Year 2021
September 2021


Abstract Title
A physiotherapy-led early mobilisation protocol for neurosurgical patients with external ventricular drains in intensive care: A service evaluation



Tan Tock Seng Hospital1, UCL Great Ormond Street Institute of Child Health, London, UK2

Background & Hypothesis

An external ventricular drain (EVD) is used to reduce intracranial pressure in neurosurgical patients, and remains in place for an average of eight days post-surgery. The presence of an EVD poses a major barrier to early mobilisation due to safety concerns. Eligibility criteria published in EVD mobilisation protocols only consisted of exclusion criteria and parameters related to the neurological system (Moyer et al, 2017; Young et al, 2019). The parameters pertaining to cardiovascular, respiratory and musculoskeletal systems deemed safe for mobilisation were not stated. The hypothesis of this study was that the early mobilisation protocol, which included physiological parameters, was safe, feasible and effective in patients with EVDs.


A retrospective service evaluation was conducted in a neurological intensive care unit. Medical records were reviewed for two periods from October 2017 to March 2018 (pre-protocol period) and October 2019 to March 2020 (protocol period).


After protocol implementation, there was a 64.8% increase in the proportion of patients with EVDs mobilised (95%CI, 35.9-82.1%, p<0.0001). Median time from EVD placement to first mobilisation decreased from 14 to 3.5 days (p<0.0001). Moreover, the median intensive care and hospital length of stays were significantly reduced from 8 to 3.5 days (p=0.037) and 38 to 22.5 days (p=0.030) respectively. No adverse events were recorded in the protocol period.

Discussion & Conclusion

The early mobilisation protocol for patients with EVDs enabled safe, feasible and effective mobilisation. Future prospective, controlled research studies are warranted.