Gruther Wolfgang, Pieber Karin, Steiner Irene, Hein Cornelia, Hiesmayr Jörg Michael, Paternostro-Sluga Tatjana
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.
Am J Phys Med Rehabil. 2017 Sep;96(9):607-615. doi: 10.1097/PHM.0000000000000718.
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.
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.
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.
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.
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.
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.
本研究旨在评估针对危重症幸存者的早期康复计划是否能改善功能恢复情况、缩短住院时间并降低住院费用。
这是一项前瞻性随机对照试验。该研究纳入了53例连续的危重症幸存者。从重症监护病房出院后，干预组接受早期康复计划，标准护理组则按照初级护理团队的医嘱接受物理治疗。记录从重症监护病房转出后在普通病房的住院时间。此外，还使用了早期康复Barthel指数、疼痛视觉模拟量表、3分钟步行试验、贝克抑郁量表、状态-特质焦虑量表和医学研究委员会量表。
在符合方案分析中，早期康复组在普通病房的住院时间中位数为14天（四分位间距[IQR]，12 - 20天），标准护理组为21天（IQR，13 - 34天）。但在意向性分析中未能证实这一显著结果（16天[IQR，13 - 23天]对21天[IQR，13 - 34天]）。两组的次要结局相似。干预组的住院费用较低。未检测到不良反应。
针对危重症幸存者的早期康复计划可使患者更早出院，改善功能恢复，且具有成本效益和安全性。
高级。认证：学术物理医学与康复医师协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理医学与康复医师协会指定此基于期刊的继续医学教育活动最多可获得0.5个美国医学协会医师认可奖第1类学分™。医生应仅根据其参与活动的程度申请相应学分。
