Critical care rehabilitation and early mobilisation: an emerging standard of care

Effects of mobility training on severe burn patients in the BICU: A retrospective cohort study

PURPOSE

To assess the effects of mobility training on severe burn patients in the Burn Intensive Care Unit (BICU).

METHODS

This was a retrospective cohort study. Severe burn patients with equal to or more than 50% Total Body Surface Area (TBSA) burns who received early rehabilitation in the BICU were included in this study. Based on the different early rehabilitation strategies during the two periods, patients admitted to the BICU from January 2011 to April 2013 were identified as the passive training cohort (n=49) while patients admitted to the BICU from May 2013 to December 2013 were identified as the mobility training cohort (n=24). Data on length of BICU stay, length of hospital stay, length of rehabilitation in the BICU, ventilator dependent days, strict bed rest time, range of motion (ROM), the Barthel Index (BI) and the Functional Independence Measure (FIM) were collected.

RESULTS

Compared with the passive training cohort, patients in the mobility training cohort had significantly shorter length of BICU stay (p=0.002), length of hospital stay (p=0.010), strict bed rest time (p<0.001) and length of rehabilitation in the BICU (p=0.026) with improved ROM of shoulder, wrist, hip, knee and ankle joints.

CONCLUSIONS

Mobility training in the BICU was shown to be feasible and effective in achieving better outcomes than passive training for severe burn patients.

Mobilization of patients in neurological Intensive Care Units of India: A survey

Context:

The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs) vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance.

Aim of the Study:

To study the current mobilization practices by the physiotherapists in neurological ICUs of India.

Subjects and Methods:

A cross-sectional survey was conducted with a content validated questionnaire about the mobilization practices. Online questionnaire was distributed to physiotherapists working in neurological ICUs of India. Descriptive statistics were used.

Results:

Out of 185 e-mails sent, 82 physiotherapists completed the survey (survey response rate = 44%). Eighty participants (97.6%) mentioned that the patients received some form of mobilization during the day. The majority of the physiotherapists (58.5%), “always” provided bed mobility exercises to their patients when it was found appropriate for the patients. Many physiotherapists (41.5%) used tilt table “sometimes” to introduce orthostatism for their patients.

Conclusion:

Mobilization in various forms is being practiced in the neurological ICUs of India. However, fewer mobilization sessions are conducted on weekends and night hours in Indian Neurological ICUs.

Effect of supervised aerobic exercise rehabilitation on physical fitness and quality-of-life in survivors of critical illness: an exploratory minimized controlled trial (PIX study)

Background

Evidence is limited for the effectiveness of interventions for survivors of critical illness after hospital discharge. We explored the effect of an 8-week hospital-based exercise-training programme on physical fitness and quality-of-life.

Methods

In a parallel-group minimized controlled trial, patients were recruited before hospital discharge or in the intensive care follow-up clinic and enrolled 8–16 weeks after discharge. Each week, the intervention comprised two sessions of physiotherapist-led cycle ergometer exercise (30 min, moderate intensity) plus one equivalent unsupervised exercise session. The control group received usual care. The primary outcomes were the anaerobic threshold (in ml O₂ kg⁻¹ min⁻¹) and physical function and mental health (SF-36 questionnaire v.2), measured at Weeks 9 (primary time point) and 26. Outcome assessors were blinded to group assignment.

Results

Thirty patients were allocated to the control and 29 to the intervention. For the anaerobic threshold outcome at Week 9, data were available for 17 control vs 13 intervention participants. There was a small benefit (vs control) for the anaerobic threshold of 1.8 (95% confidence interval, 0.4–3.2) ml O₂ kg⁻¹ min⁻¹. This advantage was not sustained at Week 26. There was evidence for a possible beneficial effect of the intervention on self-reported physical function at Week 9 (3.4; −1.4 to 8.2 units) and on mental health at Week 26 (4.4; −2.4 to 11.2 units). These potential benefits should be examined robustly in any subsequent definitive trial.

Conclusions

The intervention appeared to accelerate the natural recovery process and seems feasible, but the fitness benefit was only short term.

Clinical trial registration

Current Controlled Trials ISRCTN65176374 (http://www.controlled-trials.com/ISRCTN65176374).