.1186/s13054-025-05570-w

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