A randomised trial of an intensive physiotherapy program for patients in intensive care [commentary]

AuthorBerney, SC.
TypeJournal Article (Original Research)
JournalJournal of Physiotherapy
PubMed ID26947004
Year of Publication2016
Download 2016_July_Berney.pdf (80.9 KB)
Survivors of acute respiratory failure requiring intensive care unit (ICU) admission and mechanical ventilation frequently suffer enduring impairments of physical function.1 To date, no trial, including that of Moss and colleagues, which commenced an intervention during hospitalisation, has impacted performance-based measures of physical function after hospital discharge. The authors are to be applauded for conducting a trial with high treatment fidelity, and that achieved separation and sample size, as these elements have not always been achieved in rehabilitation trials.2 and 3 However, the results must be viewed with caution. Firstly, the primary outcome (Physical Functional Performance Test score) is not validated in critical illness survivors. The test exhibited a substantial floor effect at the primary time point, with a completion rate of 33% of participants. This increased to 48% at 3 months and 43% at 6 months. Furthermore, as measured by the short form of the Continuous Scale Physical Functional Performance Test score, two participants achieved functional independence on completion of physiotherapy treatment (both in the control group), despite 50% of participants being discharged home. Secondly, a significant between-group difference in age was observed and, although not significant, the intervention group were weaker, had lower bed mobility scores and completed less available rehabilitation days in ICU than the standard care arm, suggesting important differences may have been present at randomisation. Thirdly, although described as an early intervention, intensive treatment was not initiated until a median of 8 days (IQR 6 to 11). Despite the results of this and other rehabilitation trials for critical illness survivors, these studies consistently report a perilous state of physical function beyond hospital discharge.1 and 2 It is important that we continue to seek interventions to improve these outcomes. However, the results of the AVERT trial3 are a salient reminder that we don't yet understand the who, when and how of rehabilitation for survivors of critical illness.


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