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Early Rehabilitation Interventions and Physical Therapy in Adults Who Were Critically Ill With COVID-19 Pneumonia: A Retrospective Observational Study.
- Source :
-
PTJ: Physical Therapy & Rehabilitation Journal . Feb2023, Vol. 103 Issue 2, p1-9. 9p. - Publication Year :
- 2023
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Abstract
- Objective The primary objective of this observational study was to analyze the time to the first edge-of-bed (EOB) mobilization in adults who were critically ill with severe versus non-severe COVID-19 pneumonia. Secondary objectives included the description of early rehabilitation interventions and physical therapy delivery. Methods All adults with laboratory-confirmed COVID-19 requiring intensive care unit admission for ≥72 hours were included and divided according to their lowest PaO2/FiO2 ratio into severe (≤100 mmHg) or non-severe (>100 mmHg) COVID-19 pneumonia. Early rehabilitation interventions consisted of in-bed activities, EOB or out-of-bed mobilizations, standing, and walking. The Kaplan–Meier estimate and logistic regression were used to investigate the primary outcome time-to-EOB and factors associated with delayed mobilization. Results Among the 168 patients included in the study (mean age = 63 y [SD = 12 y]; Sequential Organ Failure Assessment = 11 [interquartile range = 9–14]), 77 (46%) were classified as non-severe, and 91 (54%) were classified as severe COVID-19 pneumonia. Median time-to-EOB was 3.9 days (95% CI = 2.3–5.5) with significant differences between subgroups (non-severe = 2.5 days [95% CI = 1.8–3.5]; severe = 7.2 days [95% CI = 5.7–8.8]). Extracorporeal membrane oxygenation use and high Sequential Organ Failure Assessment scores (adjusted effect = 13.7 days [95% CI = 10.1–17.4] and 0.3 days [95% CI = 0.1–0.6]) were significantly associated with delayed EOB mobilization. Physical therapy started within a median of 1.0 days (95% CI = 0.9–1.2) without subgroup differences. Conclusion This study shows that early rehabilitation and physical therapy within the recommended 72 hours during the COVID-19 pandemic could be maintained regardless of disease severity. In this cohort, the median time-to-EOB was fewer than 4 days, with disease severity and advanced organ support significantly delaying the time-to-EOB. Impact Early rehabilitation in the intensive care unit could be sustained in adults who are critically ill with COVID-19 pneumonia and can be implemented with existing protocols. Screening based on the PaO2/FiO2 ratio might reveal patients at risk and increased need for physical therapy. [ABSTRACT FROM AUTHOR]
- Subjects :
- *PNEUMONIA
*INTENSIVE care units
*COVID-19
*SCIENTIFIC observation
*CONFIDENCE intervals
*PHYSICAL therapy
*CRITICALLY ill
*LOG-rank test
*PATIENTS
*RETROSPECTIVE studies
*ACQUISITION of data
*EXTRACORPOREAL membrane oxygenation
*MANN Whitney U Test
*FISHER exact test
*HOSPITAL admission & discharge
*SEVERITY of illness index
*EARLY ambulation (Rehabilitation)
*MUSCLE weakness
*PEARSON correlation (Statistics)
*TREATMENT effectiveness
*MEDICAL records
*DESCRIPTIVE statistics
*CHI-squared test
*LOGISTIC regression analysis
*BODY mass index
*DATA analysis software
*EARLY medical intervention
*LONGITUDINAL method
*ADULTS
Subjects
Details
- Language :
- English
- ISSN :
- 15386724
- Volume :
- 103
- Issue :
- 2
- Database :
- Academic Search Index
- Journal :
- PTJ: Physical Therapy & Rehabilitation Journal
- Publication Type :
- Academic Journal
- Accession number :
- 162394293
- Full Text :
- https://doi.org/10.1093/ptj/pzac157