Mayer Kirby P, Haezebrouck Evan, Ginoza Lori M, Martinez Clarisa, Jan Minnie, Michener Lori A, Fresenko Lindsey, Montgomery-Yates Ashley A, Kalema Anna G, Pastva Amy M, Biehl Michelle, Mart Matthew F, Johnson Joshua K
University of Kentucky.
University of Michigan-Ann Arbor.
Res Sq. 2024 May 15:rs.3.rs-4319133. doi: 10.21203/rs.3.rs-4319133/v1.
to examine the relationship between physical rehabilitation parameters including a novel approach to quantifying dosage with hospital outcomes for patients with critical COVID-19.
Retrospective practice analysis from March 5, 2020, to April 15, 2021.
Intensive care units (ICU) at four medical institutions.
n = 3,780 adults with ICU admission and diagnosis of COVID-19.
We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: 1) mortality; 2) discharge disposition; and 3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) "6-Clicks" (6-24, 24=greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital).
The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m and 46% (n=1739) required mechanical ventilation. For 2191 patients with complete data, rehabilitation dosage and AM-PAC at discharge were moderately, positively associated (Spearman's rho [r] = 0.484, p < 0.001). Multivariate linear regression (model adjusted R= 0.68, p <0.001) demonstrates mechanical ventilation (β = -0.86, p = 0.001), average mobility score in first three sessions (β = 2.6, p <0.001) and physical rehabilitation dosage (β = 0.22, p = 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS.
Greater physical rehabilitation exposure early in the ICU is associated with physical function at hospital discharge.
研究包括一种新型剂量量化方法在内的物理康复参数与重症新型冠状病毒肺炎（COVID-19）患者医院结局之间的关系。
2020年3月5日至2021年4月15日的回顾性实践分析。
四家医疗机构的重症监护病房（ICU）。
n = 3780名入住ICU并被诊断为COVID-19的成年人。
我们测量了在ICU提供的物理康复治疗及患者结局：1）死亡率；2）出院处置情况；3）出院时通过急性后期护理活动量表（AM-PAC）“6项点击式评估”（6 - 24分，24分表示功能独立性更强）测量的身体功能。物理康复剂量定义为前三个疗程的平均活动水平得分（强度的替代指标）乘以康复频率（住院期间物理治疗 + 职业治疗的频率）。
该队列患者的平均年龄为64 ± 16岁，41%为女性，平均体重指数为32 ± 9 kg/m²，46%（n = 1739）需要机械通气。对于2191例有完整数据的患者，康复剂量与出院时的AM-PAC得分呈中度正相关（斯皮尔曼等级相关系数[r] = 0.484，p < 0.001）。多变量线性回归（模型调整后R = 0.68，p < 0.001）表明，在控制年龄、性别、体重指数和ICU住院时间后，机械通气（β = -0.86，p = 0.001）、前三个疗程的平均活动得分（β = 2.6，p < 0.001）和物理康复剂量（β = 0.22，p = 0.001）可预测出院时的AM-PAC得分。
在ICU早期接受更多的物理康复治疗与出院时的身体功能相关。
