Increasing the dose of acute rehabilitation: is there a benefit?

BMC Medicine

Dale M Needham³  Robert K Lord²  Ann M Parker¹ 

[1]Outcomes after Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 East Monument St., 5th Floor, Baltimore, MD 21205, USA

[2]Johns Hopkins University School of Medicine, 1830 East Monument St., 5th Floor, Baltimore, MD 21205, USA

[3]Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 1830 East Monument St., 5th Floor, Baltimore, MD 21205, USA

关键词: Length of stay;    Mobility limitation;    Activities of daily living;    Quality of life;    Rehabilitation;    Physical therapy modalities;    Occupational therapy;   

Others  :  855720
DOI  :  10.1186/1741-7015-11-199

 received in 2013-08-28, accepted in 2013-08-28,  发布年份 2013

【 摘 要 】

Rehabilitation interventions, including physiotherapy and occupational therapy, can improve patient outcomes; however, the optimal duration and frequency of inpatient rehabilitation interventions is uncertain. In a recent randomized controlled trial published in BMC Medicine, 996 patients in two publicly-funded Australian metropolitan rehabilitation facilities were assigned to physiotherapy and occupational therapy delivered Monday through Friday (five days/week control group) versus Monday through Saturday (six days/week intervention group). This increased dose of rehabilitation in the intervention group resulted in greater functional independence and quality of life at discharge, with a trend towards significant improvement at six-month follow-up. Moreover, the length of stay for the intervention group was shorter by two days (95% CI 0 to 4, P = 0.10). Hence, in the acute inpatient rehabilitation setting, a larger dose of physiotherapy and occupational therapy, via six versus five days/week treatment, improves patient outcomes and potentially reduces overall length of stay and costs.

Please see related research: http://www.biomedcentral.com/1741-7015/11/198 webcite.

【 授权许可】

   
2013 Parker et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kayambu G, Boots R, Paratz J: Physical therapy for the critically Ill in the ICU: a systematic review and meta-analysis. Crit Care Med 2013, 41:1543-1554.
• [2]Peiris CL, Taylor NF, Shields N: Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review. Arch Phys Med Rehabil 2011, 92:1490-1500.
• [3]Lord RK, Mayhew CR, Korupolu R, Mantheiy EC, Friedman MA, Palmer JB, Needham DM: ICU early physical rehabilitation programs: financial modeling of cost savings. Crit Care Med 2013, 41:717-724.
• [4]Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF: Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial. BMC Med 2013. In press
• [5]Keogh B: Should the NHS work at weekends as it does in the week? Yes. BMJ 2013, 346:f621.
• [6]Campbell L, Bunston R, Colangelo S, Kim D, Nargi J, Hill K, Brooks D: The provision of weekend physiotherapy services in tertiary-care hospitals in Canada. Physiother Can 2010, 62:347-354.
• [7]Smith P, Galea M, Woodward M, Said C, Dorevitch M: Physical activity by elderly patients undergoing inpatient rehabilitation is low: an observational study. Aust J Physiother 2008, 54:209-213.
• [8]Shaw KD, Taylor NF, Brusco NK: Physiotherapy services provided outside of business hours in Australian hospitals: a national survey. Physiother Res Int 2013, 18:115-123.
• [9]Parker A, Tehranchi K, Needham D: Critical care rehabilitation trials: the importance of ‘usual care’. Crit Care 2013, 17:183.
• [10]Peiris CL, Taylor NF, Shields N: Patients value patient-therapist interactions more than the amount or content of therapy during inpatient rehabilitation: a qualitative study. J Physiother 2012, 58:261-268.
• [11]Peiris CL, Taylor NF, Shields N: Additional Saturday allied health services increase habitual physical activity among patients receiving inpatient rehabilitation for lower limb orthopedic conditions: a randomized controlled trial. Arch Phys Med Rehabil 2012, 93:1365-1370.