Eli's Rehab Report

Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Needham DM, Korupolu R, Zanni JM, Colantuoni E, Palmer JB, Brower RG, Fan E. Arch Phys Med Rehabil. 2010 Apr;91(4):536-42.

Want to do your hospital's intensive care unit patients a favor? The latest research says that physical therapy is a big piece of the puzzle.

Patients who are critically ill and participate in mild physical therapy exercise programs achieve higher functional mobility and spend fewer days in the ICU and hospitals than those who receive less exercise, according to a press release from the American Physical Therapy Association.

Researchers had a multidisciplinary healthcare team in a medical ICU at Johns Hopkins Hospital focus on reducing the use of prescription sedatives to reduce patient drowsiness and thus increase patients' ability to exercise more frequently, APTA reported. The research subjects consisted of 57 patients who were on a mechanical ventilator for four or more days.

The rehab-based exercise sessions typically lasted 30- 45 minutes and consisted of arm and leg movements while lying in bed, sitting, or standing, or walking slowly in the ICU hallways, APTA said.

The results: The healthcare team found that their interventions resulted in lower median daily doses of sedatives, improved patient alertness, and reduced delirium. Thus, patients were able to participate in a greater number of rehab sessions and achieve a higher level of functional mobility in the ICU. Not surprisingly, these results led to a 2.1 day decrease in ICU length of stay, and a 3.1 day decrease in hospital length of stay.

"Historically, patients in ICUs have been heavily sedated and immobile, which contributes to neuromuscular weakness that can, in turn, lead to physical impairments and decreased quality of life," said Jennifer Zanni, PT, MSPT, a co-author of the report. "The results of our quality improvement project show that rehabilitation of patients who are critically ill is safe and effective in improving mobility and returning patients to their homes sooner."

"We hope these results encourage other critical care experts to consider early mobilization in this patient population," said R. Scott Ward, PT, PhD, president of the American Physical Therapy Association.