An Early Tailored Approach Is The Key To Effective Rehabilitation In The Intensive Care Unit

Publication date: Available online 21 February 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Alice Chiarici, Oletta Serpilli, Matteo Andreolini, Silvia Tedesco, Giovanni Pomponio, Maria Mattea Gallo, Claudio Martini, Roberto Papa, Michela Coccia, Maria Gabriella Ceravolo, Elisa Andrenelli

Abstract

Objective

To investigate the effectiveness, feasibility and safety of an evidence-based rehabilitation care pathway in the Intensive Care Unit (ICU), in different patient populations.

Design

observational prospective cohort study, with retrospective controls.

Setting

ICUs of a University-Hospital.

Participants

Patients admitted between April1st and June30th2015 were compared to a retrospective cohort admitted to the same ICUs during the same 3-month period in 2014.

Interventions

The prospective cohort benefitted of a rehabilitation care pathway based on: interdisciplinary teamwork, early customized and goal-oriented rehabilitation, daily functional monitoring and treatment revision, agreed discharge policy and continuity of care. The retrospective cohort underwent usual care.

Outcome measures

a) proportions of patients undergoing rehabilitation-team evaluation; b) latency between patient admission to ICUs and rehabilitation-team assessment; c) proportions of patients undergoing rehabilitation treatment during ICU stay; d) latency between the patient admission to ICUs and rehabilitation start; e) ICU stay and total acute hospital stay; f) proportion of ventilator-free days out of ICU stay.

Results

285 patients were studied, 152 in the prospective and 133 in the retrospective group. The novel rehabilitation care pathway led to: an increased proportion of patients receiving rehabilitative assessment (p<.0001), a decreased latency from ICU admission to both rehabilitation-team assessment and rehabilitation start(p<.0001), an increased proportion of patients undergoing rehabilitation(p<.0001), a shorter length of stay in ICUs(p<.0001) and in hospital(p=.047), a shorter mechanical ventilation duration(p<.02). A direct relationship between rehabilitation start latency and ICU length of stay was observed.

Conclusions

An early, interdisciplinary team approach, providing a customized dynamic planning of physiotherapy programs, increases ventilator-free time and reduces total hospital stay, especially in patients admitted to the ICU after general surgery. This rehabilitation care pathway can be generalized to different geopolitical scenarios, being feasible, safe and cost-effective.

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