Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19.
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2024-07
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Abstract
Objective
To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19.Design
Retrospective practice analysis from March 5, 2020, to April 15, 2021.Setting
Intensive care units (ICU) at four medical institutions.Patients
n = 3780 adults with ICU admission and diagnosis of COVID-19.Interventions
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).Measurements and main results
The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman's rho [r] = 0.484, p < 0.001). Multivariate linear regression (model adjusted R2 = 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.Conclusions
Greater physical rehabilitation exposure early in the ICU is associated with better physical function at hospital discharge.Type
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Mayer, Kirby P, Evan Haezebrouck, Lori M Ginoza, Clarisa Martinez, Minnie Jan, Lori A Michener, Lindsey E Fresenko, Ashley A Montgomery-Yates, et al. (2024). Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19. Critical care (London, England), 28(1). p. 248. 10.1186/s13054-024-05035-6 Retrieved from https://hdl.handle.net/10161/32089.
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Scholars@Duke
Amy Martha Pastva
The major themes that embody Dr. Pastva's scholarly pursuits include: a) mechanisms of physical reserve and resilience; b) rehabilitation strategies for improving the health and function of individuals living with chronic cardiovascular and pulmonary diseases and/or surviving critical illness; and c) pedagogical strategies that will optimize health professions curricula to address clinical practice expectations in aging and acute or critical illness. In addition to her faculty appointments, she is Director of Research in the Physical Therapy Division, a Senior Fellow in the Duke Center for the Study of Aging and Human Development, a Duke Pepper Older American Independence Center (OAIC) Scholar, and co-lead of the Center’s Health and Mobility Measures Core. She serves as an advisor in Duke Health's Cardiovascular and Pulmonary Physical Therapy Residency Program. She also serves on the American Physical Therapy Association’s ICU Rehabilitation Clinical Guideline Development Group, on the Research Committee of its Cardiovascular and Pulmonary Academy, and on the Editorial Board of the Physical Therapy & Rehabilitation Journal.
Joshua Kurt Johnson
As a physical therapist researcher, I seek to better understand and improve rehabilitation care delivery using the learning health system framework. This prompts overlap in my work between data science and implementation science. I have the opportunity to use various sources of health data and engage in multiple quantitative and qualitative research methods. My work also lends naturally to partnership with healthcare leaders and clinicians. To facilitate this work, I have several roles at Duke University. In the School of Medicine, I am an Assistant Professor in the Division of Physical Therapy, Department of Orthopaedic Surgery, and Department of Population Health Sciences. I am also the Clinical Research Lead for the Duke University Health System Department of Rehabilitation and a member of the Duke Clinical Research Institute. Prior to joining the faculty at Duke, I was the Director of PM&R Outcomes Research at Cleveland Clinic. My PhD training was at the University of Utah. I hold a Doctor of Physical Therapy degree from Arcadia University and Bachelors degree in Athletic Training from Brigham Young University.
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