Does 6-month home caregiver-supervised physiotherapy improve post-critical care outcomes?

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Abstract

Objective This study aims to determine whether a 6-month home physiotherapy program can improve outcomes in critical care survivors. Design Forty-eight consecutive patients were randomized. The treatment group underwent 2 sessions/day of breathing retraining and bronchial hygiene, physical activity (mobilization, sit-to-stand gait, limb strengthening), and exercise re-conditioning whereas controls underwent standard care. Maximum inspiratory/expiratory pressures (MIP/MEP), forced volumes, blood gases, dyspnea, respiratory rate, disability, peripheral force measurements, perceived health status (Euroquol-5D), patient adherence/satisfaction, safety, and costs were assessed. Results Outcomes of treatment versus controls: MIP 14 ± 17 vs. -0.2 ± 14 cm H2O, MEP 27 ± 27 vs. 6 ± 21 cm H2O both P <0.03; in addition, quality of life (Euroquol-5D) (P = 0.04), FEV 1 (P = 0.03), dyspnea (P = 0.002), and respiratory rate (P = 0.009) were significantly improved for treated cardiorespiratory patients only. Eighty-three percent of the treated patients were decannulated versus 14% of controls (P = 0.01). Compliance was high (74 ± 25%) and there were no side effects. The majority (87.4%) expressed satisfaction with the program. Treatment cost was 459€/patient/month. Conclusions Carrying over regular bronchial hygiene techniques, physical activity, and exercise into the home after long critical care stays is safe and has a beneficial effect on respiratory muscles, decannulation, pulmonary function, and quality of life.

Original languageEnglish
Pages (from-to)571-579
Number of pages9
JournalAmerican Journal of Physical Medicine and Rehabilitation
Volume95
Issue number8
DOIs
Publication statusPublished - Aug 1 2016

Keywords

  • Caregiver
  • Chronic Respiratory Failure
  • Homecare
  • Post-ICU Outcomes

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

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