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