Graduation Date

Fall 12-15-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Bunny Pozehl

Second Advisor

Breanna Hetland


Background: Physical activity (PA) beginning early in the intensive care unit (ICU) can reduce adverse outcomes commonly experienced by individuals after ICU discharge. Patient-centered approaches to PA in the ICU and reliable activity evaluations are essential for understanding PA's impact on patient outcomes.

Objective: This dissertation sought to evaluate patient-related factors associated with PA in the ICU and post-ICU hospital stay.

Methods: The purpose of the dissertation was to conduct: 1) a concept analysis to define ICU survivorship and identify critical care aspects important for patient recovery; 2) an integrative literature review to assess early mobility (EM) interventions with physical, psychological, or cognitive outcome measures, the domains most affected during survivorship; and 3) a convergent mixed methods study to examine relationships between patient characteristics, symptom burden, and experiences associated with accelerometer-based PA in the ICU and post-ICU hospital stay.

Results: Major findings include the conceptual definition of ICU survivorship as life after ICU discharge characterized by diverse challenges and ongoing functional and psychological recovery. The integrative review highlighted the variability in EM interventions and outcome measures primarily addressing physical function, and exposed gaps in the limited understanding of ICU patient activity and the need for patient-centered approaches. Finally, the mixed methods study showed that activity in the ICU and post-ICU hospital stay was characterized as pivotal for recovery and well-being and was influenced by personal characteristics, complexities of the hospital environment, and support from staff and partners. The mixed methods integration revealed relationships between baseline functional status, self-efficacy, partner support, symptoms, and PA. This research is novel in its combination of continuous accelerometer-based PA measurements with patient-reported symptom burden, and baseline functional data captured pre-admission.

Conclusions: The cumulative findings of the dissertation highlight the importance of gaining patient perspectives in ICU PA research and help fill a gap by extending the understanding of PA in the ICU within a patient-centered lens. This dissertation has implications for both research and practice, particularly in using continuous activity measurements to evaluate PA and using patient feedback to design activity interventions and enhance patient engagement.


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