Extended physiotherapy after Intensive Care Unit (ICU) stay: A prospective pilot study with a before and after design

ABSTRACT

Objective

To examine whether extended compared to standard level of physiotherapy is feasible and has beneficial effects on physical function in ICU survivors.

Methods

This prospective pilot study with a before and after design included patients discharged from ICU to a surgical ward. The comparison group were recruited between January and April 2019 and received standard level of physiotherapy. The intervention group were recruited between May and December 2019 and received extended physiotherapy, corresponding to 50% additional physiotherapist, working 4 hours per weekday. The intervention participants received an individual rehabilitation plan developed in collaboration with a ward-based physiotherapist, and an extended number of sessions provided by the extra resource included practicing individualized exercises, for example walking and stair climbing. Physical function was measured with the Chelsea Critical Care Physical Assessment tool (CPAx) at ICU discharge, during hospital stay and discharge. Group differences were analyzed using the Mann–Whitney U-test and Chi² test.

Results

Out of 46 eligible patients, 39 (85%) fulfilled the study (comparison n = 12, intervention n = 27) and were included in the final analyses. No adverse events occurred, and the attendance rate was high (98.5%). There were no statistically significant differences between the groups regarding physical function, hospital stay, and readmissions, but there were tendencies to better outcomes in all these parameters in favor of the intervention group. Additionally, patients in the intervention group had statistically significantly higher scores in the CPAx items “transferring from bed to chair” (median 5 vs 4, p = .039) and “stepping” (median 5 vs 4, p = .005) at hospital discharge.

Conclusion

This pilot study indicates that extended physiotherapy after ICU discharge is feasible and does not entail patient safety risks. However, determining the potential beneficial effects for the patients remains to be evaluated in a larger trial.

KEYWORDS:

• Critical care
• ambulation
• rehabilitation
• physical therapy
• physical assessment

Acknowledgments

A special thanks to the physiotherapists Vidar Haugen, Matheo Johansson, Annelie Söderlund, and Marion Warnhoff. The authors would also like to thank Hans Järnbert-Pettersson and Mikael Andersson Franko for their expert advice regarding statistics. The work was funded as a quality improvement project by the Regional County Council.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09593985.2022.2143251.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Regional County Council in Stockholm.