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Intensive CareJul 4, 2024

Michelle Paton advocates taking ICU patients to their 'highest mobility level' after study published

Advanced cardiac and critical care physiotherapist Michelle Paton is revelling in her dual role, which gives her a chance to combine being a clinician with being involved in influential research projects.

Michelle, who has been based at Monash Health in Victoria, Australia, for the past 11 years, recently took up a post-doctoral appointment at the Australian and New Zealand Intensive Care Research Centre.

She offered some reflections on her career and journey into the research field in an article that was published on Monash Health’s website on 20 May.  

‘I always had an interest in sports and wellbeing and decided I wanted to do physiotherapy while still in high school,’ Michelle revealed. She studied exercise science and physiotherapy at Griffith University Gold Coast, which is sited in Southport, Queensland, before gaining a master’s in physiotherapy (cardiorespiratory) at the University of Melbourne in 2011.

After joining Monash Health as a grade 4 advanced intensive care unit (ICU) physiotherapist in 2013, Michelle realised there was a paucity of information on how to prescribe early mobilisation in ICUs: ‘I wanted to find out more to ensure that I was providing the best care to my patients,’ she noted. 

Photo Credit: Image courtesy of Monash Health
Michelle is pictured in action (right) in an ICU run by Monash Health in Victoria, Australia

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Praise for Monash Health's research culture

With Monash Health’s backing, Michelle took study leave to complete a PhD. ‘I have seen the research culture at Monash Health grow dramatically over the years, with many disciplines now having clinical research leads.’

Michelle continued: ‘I have also seen the expansion of research support, such as the internship programme, the Stepping into Research initiative, and the Early Researcher Fellowship, as well as the growth of the allied health WISER [Workforce Innovation, Strategy, Education and Research] unit.’ 

Study published in The Lancet Respiratory Medicine

Michelle was the first author of a paper based on a comprehensive systematic review that appeared in The Lancet Respiratory Medicine journal in May. The team analysed data from hundreds of studies to examine the safety and efficacy of mobilisation during mechanical ventilation.  Michelle  described the findings as ‘compelling’.

Focusing on taking patients to their highest mobility level might be more beneficial than performing multiple sessions of lower intensity [Michelle Paton]   

‘The review included 7,004 critically ill patients and indicated a reassuringly low risk, with less than a 3 per cent chance of adverse events occurring during mobilisation in the ICU.’  She said the findings challenged previous assumptions and highlighted the safety of implementing early mobilisation protocols in ICU settings.  

‘Mobilisation now forms part of many international guidelines,’ Michelle said. ‘However – like many other treatment methods – there are many differing views on optimising it. Focusing on taking patients to their highest mobility level might be more beneficial than performing multiple sessions of lower intensity.’  

Michelle also emphasised the importance of patient-specific factors in determining exercise intensity. This nuanced approach suggests tailoring mobilisation protocols to individual patient needs could further optimise outcomes and improve patient satisfaction.  

Michelle acknowledged that while the results were promising, some challenges remained – especially the difficulty of generalising findings across diverse patient populations – and called for further research to refine mobilisation protocols. She also emphasised the need for clear and consistent reporting in clinical trials to enhance the quality and reliability of any findings. 

Dual roles 

Michelle’s dual roles as a clinician and researcher offer an opportunity to translate research findings directly into clinical practice. ‘Working in the area that I am researching allows me to continue to identify ongoing questions and improve the care for our patients.' 

While warning that ‘nothing in ICU care is ubiquitous’, she said: ‘Our research showed that performing mobilisation during critical illness does not lead to any harm and may improve long-term physical and cognitive function.’  

Michelle gave presentations at three sessions during the 43rd International Symposium on Intensive Care & Emergency Medicine (ISICEM), which was held in Brussels from 19-22 March and attracted more than 5,000 delegates.

Her presentation titled ‘Safe application of early active mobilisation’ provided a comprehensive overview of her research and the publication in The Lancet. 

'Top tips' for fledgling researchers

Michelle offered some practical tips to allied health professionals who might be considering embarking on a research journey themselves: ‘Always start small … the first thing you take on shouldn’t be a big project,’ she advised.

Michelle also emphasised the importance of networking and collaborating on other projects to learn the processes ‘without having to take on the whole project yourself’. 

To see the article by Michelle and colleagues – titled Association of active mobilisation variables with adverse events and mortality in patients requiring mechanical ventilation in the intensive care unit: a systematic review and meta-analysis – click 

Author: Ian A McMillan
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