While advancements in medical technology have significantly improved intensive care unit (ICU) patient survival rates, studies highlight that ICU treatments, especially mechanical ventilation, often lead to reductions in muscle mass and function(Balke et al., 2022). ICU survivors frequently suffer from complications including ICU-acquired weakness (ICU-AW), decreased muscle strength, and reduced self-care abilities (Castro-Avila et al., 2015). Early mobilization has been shown to improve patient muscle strength, reduce ICU-AW incidence, and shorten mechanical ventilation duration. Research consistently supports that early ambulation leads to improved patient outcomes, such as enhanced functional independence and reduced hospitalization duration (Monsees et al., 2023, Tipping et al., 2017, Zhang et al., 2019).

Despite numerous studies, the ideal timing for initiating early physical activity in intensive care remains a debated topic (Denehy et al., 2017). Research by Zhou Wendi and colleagues (Zhou et al., 2022) suggests that starting exercise within 24 hours of ICU admission may reduce ICU-AW and enhance muscle strength and functional independence. Conversely, a study by Fossat et al. (Fossat et al., 2018) on the use of bed-leg pedals and electrical quadriceps stimulation within 30 hours of ICU admission did not show significant muscle strength improvement at discharge. The uncertainty surrounding the best time to start early exercise and rehabilitation, especially in critically ill patients, continues to impede its widespread adoption in ICU settings. Therefore, identifying the most effective mobilization timing remains essential.

Previous meta-analyses have primarily highlighted the positive effects of early mobilization on physical function and muscle mass, or focused on systematic reviews of different mobilization start times in mechanically ventilated patients. Yet, no study has thoroughly investigated the impact of varying mobilization start times on the broader ICU patient population. Additionally, there is currently no direct comparison between various early mobilization start times. Network Meta-Analysis (NMA) is an innovative approach for comprehensive treatment comparison. It enables simultaneous evaluation of multiple interventions, thus improving the strength of statistical conclusions. This research, therefore, aims to leverage the NMA method to identify the safest and most effective start time for early mobilization in ICU patients.