Monthly Archives November 2012

Rehabilitation

Posted by admin on November 02, 2012  /   Posted in Uncategorized

Physiotherapy is an important intervention that prevents and mitigates adverse effects of prolonged bed rest and mechanical ventilation during critical illness. Rehabilitation delivered by the physiotherapist is tailored to patient needs and depends on conscious state, psychological status and physical strength. It incorporates any active and passive therapy that promotes movement and includes mobilisation. Early progressive physiotherapy, with a focus on mobility and walking whilst ventilated, is essential in minimising functional decline.(18) If this process does not occur within the critical care environment, there are increased costs of service provision to the health system, as these patients often require extensive periods of rehabilitation and follow-up to meet long-term disability needs as a result of critical illness.(19)

The National Institute for Health and Clinical Excellence (NICE)(10), The European Respiratory Society and the European Society of Intensive Care Medicine(14) recommend early assessment and management of physical morbidity (including mobilisation and muscle training) delivered by physiotherapists and other health professionals. They also recommend that the physiotherapist should be responsible for implementing mobilisation plans and exercise prescription in conjunction with other team members.

Early physiotherapy and occupational therapy of mechanically ventilated patients is safe, well-tolerated and has shown to result in more ventilator-free days compared with standard care, and a shorter duration of delirium.(20) Early rehabilitation of mechanically ventilated patients results in improved respiratory and limb muscle strength and better functional independence at hospital discharge, both in exercise capacity(21) and basic activities of daily living.(20)

Early mobilisation can reduce ICU and hospital length of stay.(21) A study that implemented a physiotherapy led early mobility protocol showed decreased intensive care unit and hospital length of stay (11.2 versus 14.5 days) and a potential cost saving of 7% of standard patient care costs.(22)