A University of Chicago clinical trial of early physical and occupational therapy in critically ill patients has been selected by the Centre for Evidence-Based Physiotherapy (CEBP) as one of the 15 most significant randomized, controlled, physiotherapy trials ever published.
CEBP, one component of the multinational George Institute for Global Health, invited therapists to nominate trials. Submissions were judged by a panel of international physiotherapy experts. Only two submissions from the United States made the list.
These ground-breaking trials “changed the way people are treated for conditions seen by physiotherapists and other healthcare professionals,” according to the organization. “Some of these trials set the stage for breakthroughs, some represent a paradigm shift, and all of them mark important milestones in the evolution of physiotherapy treatment.”
The UChicago trial, published in the Lancet in 2009, showed that “whole-body rehabilitation—consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness—was safe and well tolerated.” By waking up critically ill patients and helping them move—even get up and walk, with help—the study produced “better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care,” the study authors concluded.
Historically, patients with respiratory failure were placed on a ventilator and given medications to keep them calm, sedated and immobile. In this study, however, half of the patients were woken up and helped to move around. This change reduced their ICU stay by one third. Sixty percent of the group that got early therapy left the hospital functional, compared to 33 percent of those who got usual care.
The study demonstrated that caregivers could engage patients, even those so ill they need to be on a ventilator, “in aggressive physical and occupational therapy, including out-of-bed activity very early in their hospital stay, and that the patients who did so showed superior outcomes,” said Amy Pawlik, PT, DPT, CCS, a UCM physical therapist and an author of the study.
This aggressive approach not only helped patients recover medically from a serious illness, it also “helped them return to the activities that allow them to be independent and enjoy life,” Pawlik said.
“I’m sure I wasn’t walking,” said Richard Gardella, an ICU patient who was enrolled in the trial. Even though he was critically ill with pneumonia—and didn’t recall the exercise sessions he participated in—his caregivers believe it helped him heal faster.
“He was up. He was walking with the breathing tube in,” said his physician, pulmonologist John Kress, who worked with the physiotherapists to organize the study, which was highlighted at the time by a Chicago television station.
The researchers continue to examine the benefits of early physical therapy and to investigate the best times and methods. “If post-illness rehabilitation is not effective, as some of the studies suggest,” Pawlik and Kress note in a 2012 published review, “it is that much more imperative that patients receive physical therapy while hospitalized in an effort to prevent functional decline. Further study is needed in this area to help determine the most effective course of rehabilitation for those recovering from critical illness.”
“This study helped change the way we manage patients with critical illness,” Pawlik said. “It is becoming the standard of care in the United States and internationally.”