Introduction

Admission to acute care settings is associated with increased risk of infections, pressure ulcers, falls, and hospital-associated deconditioning [1]. Hospital-associated deconditioning refers to the reduction in cognitive and physical functioning that results from a lack of activity and can impair a person’s ability to perform activities of daily living [1]. Mobilization during an acute care admission involves engaging patients in movement; it can improve physical functioning, decrease hospital length of stay, and reduce complications, such as delirium, thromboembolic events, and psychological distress [2,3]. However, implementing mobilization within inpatient settings can be challenging with risks that include mechanical falls, unplanned removal of lines and tubes, oxygen desaturation, and hemodynamic changes [2]. For patients with obesity, mobilization requires careful consideration of additional safety factors. Safe mobilization of patients with obesity often requires additional planning, more staff, specialized bariatric equipment, and patient education [4]. Absence of these resources may pose a challenge for maintaining the safety of both the patient and the staff involved [4].

In 2021, an estimated 2.11 billion adults were classified as overweight or obese worldwide [5]. Globally, adult obesity has more than doubled since 1990, and adolescent obesity has quadrupled, placing a greater number of individuals at risk for obesity-related disease and mortality [6,7]. Obesity is a complex, chronic, multifactorial disease characterized by excessive accumulation of adipose tissue to an extent that impairs health and poses implications for healthcare delivery [8].

Within inpatient settings, obesity can pose health and safety risks to both patients and health care professionals. Evidence suggests that obesity increases the economic burden on healthcare systems due to lifting injuries among health care professionals, longer patient admissions, bariatric equipment costs, and higher medical complication rates [3,9]. This burden reflects the increased complexity of care for patients with obesity due to comorbidities, respiratory complications, and mobility challenges [3,9]. Mobilization during admission to inpatient settings is vital to reduce complications, improve functional outcomes, prevent deconditioning, and decrease length of stay, particularly when patients have obesity [10,11]. However, there are barriers to mobilizing patients with obesity, including a lack of appropriate equipment, staff discomfort or fear, inadequate staffing, and safety concerns [6,12]. Additionally, weight-based stereotypes held by some health care professionals can result in judgmental behaviors, lowered expectations for recovery, and diminished quality of care, which present barriers to effective mobilization of patients with obesity [13,14]. Although literature exists supporting both the benefits and challenges associated with early and safe mobilization, there remains limited synthesized evidence addressing mobilization strategies for patients with obesity in inpatient settings.

To facilitate safe mobilization of patients with obesity, there is a need to identify and understand the strategies or interventions that have been utilized to promote mobilization with this population. Additionally, staff perspectives, system-level factors (e.g., training, equipment availability, and institutional protocols), and barriers and facilitators that influence mobilization practices need to be further explored [8]. To our knowledge, this is the first scoping review to comprehensively map the literature on the safe mobilization of patients with obesity in inpatient care settings. Evidence specific to adults with obesity remains fragmented across different settings, interventions, and implementation contexts. This review aims to identify and synthesize existing evidence on mobilization strategies used with adults with obesity within inpatient settings, helping to clarify what approaches are being used, where the evidence is concentrated, and where gaps in the literature remain. Our secondary objective is to explore the barriers and facilitators that influence the safe mobilization of adults with obesity within these settings in order to identify modifiable factors relevant to clinical practice, education, and patient safety. In addition to describing current practice, this review will identify contextual and behavioural factors associated with implementation, with the goal of informing future practice, training, and service design. To this end, our research questions are: What strategies are used to safely mobilize adults with obesity during admission to inpatient settings, and what are the barriers and facilitators to this mobilization?

Materials and methods

This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methods [15] and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (S1 Table) [16]. Our study has been registered a priori with Open Science Framework.

Eligibility criteria

We utilized the JBI Population, Concept, Context (PCC) [15] framework to guide the development of our eligibility criteria (Table 1). Peer-reviewed full-text publications will be included if they (1) enrolled adults (aged ≥18 years old) with obesity who were admitted to an acute care or inpatient rehabilitation setting, and (2) report strategies to facilitate mobilization (e.g., physical interventions, equipment use, staff education, multidisciplinary approaches), or discuss the barriers and facilitators to safely mobilizing patients with obesity. Obesity will be defined as per the authors’ of the included publications; anticipated definitions of obesity include Body Mass Index (BMI) >30 [5], Class I-III obesity, or Edmonton Obesity Staging System (EOSS) scores >1 [17]. Where studies enroll some participants that do not meet our criteria, we will include a publication if at least 50% of participants meet our criteria. We will exclude citations published in a language other than English, French, and Portuguese, grey literature, conference abstracts, letters to the editor, review articles, and studies set in long-term care and retirement residences. We restricted inclusion to peer-reviewed full-text studies to ensure methodological consistency, rigour, and synthesis feasibility.

Download:

• PNG
  larger image
• TIFF
  original image

Table 1. Eligibility criteria.

https://doi.org/10.1371/journal.pone.0353176.t001

Search strategy

The search strategy for this review will be developed in consultation with a health sciences librarian using the search concepts “obesity”, “inpatient”, and “mobilization”. Controlled vocabulary (i.e., subject headings) and keywords of their synonyms will be combined using Boolean operators, as appropriate. A preliminary search strategy is provided in Table 2, which will be adapted to each database. A validation exercise will be conducted for each database to verify that the search strategy successfully retrieves three previously identified relevant studies [10,12,18].

Download:

• PNG
  larger image
• TIFF
  original image

Table 2. Preliminary medline search strategy.

https://doi.org/10.1371/journal.pone.0353176.t002

Discussion

This scoping review will comprehensively map and synthesize the current evidence on mobilization practices for individuals with obesity within inpatient settings. By examining both current strategies and the contextual factors that influence their implementation, the review will help identify modifiable barriers and facilitators that may support safer and more effective mobilization within acute care and inpatient rehabilitation settings. These findings may inform clinical practice, policies, and continuing education for healthcare professionals involved in the mobilization of individuals with obesity. They may also support more equitable access to rehabilitation and help reduce work-related injuries among clinicians, such as physiotherapists. Findings will be disseminated through publication and presentation at relevant rehabilitation conferences.

This scoping review will have several strengths, including adherence to JBI methodology, a comprehensive search of peer-reviewed literature across multiple databases developed in consultation with a health sciences librarian, and a structured approach to interpreting barriers and facilitators which will be grounded in the COM-B framework. This scoping review will have limitations. Due to the language expertise of the review team, we will only include peer-reviewed studies in English, French, and Portuguese. To manage the scope of the review, we have opted to exclude grey literature.

Supporting information