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Abstract

I thank Dr Davis and colleagues for their interest in my systematic review.1Stiller K Physiotherapy in intensive care: an updated systematic review.Chest. 2013; 144: 825-847Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar I completely agree that patient mobilization should be a priority in adult ICUs for virtually all patients, not just those who are intubated and receiving mechanical ventilation. The study Dr Davis and colleagues have undertaken, showing that early mobilization is feasible and safe for patients with ischemic stroke within 13 to 24 h of receiving IV tissue plasminogen activator, is very welcome.2Davis O Mooney L Dinkins M Freeman WD Arnold S Early mobilization of ischemic stroke patients post intravenous tissue plasminogen activator [abstract].Stroke. 2013; 44: A121Crossref Google Scholar The AVERT (A Very Early Rehabilitation Trial) series of trials by Bernhardt and colleagues,3Bernhardt J Dewey H Donnan G et al.http://www.florey.edu.au/research/stroke/a-very-early-rehabilitation-trial-avert-phase-iiiGoogle Scholar who are investigating the feasibility, safety, and effectiveness of very early rehabilitation for patients with stroke, offer further evidence of the importance of early progressive mobilization and rehabilitation for patients with neurologic conditions. Increasing evidence is also showing that early progressive mobilization is the most important physiotherapy intervention after major surgical procedures, such as upper abdominal surgery.4Mackay MR Ellis E Johnston C Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients.Aust J Physiother. 2005; 51: 151-159Abstract Full Text PDF PubMed Scopus (68) Google Scholar My two systematic reviews1Stiller K Physiotherapy in intensive care: an updated systematic review.Chest. 2013; 144: 825-847Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar, 5Stiller K Physiotherapy in intensive care: towards an evidence-based practice.Chest. 2000; 118: 1801-1813Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar deliberately focused on adult patients who are intubated and receiving mechanical ventilation in the ICU, hence, studies involving patients who were ventilating spontaneously were not considered. Although both reviews identified studies where patients with neurologic or neurosurgical conditions were specifically investigated, such studies were sparse. There clearly is a need for further research involving specific patient groups (eg, with specific neurologic conditions) regarding the feasibility and safety of early progressive mobilization and rehabilitation and to evaluate the effectiveness of early progressive mobilization and rehabilitation at improving functional outcomes, decreasing ICU and hospital lengths of stay, and reducing health-care costs. Physiotherapy in Patients in the ICU Treated With IV Tissue Plasminogen Activator for StrokeCHESTVol. 145Issue 2PreviewWe read with interest the recent article in CHEST (September 2013) by Stiller,1 who provided a systematic review of the literature on physiotherapy in the ICU. The author concluded that early patient mobilization should be a priority in adult ICUs. We agree with this practice and suggest that it is beneficial for most critically ill patients, even in patients not receiving mechanical ventilation. Although not a primary focus of this review, we found little mention of patients in the neuro-ICU, with the exception of intracranial pressure monitoring in neurosurgery patients as seen in Table 3 of the article. Full-Text PDF