More-Frequent Rehab Doesn't Benefit ICU Patients

Summary and Comment |
August 18, 2016

More-Frequent Rehab Doesn't Benefit ICU Patients

  1. Patricia Kritek, MD

Daily rehabilitation therapy did not result in shorter length of stay in the intensive care unit or improve functional status.

  1. Patricia Kritek, MD

Many patients experience long-lasting physical and psychological effects after intensive care unit (ICU) admissions. Early physical therapy and mobility as potential mediators of these effects have been studied intensely, but have not demonstrated a clear benefit (Crit Care Med 2008; 36:2238). Investigators at Wake Forest randomized 300 patients who were receiving mechanical ventilation to standardized rehabilitation therapy (SRT) or usual care. SRT included passive range of motion, physical therapy, and progressive resistance exercises and was performed every day.

The median times to begin therapy were 1 day in the SRT group and 7 days in the control group. In all metrics, SRT patients received more therapy. Neither hospital length of stay nor any other ICU metric (including ventilator-free days, days of delirium, and vasopressor use) differed between the SRT and control groups. Measurements of physical function on hospital discharge did not differ nor did discharge destinations. At 6 months, self-evaluated physical function was better in SRT patients than in controls.

Comment

This is another study that shows minimal benefit for more-intense physical therapy among critically ill patients. Although self-reported function is important, the hope is that these interventions will shorten hospital stays or minimize complications of intensive care. We don't yet understand when therapy will have the greatest benefit and for whom it is most appropriate. Despite this result, I don't think the answer is to stop working on early mobility for ICU patients, but instead, to figure out how to target it most effectively.

Editor Disclosures at Time of Publication

  • Disclosures for Patricia Kritek, MD at time of publication Speaker’s Bureau American College of Chest Physicians (Critical Care Board Review Course)

Citation(s):

Reader Comments (1)

RICHARD THORNTON Physician, Obstetrics/Gynecology

What measures were used to compare the SRT and study groups??

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