Exercise therapy benefits ICU patients

An exercise program developed at Wake Forest University Baptist Medical Center aimed at helping patients in the medical Intensive Care Unit (ICU) maintain physical conditioning is a featured 'Innovation Profile' on the Agency for Healthcare Research and Quality (AHRQ) Web site.

The movement therapy, designed for patients who require a mechanical ventilator to breathe, has been shown to encourage early walking and has reduced length of hospital stay. Read about the protocol at http://www.ahrq.gov/. AHRQ is part of the Department of Health and Human Services and focuses on advancing health care quality.

Peter Morris, M.D., an associate professor of internal medicine-pulmonary/critical care, launched a 24-month study of 'mobility therapy' in 2004, following 330 ICU patients who received either standard care or a daily exercise intervention performed with the help of a critical care nurse, physical therapist and nursing assistant.

Weakness and loss of conditioning are common problems suffered by patients with acute respiratory failure who can breathe only with the assistance of a ventilator, but most institutions do not provide consistent physical therapy, or any physical therapy at all, to ICU patients on ventilators, Morris said. Research shows that physical deconditioning may contribute to extended stays in the ICU of 25 days or more.

The study, funded by North Carolina Baptist Hospital, which is a part of the Medical Center, included patients ages 18 and older who were on ventilators in the ICU. Patients with neuromuscular disease, stroke, hip fracture, and those unable to walk or with cognitive impairment prior to ICU admittance were not included in the study.

Patients receiving the exercise therapy were assessed each day to ensure that it was safe for them to participate. Therapists moved the patients through four escalating levels of exercise toward the goal of standing and walking. The regimen continued until the patient was transferred out of the ICU.

Patients who received the exercise therapy got out of bed in an average of 5 days, compared to 11.3 days in the 'usual care,' or control, group.  Their average length of stay in the ICU was 5.5 days, compared to 6.9 days in the control group, and the overall hospital length of stay for patients who received the mobility therapy was an average of 11.2 days compared to 14.5 days for the control group.

"We've shown that there is a measurable benefit to physical therapy in the ICU environment," Morris said. "I am pleased to have our findings included on the AHRQ innovations Web site and hope to advance knowledge in this area of care."

Articles about Morris' findings regarding mobility therapy have been published in Critical Care Medicine (Aug. 2008) and Critical Care Clinics (Jan. 2007). The AHRQ article includes pointers for providers who want to implement mobility therapy in their hospitals.

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