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Does physical therapy in the intensive care unit improve outcomes for critically ill patients?
This study finds that physical therapy (PT) in critically ill patients may have beneficial effects such as improved physical function and quality of life. Additionally, PT in these patients may lead to increased ventilator-free days and decreased length of stay (LOS) in the hospital and the intensive care unit (ICU). Major limitations of this study are the heterogeneity in the interventions used and outcomes reported, as well as the baseline variability in the patient case mix. (LOE = 1a-)
Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med 2013;41(6):1543-1554. [PMID:23528802]
Meta-analysis (randomized controlled trials)
Inpatient (ICU only)
Critical illness can have a deleterious effect on a patient’s physical ability. These investigators searched multiple databases including MEDLINE, PubMed, and the Cochrane Database, as well as reference lists from retrieved articles for randomized controlled trials that studied the use of physical therapy (PT) versus no PT or minimal PT in patients in the ICU. Two authors independently evaluated studies for inclusion and performed quality assessments. Discrepancies were resolved by consultation with a third author. Of the 10 studies included (N = 790), the mean quality score was 5.4 on a scale of 0 to 10, with higher scores reflecting well-designed trials. Five of the studies took place in surgical or mixed ICUs, while the remaining 5 were in medical or respiratory units. PT interventions in the different trials varied, including passive and active range of motion exercises progressing to ambulation, early mobilization, electrical muscle stimulation, and ergometry. Control group treatments ranged from no treatment or sham treatment to standard PT. Outcomes were reported using the standardized mean difference between the intervention and control groups. An effect size of 0.2 to 0.5 suggests a small to medium effect. Pooling of data from the 2 trials that reported on physical function suggested a small effect favoring PT (effect size = 0.46; 95% CI, 0.13-0.78). Health-related quality of life was measured in 2 trials and also showed a small favorable effect with PT (effect size = 0.40; 0.08-0.71). Data from the 3 trials that reported on ventilator-free days again favored PT (effect size = 0.38; 0.16-0.59). Finally, 5 trials examined hospital LOS and 6 trials examined ICU LOS. Data for both suggested a reduction in LOS with use of PT (effect size = -0.34; -0.53 to -0.15 for hospital LOS; and effect size = -0.34; -0.51 to -0.18 for ICU LOS). There was no mortality benefit noted with the use of PT.