Timing and Amount of Physical Therapy Treatment are Associated with Length of Stay in the Cardiothoracic ICU

Audrey M Johnson,Peter E Morris,Angela N Henning,Esther E Dupont-Versteegden,Alejandro G Villasante Tezanos

doi:10.1038/s41598-017-17624-3

Abstract

Significant variability exists in physical therapy early mobilization practice. The frequency of physical therapy or early mobilization of patients in the cardiothoracic intensive care unit and its effect on length of stay has not been investigated. The goal of our research was to examine variables that influence physical therapy evaluation and treatment in the intensive care unit using a retrospective chart review. Patients (n = 2568) were categorized and compared based on the most common diagnoses or surgical procedures. Multivariate semi-logarithmic regression analyses were used to determine correlations. Differences among patient subgroups for all independent variables other than age and for length of stay were found. The regression model determined that time to first physical therapy evaluation, Charlson Comorbidity Index score, mean days of physical therapy treatment and mechanical ventilation were associated with increased hospital length of stay. Time to first physical therapy evaluation in the intensive care unit and the hospital, and mean days of physical therapy treatment associated with hospital length of stay. Further prospective study is required to determine whether shortening time to physical therapy evaluation and treatment in a cardiothoracic intensive care unit could influence length of stay.

Highlights

Despite growing support for the benefits of early active mobilization of patients in the ICU, significant variability in this practice exists17
Complications related to clinical care are a risk for cardiothoracic ICU patients, who are increasingly diagnosed with frailty22–26, which may predict post-surgical complications including, mortality, prolonged ventilation, and poor medical and functional outcomes27,28
We have successfully investigated variables related to timing and amount of physical therapy for select patient subgroups in a cardiothoracic ICU (CT ICU)

Summary

Introduction

Despite growing support for the benefits of early active mobilization of patients in the ICU, significant variability in this practice exists. Complications related to clinical care are a risk for cardiothoracic ICU patients, who are increasingly diagnosed with frailty, which may predict post-surgical complications including, mortality, prolonged ventilation, and poor medical and functional outcomes27,28 These complications and comorbidities have the potential to influence time to physical therapy evaluation and consistency of physical therapy treatment to achieve early active mobilization of patients, but it is currently unknown what factors influence timing and amount of treatment. Physical therapy evaluation and treatment in the acute care setting is highly focused on functional mobility status with interventions related to patient functional ability (bed mobility, transfers, use of assistive devices, gait or ambulation, etc.) representing the greatest percentage of treatment30 Both early mobilization and rehabilitation begin upon achievement of hemodynamic stability and international consensus on guidelines for safe mobilization of ventilated patients was achieved using criteria established for a variety of medical considerations. This includes determining that associations exist between LOS in this patient population and timing and amount of physical therapy

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