The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials

Abdullah I. Aedh; Khalid Atyah Alharbi; Norah Muidh Alwadai; Ziyad Mohammed Alqurayqiri; Ammar Abdulkhaliq Alshuaibi; MuhannadMuslih Alhazmi; Bandar Halil Alyoubi; Abdulelah Mohammed Alotaibi; Abdullah Hasan Mahallawi; Sulaiman Shakir Alkayal

doi:10.24911/IJMDC.51-1762703468

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Online Published: 09 Jan 2026

IJMDC. 2026; 10(1): 301-311

doi: 10.24911/IJMDC.51-1762703468

The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials

Abdullah I. Aedh, Khalid Atyah Alharbi, Norah Muidh Alwadai, Ziyad Mohammed Alqurayqiri, Ammar Abdulkhaliq Alshuaibi, Muhannad Muslih Alhazmi, Bandar Halil Alyoubi, Abdulelah Mohammed Alotaibi, Abdullah Hasan Mahallawi, Sulaiman Shakir Alkayal.

Abstract
Commonly recommended in the prevention of intensive care unit-acquired weakness (ICU-AW) in critically ill patients, early mobilization (EM) is an emerging therapeutic strategy, but its efficacy, harm, and optimal intensity remain poorly defined. Based on PRISMA 2020 guidelines, 13 randomized controlled trials (RCTs) of EM compared to usual care were examined. The analyses assessed EM efficacy (ICU-AW frequency, clinical function) and safety (adverse outcomes). These data pools were incorporated to identify the overall effects of these outcomes and to evaluate the potential for bias in pooled studies. EM also showed improvement in decreasing ICU-AW. Pooled data incidence rates within intervention groups fell to as low as 2%, compared to a level of 16-54% within control groups. As the Barthel Index tracks, functional status post-hospital discharge significantly improved with EM. That effectiveness was, however, partially countered by a strong safety signal. In the most extensive RCT, adverse events were observed in 9.2% of patients receiving EM versus 4.1% in controls. Higher-dose EM regimens did not improve primary outcomes (e.g., “days alive and out of hospital”) compared to standard care. There was no clear effect on mortality. EM was both a high-risk, high-return strategy and was recovery-related, as well as injury-promoting. They do not support the "more is better" mantra. Clinical practice should therefore focus on the use of EM that is standardized, safety-oriented, versus aggressive high-intensity EM techniques in medical treatment. Further research should focus on individualized rehabilitation, showing patient subgroups of patients more amenable to specific mobilization methods.

Key words: Early mobilization, intensive care unit, ICU-acquired weakness, critical illness, systematic review.

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Pubmed Style

Aedh AI, Alharbi KA, Alwadai NM, Alqurayqiri ZM, Alshuaibi AA, Alhazmi MM, Alyoubi BH, Alotaibi AM, Mahallawi AH, Alkayal SS. The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials. IJMDC. 2026; 10(1): 301-311. doi:10.24911/IJMDC.51-1762703468

Web Style

Aedh AI, Alharbi KA, Alwadai NM, Alqurayqiri ZM, Alshuaibi AA, Alhazmi MM, Alyoubi BH, Alotaibi AM, Mahallawi AH, Alkayal SS. The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials. https://www.ijmdc.com/?mno=295532 [Access: January 25, 2026]. doi:10.24911/IJMDC.51-1762703468

AMA (American Medical Association) Style

Aedh AI, Alharbi KA, Alwadai NM, Alqurayqiri ZM, Alshuaibi AA, Alhazmi MM, Alyoubi BH, Alotaibi AM, Mahallawi AH, Alkayal SS. The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials. IJMDC. 2026; 10(1): 301-311. doi:10.24911/IJMDC.51-1762703468

Vancouver/ICMJE Style

Aedh AI, Alharbi KA, Alwadai NM, Alqurayqiri ZM, Alshuaibi AA, Alhazmi MM, Alyoubi BH, Alotaibi AM, Mahallawi AH, Alkayal SS. The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials. IJMDC. (2026), [cited January 25, 2026]; 10(1): 301-311. doi:10.24911/IJMDC.51-1762703468

Harvard Style

Aedh, A. I., Alharbi, . K. A., Alwadai, . N. M., Alqurayqiri, . Z. M., Alshuaibi, . A. A., Alhazmi, . M. M., Alyoubi, . B. H., Alotaibi, . A. M., Mahallawi, . A. H. & Alkayal, . S. S. (2026) The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials. IJMDC, 10 (1), 301-311. doi:10.24911/IJMDC.51-1762703468

Turabian Style

Aedh, Abdullah I., Khalid Atyah Alharbi, Norah Muidh Alwadai, Ziyad Mohammed Alqurayqiri, Ammar Abdulkhaliq Alshuaibi, Muhannad Muslih Alhazmi, Bandar Halil Alyoubi, Abdulelah Mohammed Alotaibi, Abdullah Hasan Mahallawi, and Sulaiman Shakir Alkayal. 2026. The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials. International Journal of Medicine in Developing Countries, 10 (1), 301-311. doi:10.24911/IJMDC.51-1762703468

Chicago Style

Aedh, Abdullah I., Khalid Atyah Alharbi, Norah Muidh Alwadai, Ziyad Mohammed Alqurayqiri, Ammar Abdulkhaliq Alshuaibi, Muhannad Muslih Alhazmi, Bandar Halil Alyoubi, Abdulelah Mohammed Alotaibi, Abdullah Hasan Mahallawi, and Sulaiman Shakir Alkayal. "The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials." International Journal of Medicine in Developing Countries 10 (2026), 301-311. doi:10.24911/IJMDC.51-1762703468

MLA (The Modern Language Association) Style

Aedh, Abdullah I., Khalid Atyah Alharbi, Norah Muidh Alwadai, Ziyad Mohammed Alqurayqiri, Ammar Abdulkhaliq Alshuaibi, Muhannad Muslih Alhazmi, Bandar Halil Alyoubi, Abdulelah Mohammed Alotaibi, Abdullah Hasan Mahallawi, and Sulaiman Shakir Alkayal. "The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials." International Journal of Medicine in Developing Countries 10.1 (2026), 301-311. Print. doi:10.24911/IJMDC.51-1762703468

APA (American Psychological Association) Style

Aedh, A. I., Alharbi, . K. A., Alwadai, . N. M., Alqurayqiri, . Z. M., Alshuaibi, . A. A., Alhazmi, . M. M., Alyoubi, . B. H., Alotaibi, . A. M., Mahallawi, . A. H. & Alkayal, . S. S. (2026) The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials. International Journal of Medicine in Developing Countries, 10 (1), 301-311. doi:10.24911/IJMDC.51-1762703468

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