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Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19
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Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19
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Journal Article
Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19
2024
Overview
Objective
To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19.
Design
Retrospective practice analysis from March 5, 2020, to April 15, 2021.
Setting
Intensive care units (ICU) at four medical institutions.
Patients
n = 3780 adults with ICU admission and diagnosis of COVID-19.
Interventions
We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) “6-Clicks” (6–24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital).
Measurements and main results
The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m
2
and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman’s rho [r] = 0.484,
p
< 0.001). Multivariate linear regression (model adjusted R
2
= 0.68,
p
< 0.001) demonstrates mechanical ventilation (β = − 0.86,
p
= 0.001), average mobility score in first three sessions (β = 2.6,
p
< 0.001) and physical rehabilitation dosage (β = 0.22,
p
= 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS.
Conclusions
Greater physical rehabilitation exposure early in the ICU is associated with better physical function at hospital discharge.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V
Subject
/ Analysis
/ Clinical practice guidelines
/ COVID-19
/ Critical Illness - rehabilitation
/ Female
/ Humans
/ Intensive Care Units - organization & administration
/ Intensive Care Units - statistics & numerical data
/ Male
/ Medicine
/ Mobility
/ Patient Discharge - statistics & numerical data
/ Patients
