Physiotherapy led early rehabilitation of the patient with critical illness

Abstract

Background: Studies revealing the effectiveness of physical rehabilitation techniques provided during a critical care admission have been hampered by experimental control issues and ethical constraints. However, because of worldwide variations in physiotherapy practice, differences in patient outcomes can be investigated when physical rehabilitation is provided immediately upon critical care admission compared to rehabilitation initiated after extubation, after withdrawal of mechanical ventilation, after discharge from the acute environment or not at all.

Objectives: The purpose of this review is to examine reports describing the effects of physical rehabilitation which is commenced immediately on critical care admission compared to rehabilitation which is delayed.

Major findings: Overall, early initiation of rehabilitation reveals an increased incidence of physiotherapy consultation, decreased time to achieve activity milestones, improved functional outcomes at intensive care unit and hospital discharge and reduced direct patient costs. Where early rehabilitation is already a key component of care for critically ill patients, research has concentrated on determining the acute physiological effects of interventions, or the impact of providing additional specific therapies to overall functional and administrative outcomes.

Conclusions: Early physiotherapy led rehabilitation of the critically ill patient has the potential to dramatically influence recovery and functional outcomes in this vulnerable patient group.

Keywords:

• Critical illness
• Intensive care
• Critical care
• Mobilization
• Physiotherapy
• Rehabilitation

The authors give their kind thanks to Lesley Mill, Clinical Lead Physiotherapist, Rehabilitation, The Wellington Hospital (London, UK) for her comments and editorial assistance in the preparation of this review.