When periods before and after the protocol were compared, an association was
apparent between the presence of the protocol and planned out-of-bed activity. During
implementation and evaluation of the protocol, out-of-bed activity increased and occurred
on day 6 compared with day 9 among patients with long ICU stays. Another factor
correlated with out-of-bed activity was a score of 10 or greater on the Glasgow Coma
Scale. Limitations included that study was done at a single institution with a convenience
sample. In addition, the design did not examine whether the protocol caused a change in
nursing behavior. However, this study does provide unique data about nurses’
perceptions of patients’ readiness for mobility activity and how assessment is linked to
progression of mobility in the ICU. The authors suggested that the presence of a protocol
could act as a facilitator in implementing progressive mobility (Winkelman &
Peereboom, 2010).