Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19

Abstract 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...

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Published in:Critical care (London, England) England), 2024-07, Vol.28 (1), p.1, Article 248
Main Authors: Mayer, Kirby P., Haezebrouck, Evan, Ginoza, Lori M., Martinez, Clarisa, Jan, Minnie, Michener, Lori A., Fresenko, Lindsey E., Montgomery-Yates, Ashley A., Kalema, Anna G., Pastva, Amy M., Biehl, Michelle, Mart, Matthew F., Johnson, Joshua K.
Format: Article
Language:English
Subjects:
Analysis
Body mass index
Brief Report
Clinical medicine
Clinical practice guidelines
COVID-19
Critical care
Illnesses
Intensive care
Length of stay
Mobility
Mortality
Occupational therapy
Older people
Patients
Physical therapy
Regression analysis
Rehabilitation
Therapeutics, Physiological
Ventilators
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Summary:Abstract 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.
ISSN:1364-8535
1466-609X
1364-8535
1466-609X
1366-609X
DOI:10.1186/s13054-024-05035-6