The results of the first study to show the effectiveness of early physical therapy in a medical intensive care unit (ICU) were presented yesterday (Oct. 23) by a researcher from Wake Forest University Baptist Medical Center at the national meeting of the American College of Chest Physicians in Chicago.

The length of stay for a group of respiratory-failure patients who received mobility therapy within 48 hours of the insertion of a breathing tube was reduced by an average of three days compared to the stay for patients who did not receive the therapy. This reduced length of stay included a reduction of time in the ICU of more than a day.

Initial therapy -- called passive range of motion -- was provided by nursing assistants who flexed the joints of the patients' upper and lower limbs three times a day, seven days a week. As patients progressed, they received more advanced physical therapy from a physical therapist. The therapy proved safe, and there was also no addition to hospital costs because the salaries of the employees who provided mobility therapy were offset by reduced lengths of stay in the hospital, according to Peter Morris, M.D., lead investigator and associate professor in the Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases.

Immobility and the resulting loss of physical conditioning are common problems for patients with respiratory failure, which means they cannot breathe without the assistance of a ventilator, said Morris. However, little data exist on whether early mobility therapy for ICU patients is associated with improved outcomes or cost benefits.

"Although there are data for efficacy of exercise for emphysema patients and for congestive heart failure patients in the outpatient setting, this was the first time for ICU administration of exercise as a therapeutic agent," said Morris. "The project confirms that it is safe to administer early mobility to ICU patients and that it is of benefit."

Phase I of a planned two-phase study was designed to address this lack of data by conducting a structured project, or protocol, over 24 consecutive months from 2004 to 2006 in which respiratory-failure patients admitted to the Medical Center's ICUs were assigned to one of two groups: 165 to a protocol group, which received early therapy from a mobility team (a critical care nurse, a nursing assistant and a physical therapist), and 165 to a control group, which received usual care. Some of those patients who received usual care also received therapy, although not as early or as frequently as those in the protocol group. Once patients were transferred to a regular nursing unit, both groups received usual care.

In addition to shorter hospital stays, the protocol patients also progressed more quickly to active physical therapy, were out of bed earlier and experienced no adverse events during an ICU therapy session.

Morris said further studies are needed in order to clarify the optimum number and duration of exercise sessions. Phase II of the study at the Medical Center will look at a broader range of ICU patients, both more and less ill, and will continue through hospital discharge. In addition, a study funded by the Medical Center's Claude D. Pepper Older Americans Independence Center will examine the effect of early mobility therapy for the elderly, who may be more at risk than younger patients for ICU-related arm and leg weakness.

Morris will make additional presentations on the study in February at the 37th Critical Care Congress of the Society of Critical Care Medicine, and in May at the 2008 International Conference of the American Thoracic Society.

Phase I of the early mobility therapy study was conducted by a team from both N.C. Baptist Hospital and Wake Forest University School of Medicine representing hospital administration, nursing leadership, the Division of Public Health Sciences, physical therapy, and the Section on Pulmonary Care. The study was funded primarily by Baptist Hospital.

The Medical Center's ICUs are one of 10 sites for the adult respiratory distress syndrome (ARDS) network of the National Institutes of Health, which is the critical care research network for the United States.

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Article adapted by Medical News Today from original press release.
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Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 18th in family medicine, 20th in geriatrics, 25th in primary care and 41st in research among the nation's medical schools. It ranks 35th in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.

Source: Karen Richardson
Wake Forest University Baptist Medical Center

The American Physical Therapy Association (APTA) cites the results of the first study to show the effectiveness of early physical therapy for patients in a medical intensive care unit (ICU). The study, conducted by Peter Morris, MD, associate professor in the Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases at Wake Forest University Baptist Medical Center, was presented at the October 23 meeting of the American College of Chest Physicians in Chicago.

"This non-randomized study, the first of its kind on this particular topic, proves that the skills of a physical therapist are essential to the expedient recovery of ICU patients," said Mary Pat C Jobes, PT, MA, president of APTA's Acute Care Section and manager of physical therapy at Haywood Park Community Hospital in Brownsville, Tennessee.

Depending on the medical history and status of a patient, physical therapy can begin as soon as an ICU patient regains consciousness, notes Ethel Frese, PT, DPT, CCS, president of APTA's Cardiovascular and Pulmonary Section and an associate professor at St Louis University's Department of Physical Therapy. "Physical therapists work with ICU patients, both those breathing with or without a ventilator, with breathing exercises that use respiratory muscles, as well as range of motion exercises to do either sitting up in bed or in a chair," she said. "What physical therapists have always known and what Morris has proven in his study is that for patients who receive initial physical therapy, the number of days in the ICU and total number of hospital days were dramatically reduced," she added.

