PHYS THER
Vol. 86, No. 9, September 2006, p. 1272
DOI: 10.2522/ptj.20050036.bl
The Bottom Line
[Chiang LL, Wang LY, Wu CP, et al. Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther. 2006;86:1271–1281.]
The Bottom Line is a translation of study findings for application to clinical practice. It is not intended to substitute for a critical reading of the research article. Summaries are written by members of The Bottom Line Committee.
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What problems did the researchers set out to study, and why?
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During the past 20 years, improved intensive care of patients who are critically ill has enhanced patient survival. However, some patients require breathing support by mechanical ventilators for prolonged periods of time during their recovery. During these periods of mechanical ventilation, patients often become severely deconditioned due to their illness, the adverse effects of medications, and bed rest. Following discharge from the hospital, they require intensive physical rehabilitation to regain their strength to resume their daily activities. These authors sought to determine whether participation in a physical rehabilitation program in the acute care setting while the patient is receiving mechanical ventilation would result in the patient having a higher functional level upon discharge from the hospital.
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Who participated in the study?
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The participants were adult male and female patients (n=32) who required mechanical ventilation for more than 14 days. Patients were required to be medically stable, mentally alert, and be free of neurological impairments.
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What new information does this study offer?
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Participation in a physical rehabilitation program during hospitalization while receiving mechanical ventilation improved the patients' arm, leg, and respiratory muscle strength. These improvements were associated with improvements in performing functional activities, such as self-care, being able to get from a bed to a chair, and being able to walk short distances.
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How did the researchers go about the study?
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The investigators randomly assigned the patients to 2 groups. One group participated in a 6-week physical rehabilitation program administered by a physical therapist. The program consisted of exercises for the arms and legs using weights and breathing exercises for the respiratory muscles. Patients also practiced functional activities such as rolling, sitting, standing, and walking as their strength progressed. The other group was not seen by the physical therapist. Both groups received comprehensive treatment for their medical conditions by the doctors and nurses. The strength and functional level of both groups of patients was evaluated at the beginning of the study and 3 and 6 weeks later.
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How might the results of this study apply to patients who are treated by physical therapists from this point forward?
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Both groups of patients were similar in age, severity, and cause of illness and had the same muscle strength and function at the beginning of the study. Patients who participated in the physical rehabilitation program improved arm, leg, and respiratory muscle strength, whereas patients who did not participate in the program became weaker throughout the study period. Participation in the program also resulted in improvements in performance of functional activities, including 53% of patients being able to walk short distances by the end of the study. The other group of patients remained bedridden throughout the 6-week study period with little change in their functional level.
Physical therapists should consider providing physical rehabilitation programs to patients who are receiving long periods of mechanical ventilation as long as the patients are mentally alert and medically stable. This study demonstrated that patients can improve extremity and respiratory muscle strength as well as the ability to perform functional activities if they participate in a physical rehabilitation program during periods of prolonged mechanical ventilation in the acute hospital setting. Involvement in a physical rehabilitation program while mechanically ventilated also may contribute to earlier return of the ability to walk.
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What are the limitations of the study, and what further research is needed?
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This study applied only to patients who were receiving long periods of mechanical ventilation and who were medically stable. The patients also were required to be mentally alert and not have any neurological impairment to participate in the study. This study was not designed to determine the effect of physical rehabilitation in other patients who are critically ill. Although the results were positive, the number of patients included in the study was small. Further research is needed to examine the results of physical rehabilitation in a larger number of patients who are ventilator dependent. In addition, it is important to identify which patient populations will benefit from physical rehabilitation in the critical care setting and to determine the optimal guidelines for the therapeutic interventions utilized.
Related Article
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Effects of Physical Training on Functional Status in Patients With Prolonged Mechanical Ventilation
- Ling-Ling Chiang, Li-Ying Wang, Chin-Pyng Wu, Huey-Dong Wu, and Ying-Tai Wu
Physical Therapy 2006 86: 1271-1281.
[Abstract]
[Full Text]
[PDF]
Copyright © 2006 by the American Physical Therapy Association.
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