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Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness?: A Randomized Controlled Trial

Gruther, Wolfgang MD, MSc; Pieber, Karin MD; Steiner, Irene MSc; Hein, Cornelia PT; Hiesmayr, Jörg Michael MD; Paternostro-Sluga, Tatjana MD

American Journal of Physical Medicine & Rehabilitation: September 2017 - Volume 96 - Issue 9 - p 607–615
doi: 10.1097/PHM.0000000000000718
Original Research Articles CME Article . 2017 Series . Number 11

Objective: The aim of this study was to evaluate if an early rehabilitation program for survivors of critical illness improves functional recovery, reduces length of stay, and reduces hospital costs.

Design: This was a prospective randomized controlled trial. Fifty-three consecutive survivors of critical illness were included in the study. After discharge from the intensive care unit, the intervention group received an early rehabilitation program, and the standard-care group received physical therapy as ordered by the primary care team. Length of stay at the general ward after transfer from the intensive care unit was recorded. In addition, Early Rehabilitation Barthel Index, visual analog scale for pain, 3-minute walk test, Beck Depression Inventory, State-Trait Anxiety Inventory, and Medical Research Council scale were used.

Results: In the per-protocol analysis, length of stay at the general ward was a median 14 days (interquartile range [IQR], 12–20 days) in the early rehabilitation and 21 days [IQR, 13–34 days) in the standard-care group. This significant result could not be confirmed by the intention-to-treat analysis (16 days [IQR, 13–23 days] vs. 21 days [IQR, 13–34 days]). Secondary outcomes were similar between the groups. Hospital costs were lower in the intervention group. No adverse effects were detected.

Conclusions: An early rehabilitation program in survivors of critical illness led to an earlier discharge from the hospital, improved functional recovery, and was also cost-effective and safe.

To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives: Upon completion of this article, the reader should be able to (1) delineate the benefits of early rehabilitation on a general medicine ward after an intensive care unit stay, (2) recognize the safety of appropriately implemented early rehabilitation, and (3) incorporate early rehabilitation on the general medical ward as applicable.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital Vienna (WG, KP, CH, TP-S); Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna (IS); Department of Anaesthesia and Intensive Care, Medical University of Vienna, General Hospital Vienna (JMH); and Department of Physical Medicine and Rehabilitation, Danube Hospital Vienna, Vienna Hospital Association (TP-S), Vienna, Austria.

All correspondence and requests for reprints should be addressed to: Karin Pieber, MD, Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.

This study was supported by funds of the Oesterreichische Nationalbank (Anniversary Fund, project no. 12751) awarded to T.P.-S. The funding source had no role in the study concept, design, data collection, data analysis, data interpretation or the writing of the report. The researchers I.S., C.H., Matthias Lenz, and Bryon Hofbauer have received honoraria from this grant. For the remaining authors, none were declared.

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