Journal of Rehabilitation Medicine 51-10 | Page 77
J Rehabil Med 2019; 51: 797–804
ORIGINAL REPORT
EFFECT OF PHYSIOTHERAPY ON REGAINING INDEPENDENT WALKING IN
PATIENTS WITH INTENSIVE-CARE-UNIT-ACQUIRED MUSCLE WEAKNESS: A
COHORT STUDY
Simone THOMAS, PT, PhD 1 #, Jan MEHRHOLZ, PT, PhD 1 #, Ulf BODECHTEL, MD 2 and Bernhard ELSNER, PT, PhD 3
From the 1 Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa, 2 Comprehensive Sepsis
Center Dresden/Kreischa, Klinik Bavaria in Kreischa, Kreischa and 3 Department of Public Health, Medical Faculty, TU Dresden, Germany
#These authors contributed equally to this publication.
Objectives: To describe physiotherapeutic interven-
tions used in the post-acute inpatient rehabilitation
of chronic critically ill patients with intensive-care-
unit-acquired muscle weakness, and to determine
the influence of such interventions on patients’ abi-
lity to walk.
Methods: Chronic critically ill patients with intensi-
ve-care-unit-acquired muscle weakness who were
in post-acute and rehabilitation units were included
in a cohort study. During post-acute rehabilitation,
the patients’ functional status at baseline, all daily
physiotherapeutic interventions, and ability to walk
were documented.
Results: A total of 150 patients were investigated.
In patients who regained walking ability, the most
frequent interventions in the first 2 weeks of post-
acute rehabilitation were practicing walking, sit-to-
stand training, and balance training while sitting
(total time per week: 48.03 (standard deviation (SD)
41.10), 20.13 (SD 21.12), and 12.37 (SD 26.95) min,
respectively). The most frequent interventions in
those who did not regain walking ability were pas-
sive-assistive movements, sit-to-stand training, and
balance training while sitting (total time per week:
15.29 (SD 22.93), 15.15 (SD 22.75), and 14.85 (SD
16.99) min, respectively). The time spent walking
increased the chance of regaining walking ability
(adjusted hazard ratio = 1.017 per min walking,
p < 0.0001).
Conclusion: These results suggest that physiothera-
py interventions in the rehabilitation of chronic cri-
tically ill patients with intensive-care-unit-acquired
muscle weakness may stimulate walking function.
Key words: critical care; rehabilitation; walking; physical th-
erapy modalities.
Accepted Sep 6, 2019; Epub ahead of print Sep 23, 2019
J Rehabil Med 2019; 51: 797–804
Correspondence address: Jan Mehrholz, Wissenschaftliches Institut,
Private Europäische Medizinische Akademie der Klinik Bavaria in Krei-
scha GmbH, An der Wolfsschlucht 1-2, 01731 Kreischa, Germany. E-
mail: [email protected]
A
stay in an intensive care unit (ICU) may be asso-
ciated with long-term impairments, such as ICU-
acquired muscle weakness (ICUAW) and participation
in life situations (1). Consequently the Society of Cri-
LAY ABSTRACT
The aim of this study was to describe physiotherapeutic
interventions during post-acute inpatient rehabilitation
of chronic critically ill patients with intensive-care-unit-
acquired muscle weakness, and to determine the re-
lationship of such interventions with patients’ recovery
of walking ability. The study included 150 patients with
chronic critical illness and acquired muscle weakness,
and documented what interventions physiotherapists
applied during rehabilitation and how well patients re-
gained walking function. The most frequent interven-
tions in the first 2 weeks of rehabilitation in patients
who regained walking ability were: practicing walking,
sit-to-stand training, and balance training while sitting.
In those who did not regain walking ability the most
frequent interventions were: passive-assistive move-
ments, sit-to-stand training, and balance training while
sitting. The time spent walking in physiotherapy was
correlated with walking function. Physiotherapy in the
rehabilitation of chronically critically ill patients with
intensive-care-unit-acquired muscle weakness may be
correlated with achieving independent walking.
tical Care Medicine (SCCM) recommends improving
the continuity of care for ICU survivors, involving
comprehensive treatment, such as physiotherapy, oc-
cupational and cognitive therapies during all phases
of recovery (2). People with severe ICUAW may take
months to improve their physical and mental function
(1, 3), and recent studies have shown that ICUAW
may have longer-term consequences, beyond the acute
phase (7–14 days) (2, 4). For example, ICUAW may
be part of post-intensive care syndrome, including
physical, mental, and cognitive dysfunction, which
extends beyond the acute hospitalization phase and has
a major impact on quality of life in ICU survivors (4).
Some researchers have found that ICUAW is indepen-
dently associated with post-ICU mortality and with clini-
cally relevant lower physical functioning at 6 months
after discharge from the ICU (5). Other studies have
shown that the presence of ICUAW at discharge from
the ICU is associated with poor long-term outcome, e.g.
health-related quality of life (6–8). Longitudinal studies
have described the recovery of critically ill people with
relatively short stays in the ICU (1, 5, 9–11). However,
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2606