# Benchmarking mobilization practice and functional outcomes in traumatic brain injury patients admitted to the intensive care unit: a three-year service evaluation

## TL;DR

This study evaluated how often and when patients with traumatic brain injury were mobilized in the ICU and found low mobilization rates and limited mobility at discharge.

## Contribution

The study provides new insights into mobilization practices and outcomes for TBI patients in the ICU, highlighting a gap in current evidence.

## Key findings

- Only 53.0% of TBI patients were mobilized in the ICU, with a median mobilization time of 11 days.
- Severe TBI patients had significantly lower mobilization rates and longer delays in mobilization compared to mild TBI patients.
- At ICU discharge, most patients had low mobility levels, with only 9.1% achieving 30 meters or more of mobilization.

## Abstract

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Mobilization is defined as the application of assisted movement and physical therapy to hospitalized patients, including progressive exercise and ambulation programs. While early mobilization in the intensive care unit (ICU) has been shown to be a safe and effective intervention to improve patient outcomes in the general ICU cohort, there is currently limited evidence specific to patients with acute TBI. The aim of this service evaluation was to identify current mobilization activity and functional outcomes in patients admitted to the ICU at our institution following an acute TBI.

A single-center retrospective service evaluation was performed for all patients, over 16 years-old, admitted to the ICU at our institution (a Level 1 major trauma center) with an acute TBI between January 2022 and November 2024. Patient demographics, ICU admission details, TBI severity (based on the Glasgow Coma Scale [GCS]) and functional outcomes were extracted. Mobilization outcomes included the timing of the commencement of mobilization (defined as sitting on the edge of the bed or better) and mobilization status, defined using the Manchester Mobility Scale (MMS).

The service evaluation included 353 patients, of whom 56.0% had severe TBI (GCS: 3–7). Mobilization was achieved in ICU for 53.0% of patients, with a further 18.1% first mobilized on a hospital ward post-ICU discharge. The first mobilization occurred at a median of 11 days (interquartile range: 6–18) after ICU admission. In patients surviving to ICU discharge, 28.9% had an MMS of 1 (bed-based exercises) at this time, with only 9.1% achieving an MMS of 7 (mobilizing 30 meters or more). Analysis by TBI severity found a significant decline in in-hospital mobilization rates with increasing TBI severity (90.7% vs. 58.4% for mild vs. severe TBI; p < 0.001), with a corresponding increase in the time to the first mobilization (median: 6 vs. 13 days for mild vs. severe TBI; p < 0.001).

Acute TBI patients admitted to the ICU at our institution had low rates of mobilization and achieved low levels of mobility at ICU discharge. This service evaluation highlights the need for prospective studies into early mobilization practices in the neurotrauma ICU.

Created in BioRender. Sardeli, A. (2026) https://BioRender.com/w84u9jj.Traumatic Brain Injury (TBI) graphic showing mobilization data for patients in a UK-based ICU. Key statistics include 53.0% mobilized in ICU, median mobilization at 11 days, and 53.6% had a Manchester Mobility Scale (MMS) ≤ 2 at discharge. MMS details: Bed-based exercises 28.9%, sitting at edge of bed 24.7%, passive transfer to chair 12.5%, standing practice 8.4%, step transfer with assistance 11.4%, mobilizing <30 meters 4.9%, and >30 meters 9.1%.

Created in BioRender. Sardeli, A. (2026) https://BioRender.com/w84u9jj.