Simulation-Based Education for Mobilizing Critically Ill Patients: A Systematic Review

Introduction: Early mobility in the ICU is associated with improved patient outcomes; however, barriers exist to implementation. A commonly cited barrier to early mobility is lack of staff knowledge and comfort mobilizing patients. Clinicians have identified simulation as a potential tool to increase ICU early mobility. Our objective was to review the current evidence on simulation training for healthcare professionals in mobilizing critically ill patients.


Methods: We conducted a systematic review using EMBASE, CINAHL, Scopus, and PubMed, searching each database with MeSH terms. Studies were included if they: involved training for healthcare or pre-healthcare professionals; used simulation training involving mannequins or simulated patient actors; and included at least one component of education on mobilizing critically ill patients. Extracted data included study design, participant type and number, ICU type, simulation modality, and outcome measures.


Results: From 6908 studies identified, 525 abstracts were examined for full-text review, and 34 studies were chosen for data extraction. There was one systematic review, and the other studies had a quasi-experimental design: 20 studies were curriculum development and 13 were quality improvement initiatives. 9 studies simulated critically ill neonates, 7 simulated critically ill children, and 19 simulated critically ill adults. At least 1437 learners participated in simulation-based mobility training, though 11 studies did not list the total number of learners. 15 studies trained physical or occupational therapy students and 18 trained healthcare professionals. 23 studies used mannequins and 11 used simulated patient actors. The main outcome analyzed was participant satisfaction (n=28) or patient effects (n=12) in which all studies demonstrated improvements.


Conclusions: This systematic review found that simulation is being used to train healthcare and pre-healthcare professionals in mobilizing critically ill patients and is associated with improved participant satisfaction and patient outcomes. However, more rigorous evaluation of early mobility simulation curricula on patient outcomes is needed. Future studies should expand to include the entire interprofessional team involved in the care of ICU patients.