Journal of Rehabilitation Medicine 51-10 | Page 81

Effect of physiotherapy for ICU-acquired muscle weakness
Fig. 2. Kaplan–Meier estimate of final multivariate adjusted Cox
proportional hazards model for regaining walking ability.
(confounding) effects of the following variables were
analysed: total time (in min) of all physiotherapy inter-
ventions per week in the first 2 weeks of rehabilitation,
total time (in min) per week spent with walking activi-
ties, age at baseline, body mass index (BMI), sex, lower
limb strength, duration of illness, duration of mechanical
ventilation, and the number (total) of secondary diagno-
sis in adjusted Cox proportional hazard models. After
adjusting for these variables it was found that patients
who practised walking post-acute ICU and rehabilitation
units had a higher chance of regaining walking ability.
The final multivariate adjusted Cox proportional
hazards model included: total time (in min) per week
spent in walking activities (adjusted HR = 1.017; 95%
801
CI 1.013–1.021; per min walking, p < 0.0001). An ad-
justed HR of 1.017 means that the specific treatment
results in the patient progressing 1.017 times faster
than patients not receiving that type of therapy. In
other words, every minute of physiotherapy in walking
activities per week increases the chance of regaining
walking ability by 1.7% (95% CI 1.3–2.1). Adjusted
HR means that the effect of time spent in walking
activities is controlled for other components of phy-
siotherapy in rehabilitation. A Kaplan–Meier estimate
of the final multivariate adjusted Cox proportional
hazards model (Fig. 2) was made. This estimate shows
the adjusted time course of regaining walking function.
The subjectively perceived physical stress of phy-
siotherapists during therapies was lower than expected
and did not differ significantly between patients who
regained or did not regain walking ability during post-
acute rehabilitation (mean 4.03 (SD 1.57) vs 3.61 (SD
1.31), respectively, p = 0.19).
A summary of all secondary outcome measures at
all time-points has been described elsewhere (33, 34).
DISCUSSION
This cohort study of severely ill persons of conside-
rable age with ICUAW found that persons regaining
walking ability received task-oriented practice in
terms of walking, sit-to-stand, and balance exercises
in the first 2 weeks of post-acute rehabilitation. This
was in contrast to those not regaining walking ability
in an ICU setting. Overall, relatively good recovery
Table III. Results of independent walking categorized by physiotherapeutic intervention
People who did not achieve FAC ≥ 3 People who achieved FAC ≥ 3
Physiotherapeutic intervention Total time (min per week) n  =  36
Mean (SD) Total time (min per week) n  = 114
Mean (SD)
p-value
Assistive/active stance
Treadmill training
Electromechanical-assisted walking
Active breathing therapy
Strengthening exercises
Sit-to-stand training
Position shift training
Balance exercises in the sitting position
Balance exercises in a standing position
Conventional walking training
Stair training
Transfer training
Wheelchair training
Passive mobilization into the stand
Patient positioning
Secretion mobilization
Passive/assistive movement
Stretching
Pre- and post-processing time
Physical heat applications
Electrotherapeutic applications
Massage techniques and manual lymphatic drainage 8.24 (15.8)
0.0 (0.0)
0.0 (0.0)
4.27 (8.36)
10.74 (16.43)
15.15 (22.75)
6.32 (7.82)
14.85 (16.99)
1.62 (5.03)
6.62 (21.52)
0.29 (1.72)
6.62 (11.85)
2.21 (6.98)
2.94 (9.62)
14.41 (16.60)
9.27 (14.98)
15.29 (22.93)
1.18 (3.27)
36.62 (21.45)
3.03 (8.10)
0.00 (0.00)
0.91 (3.18) 4.61 (10.1)
0.97 (6.06)
0.0 (0.0)
3.07 (7.48)
8.60 (12.89)
20.13 (21.12)
4.56 (6.99)
12.37 (26.95)
4.78 (11.40)
48.03 (41.09)
5.00 (12.14)
10.35 (10.93)
3.07 (8.71)
1.05 (5.04)
4.30 (10.52)
1.71 (5.40)
3.07 (10.30)
0.44 (3.09)
39.17(22.56)
0.26 (2.09)
0.00 (0.00)
0.09 (0.94)
0.15
0.27
1.00
0.46
0.61
0.06
0.19
0.12
0.04
< 0.001
0.01
0.01
0.48
0.18
< 0.001
< 0.001
< 0.001
0.03
0.50
< 0.001
1.00
0.01
p-values: based on Wilcoxon rank-sum tests (also known as Wilcoxon 2-sample test, a statistical test of the null hypothesis that there is no difference between
the effects of the 2 categories). FAC: Functional Ambulation Categories; SD: standard deviation.
J Rehabil Med 51, 2019