Michelle Paton, an Advanced Cardiac and Critical Care Physiotherapist at Monash Health, has delved deep into the research of early mobilisation in Intensive Care Units (ICUs), challenging conventional wisdom and reshaping how we approach patient care. Michelle’s journey from her early interest in physiotherapy to becoming a leading researcher reflects her unwavering dedication to improving patient outcomes.
Reflecting on her career, Michelle recalls, “I always had an interest in sports and well-being and decided I wanted to do physiotherapy while still in high school.” Although initially inclined towards musculoskeletal physiotherapy, a student placement in ICU revealed to her the benefits provided to these patients.
After joining Monash Health as a Grade 4 Advanced ICU Physiotherapist in 2013, she identified, “There was very little information on how to prescribe early mobilisation in ICU, so I wanted to find out more to ensure that I was providing the best care to my patients.”
Supported by Monash Health, she embarked on her research journey, obtaining study leave to complete her PhD and recently securing a post-doctoral appointment at the Australian and New Zealand Intensive Care Research Centre.
“I have seen the research culture at Monash Health grow dramatically over the years, with many disciplines now having Clinical Research Leads.”
She continues, “I have also seen the expansion of research support, such as the internship program, the Stepping into Research initiative, and the Early Researcher Fellowship, as well as the growth of the allied health WISER unit.”
Michelle’s dual roles as a clinician and researcher synergise seamlessly, allowing her 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.”
“Nothing in ICU care is ubiquitous,” Michelle explains, addressing the complexity of patient outcomes. “Our research showed that performing mobilisation during critical illness does not lead to any harm and may improve long-term physical and cognitive function.”
Early mobilisation, or physical activity, in the ICU is crucial to mitigate the many issues patients often face following their stay.
In the comprehensive systematic review published in the prestigious journal, The Lancet Respiratory Medicine, Michelle and contributors meticulously analysed data from hundreds of studies to thoroughly examine the safety and efficacy of mobilisation during mechanical ventilation.
“The results were compelling,” Michelle says.
“The review included 7,004 critically ill patients and indicated a reassuringly low risk, with less than a 3% chance of adverse events occurring during mobilisation in the ICU.”
This challenges previous assumptions and highlights the safety of implementing early mobilisation protocols in ICU settings.
Michelle’s research has also delved into the long-term benefits of early mobilisation for ICU patients. Her research showed significant physical and cognitive function improvement six months post-ICU admission. These findings highlight the potential for early mobilisation to reduce long-term healthcare costs by improving patient outcomes and reducing rehabilitation needs.
“Mobilisation now forms part of many international guidelines,” Michelle notes. “However, like many other treatment methods, there are many differing views on optimising it.”
She explains, “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 acknowledges the promising results while highlighting the challenges, especially the difficulty of generalising findings across diverse patient populations, calling for further research to refine mobilisation protocols.
She also emphasises the need for clear and consistent reporting in clinical trials to enhance the quality and reliability of research in this field.
Her recent contributions were highlighted at the 43rd International Symposium on Intensive Care & Emergency Medicine (ISICEM) in Brussels, one of the world’s largest ICU conferences, with over 5,000 delegates in attendance. Such is the regard for her work that Michelle was invited to speak in three sessions, including presenting ‘Safe application of early active mobilisation,’ which provided a comprehensive overview of her research and publication in The Lancet, offering valuable insights and fostering discussions among global ICU experts.
Michelle envisions Monash Health continuing to foster a culture of research and innovation among allied health professionals.
“I feel that Monash Health as a whole really promotes the importance of research, with many clinical areas having research committees and strategic plans.”
Michelle offers practical advice to allied health professionals considering a research journey. “Always start small…the first thing you take on shouldn’t be a big project,” she advises, emphasising the importance of networking and collaborating on other projects to learn the processes “without having to take on the whole project yourself.”
Her vision is to foster a culture of research and innovation, particularly among allied health professionals, and always with the intention of benefiting patient outcomes.
Approved by Danielle Ryan, Chief Allied Health Officer.