Early mobility to improVE health outcomes following cardiac surgery (EVE) clinical trial development: findings from workshop 2—co-created definition and prioritized barriers, facilitators and outcome and experience measures

Abstract

Introduction New or worsening cognitive, mental, and/or physical health after a stay in an intensive care unit (ICU) defines post-intensive care syndrome (PICS). PICS is prevalent post-cardiac surgery (CS), and interventions are needed for prevention. Early mobility shows potential to prevent PICS but is not optimally integrated into CSICU clinical care. This may relate to the absence of engagement of people with lived experience (PWLE) in CSICU early mobility research. Methods PWLE of the CSICU were engaged to meet three objectives: 1) co-create a definition of early mobility, 2) identify barriers and facilitators to early mobility, and 3) prioritize outcome and experience measures for use in future intervention research. Engagement occurred through two virtual consultation workshops involving group discussions, consensus building, and prioritization using the nominal group technique. Results Eight patients and two care partners participated. The co-created definition of early mobility was a progression of functional life activities that begins as soon as the patient can participate (typically within six hours post-surgery), where the patient uses their muscle strength intentionally. The top barrier to early mobility was brain “fuzziness/fogginess”. The top facilitator was a “positive attitude”. The top physical outcome was “Do you feel lightheaded/dizzy?”. The top cognitive outcome was “Do you feel fuzzy/foggy”. The top mental outcome was “Are you focusing on the positives in your life right now?”. The top experience measure was “Do you feel your doctors gave you the care and attention you needed?”. Discussion This important contribution of the lived experience with early mobility in the CSICU advances the literature and will empower future research to align with the perspectives and priorities of people undergoing CS. This contribution may advance the integration of early mobility into CSICU clinical care and reduce the prevalence of adverse cognitive, mental, and/or physical health outcomes that are seen in PICS.