Physical therapy in intensive care reduce hospital stays

The American Physical Therapy Association (APTA) cites the results of the first study to show the effectiveness of early physical therapy for patients in a medical intensive care unit (ICU).

The study, conducted by Peter Morris, M.D., associate professor in the Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases at Wake Forest University Baptist Medical Center, was presented at the October 23 meeting of the American College of Chest Physicians in Chicago.

"This non-randomized study, the first of its kind on this particular topic, proves that the skills of a physical therapist are essential to the expedient recovery of ICU patients," said Mary Pat C. Jobes, PT, MA, president of APTA's Acute Care Section and manager of physical therapy at Haywood Park Community Hospital in Brownsville, Tennessee.

Depending on the medical history and status of a patient, physical therapy can begin as soon as an ICU patient regains consciousness, notes Ethel Frese, PT, DPT, CCS, president of APTA's Cardiovascular and Pulmonary Section and an associate professor at St Louis University's Department of Physical Therapy. "Physical therapists work with ICU patients, both those breathing with or without a ventilator, with breathing exercises that use respiratory muscles, as well as range of motion exercises to do either sitting up in bed or in a chair," she said. "What physical therapists have always known and what Morris has proven in his study is that for patients who receive initial physical therapy, the number of days in the ICU and total number of hospital days were dramatically reduced," she added.

The length of stay for a group of respiratory-failure patients who received early mobilization and physical therapy within 48 hours of the insertion of a breathing tube was reduced by an average of 3 days compared with the stay for patients who did not receive the therapy. This reduced length of stay included a reduction of time in the ICU of more than a day.

Initial therapy - called passive range of motion - was provided by nursing assistants, with their training designed and implemented by physical therapists. The nursing assistants flexed the joints of the patients' upper and lower limbs 3 times a day, 7 days a week. As patients progressed, they received more advanced physical therapy from a physical therapist. The therapy proved safe, and there was also no addition to hospital costs because the salaries of the employees who provided range of motion and physical therapy were offset by reduced lengths of stay in the hospital, according to Morris and his research colleagues, Karen Taylor, PT, MPT and Bethany Harry, PT, MPT.

"Dr. Morris's study is particularly compelling because it so clearly demonstrates that it takes a multi-disciplinary team to care for ICU patients," observed Jobes. "The patients in the study were treated by a medical team that included an attending physician, critical care nurse, physical therapist and nursing assistant. Just as the patient could not recover without the skills of a critical care nurse, this study proved that the skills of a physical therapist were equally integral to recovery."

Immobility and the resulting loss of physical conditioning are common problems for patients with respiratory failure, which means they cannot breathe without the assistance of a ventilator, said Morris. However, little data exist on whether early mobility therapy for ICU patients is associated with improved outcomes or cost benefits.

"Although there are data for efficacy of exercise for emphysema patients and for congestive heart failure patients in the outpatient setting, this was the first time for ICU administration of exercise as a therapeutic agent," said Morris. "The project confirms that it is safe to administer early mobility to ICU patients, and that it was associated with benefit."

Phase I of a planned two-phase study was designed to address this lack of data by conducting a structured project, or protocol, over 24 consecutive months from 2004 to 2006 in which respiratory-failure patients admitted to the Medical Center's ICUs were assigned to one of two groups: 165 to a protocol group, which received early therapy from a mobility team (a critical care nurse, a nursing assistant and a physical therapist), and 165 to a control group, which received usual care. Some of those patients who received usual care also received physical therapy, although not as early or as frequently as those in the protocol group. Once patients were transferred to a regular nursing unit, both groups received usual care.

In addition to shorter hospital stays, the protocol patients also progressed more quickly to active physical therapy, were out of bed earlier, and experienced no adverse events during an ICU therapy session.

Physical therapists are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

The American Physical Therapy Association (www.apta.org) is a national organization representing more than 73,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access "Find a PT" to find a physical therapist in their area, as well as physical therapy news and information at www.apta.org/consumer.