ICU Early Physical Rehabilitation Programs

Lord, Robert K.; Mayhew, Christopher R.; Korupolu, Radha; Mantheiy, Earl; Friedman, Michael; Palmer, Jeffrey B.; Needham, Dale M.

doi:10.1097/ccm.0b013e3182711de2

Cited by 174 publications

(132 citation statements)

References 23 publications

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“…More specifically, both a metaanalysis of randomized trials and studies of routine ICU clinical practice have demonstrated that early rehabilitation decreases ICU length of stay (60,62,63). Hence, early rehabilitation may have a direct benefit on physical impairment, plus an indirect benefit from reducing ICU length of stay, thus making length of stay a modifiable risk factor for physical impairment.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

Needham

Wozniak

Hough

et al. 2014

Am J Respir Crit Care Med

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165

133

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Rationale: Existing studies of risk factors for physical impairments in acute lung injury (ALI) survivors were potentially limited by single-center design or relatively small sample size.Objectives: To evaluate risk factors for three measures of physical impairments commonly experienced by survivors of ALI in the first year after hospitalization.Methods: A prospective, longitudinal study of 6-and 12-month physical outcomes (muscle strength, 6-minute-walk distance, and Short Form [SF]-36 Physical Function score) for 203 survivors of ALI enrolled from 12 hospitals participating in the ARDS Network randomized trials. Multivariable regression analyses evaluated the independent association of critical illness-related variables and intensive care interventions with impairments in each physical outcome measure, after adjusting for patient demographics, comorbidities, and baseline functional status.Measurements and Main Results: At 6 and 12 months, respectively, mean (6 SD) values for strength (presented as proportion of maximum strength score evaluated using manual muscle testing) was 92% (6 8%) and 93% (6 9%), 6-minute-walk distance (as percent-predicted) was 64% (6 22%) and 67% (6 26%), and SF-36 Physical Function score (as percent-predicted) was 61% (6 36%) and 67% (6 37%). After accounting for patient baseline status, there was significant association and statistical interaction of mean daily dose of corticosteroids and intensive care unit length of stay with impairments in physical outcomes.Conclusions: Patients had substantial impairments, from predicted values, for 6-minute-walk distance and SF-36 Physical Function outcome measures. Minimizing corticosteroid dose and implementing existing evidence-based methods to reduce duration of intensive care unit stay and associated patient immobilization may be important interventions for improving ALI survivors' physical outcomes.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

Needham

Wozniak

Hough

et al. 2014

Am J Respir Crit Care Med

Self Cite

165

133

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“…Two types of cost contribute to the financial model of incorporating a new program into an ICU: fixed costs and direct variable costs. Fixed costs are items such as salaries, benefits, and overhead [81,82]. The direct variable costs account for less than 20% of total operating costs and include monies associated with supplying medical services and patient consumable costs (ie, blood bank, laboratory, pharmacy, radiology, and respiratory services) [81,82].…”

Section: Costmentioning

confidence: 99%

Early mobilization in the critical care unit: A review of adult and pediatric literature

Cameron¹,

Ball²,

Cepinskas³

et al. 2015

Journal of Critical Care

229

179

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“…Implementation of early RT may decrease functional deficits associated with surgery, decrease comorbidities and LOS, as well as improve functional outcomes. Financial analysis models have shown that investment in early rehabilitation programs in the intensive care unit for adults has the potential to generate substantial net cost savings for hospitals while improving patient outcomes 27. While deconditioning and critical neuropathy are the biggest issues in adult postcardiac surgery patients,28, 29 our data highlight the important differences in the adult patient population in whom PT is the most common therapy used compared with patients following congenital heart surgery where they might need a combination of interventions.…”

Section: Discussionmentioning

confidence: 85%

Predictors of Postoperative Rehabilitation Therapy Following Congenital Heart Surgery

Tikkanen

Nathan

Sleeper

et al. 2018

JAHA

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BackgroundPatients with congenital heart disease are at risk of motor, cognitive, speech, and feeding difficulties after cardiac surgery. Rehabilitation therapy could improve functional outcomes in this population if applied in the acute postcardiac surgical in‐hospital stay. However, information on the types of acute postcardiac surgery therapy needs in children is scarce. Our goal was to describe rehabilitation therapy following congenital heart surgery and pre/intraoperative factors associated with need for therapy.Methods and ResultsThis is a retrospective cohort study of patients <18 years undergoing heart surgery at our center from January 1, 2013 to January 31, 2015. Demographic, and pre‐, intra‐, and postoperative clinical and rehabilitation therapy (physical, occupational, speech, feeding therapy, and neurodevelopment intervention) data were collected. Need for rehabilitation therapy in the acute postoperative period, particularly following palliative repair, was the outcome variable in a multivariable logistic regression model to identify independent pre‐ and intraoperative factors associated with therapy. A total of 586 out of 1415 (41%) subjects received rehabilitation therapy postsurgery. Certain subgroups had increased rehabilitation therapy use such as neonates (80%). On multivariable analysis, palliative repair, prematurity, genetic syndrome, presurgical hospital stay of more than 1 day, and prolonged cardiopulmonary bypass time were independently associated with rehabilitation therapy.ConclusionsNearly half of patients who underwent post–congenital heart surgery received rehabilitation therapy. Frequency of use and types of therapy vary according to patient characteristics; however, certain pre‐ and intraoperative factors are associated with need for rehabilitation therapy, and may aid decision‐making for appropriate resource allocation.

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ICU Early Physical Rehabilitation Programs

Cited by 174 publications

References 23 publications

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

Early mobilization in the critical care unit: A review of adult and pediatric literature

Predictors of Postoperative Rehabilitation Therapy Following Congenital Heart Surgery

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