The length of stay for a group of respiratory-failure patients who received early mobilization and physical therapy within 48 hours of the insertion of a breathing tube was reduced by an average of 3 days compared with the stay for patients who did not receive the therapy. This reduced length of stay included a reduction of time in the ICU of more than a day.

Initial therapy - called passive range of motion - was provided by nursing assistants, with their training designed and implemented by physical therapists. The nursing assistants flexed the joints of the patients' upper and lower limbs 3 times a day, 7 days a week. As patients progressed, they received more advanced physical therapy from a physical therapist. The therapy proved safe, and there was also no addition to hospital costs because the salaries of the employees who provided range of motion and physical therapy were offset by reduced lengths of stay in the hospital, according to Morris and his research colleagues, Karen Taylor, PT, MPT and Bethany Harry, PT, MPT.

"Dr. Morris's study is particularly compelling because it so clearly demonstrates that it takes a multi-disciplinary team to care for ICU patients," observed Jobes. "The patients in the study were treated by a medical team that included an attending physician, critical care nurse, physical therapist and nursing assistant. Just as the patient could not recover without the skills of a critical care nurse, this study proved that the skills of a physical therapist were equally integral to recovery."

Immobility and the resulting loss of physical conditioning are common problems for patients with respiratory failure, which means they cannot breathe without the assistance of a ventilator, said Morris. However, little data exist on whether early mobility therapy for ICU patients is associated with improved outcomes or cost benefits.

"Although there are data for efficacy of exercise for emphysema patients and for congestive heart failure patients in the outpatient setting, this was the first time for ICU administration of exercise as a therapeutic agent," said Morris. "The project confirms that it is safe to administer early mobility to ICU patients, and that it was associated with benefit."

Phase I of a planned two-phase study was designed to address this lack of data by conducting a structured project, or protocol, over 24 consecutive months from 2004 to 2006 in which respiratory-failure patients admitted to the Medical Center's ICUs were assigned to one of two groups: 165 to a protocol group, which received early therapy from a mobility team (a critical care nurse, a nursing assistant and a physical therapist), and 165 to a control group, which received usual care. Some of those patients who received usual care also received physical therapy, although not as early or as frequently as those in the protocol group. Once patients were transferred to a regular nursing unit, both groups received usual care.

In addition to shorter hospital stays, the protocol patients also progressed more quickly to active physical therapy, were out of bed earlier, and experienced no adverse events during an ICU therapy session.

Physical therapists are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

The American Physical Therapy Association is a national organization representing more than 73,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access "Find a PT" to find a physical therapist in their area, as well as physical therapy news and information at http://www.apta.org/consumer.

American Physical Therapy Association

CPAP therapy can improve couple's mental and physical health
 
NORTHBROOK, IL (USA) - Continuous positive airway pressure (CPAP) for  the treatment of obstructive sleep apnea (OSA) not only improves  patients' lives, it can improve the lives of their bed partners, says a  study published in the September issue of CHEST, the peer-reviewed  journal of the American College of Chest Physicians (ACCP).

The study found that when patients with OSA were treated with CPAP, the  mental and physical health, and overall quality of life (QOL) of  patients and their bed partners significantly improved.

OSA  is a common disorder that is characterized by repetitive episodes of  upper airway closures during sleep that result in arousal from sleep  and can often lead to daytime sleepiness. CPAP prevents upper airway  closure, improving sleep quality and, subsequently, reducing daytime  sleepiness.

'Snoring and sleep apnea interfere with the quality of sleep of both the patient and the bed partner.

Many bed partners choose to sleep in separate rooms rather than endure  continuous sleepless nights caused by sleep apnea,' said lead author  James M. Parish, MD, FCCP, Chair, Division of Pulmonary Medicine and  Director, Sleep Disorders Center, Mayo Clinic, Scottsdale, Arizona.

'With  CPAP therapy, patients and their partners can experience restful nights  which can ultimately benefit them physically and mentally.'

Researchers from the Mayo Clinic in Scottsdale examined the effects of  OSA on QOL in 54 pairs of patients and their regular bed partners and  the effects of CPAP therapy on QOL in both groups after six weeks of  patient treatment.

Patients and bed partners completed three pre- and post-treatment  questionnaires on their likelihood to fall asleep in routine  situations, their overall physical and mental QOL, and their QOL  specifically related to their experience with OSA.

Prior  to therapy, patients reported situational sleepiness more than the  national norm, and overall QOL was significantly lower than national  norms.

Initial bed partner scores were similar to national norms, except in  the category of bodily pain, which was below the expected norm.

After CPAP treatment, both patient and partner scores showed a decrease  in situational sleepiness and an increase in the majority of physical  and mental QOL categories, including vitality, social functioning, role  limitations due to physical health, and mental health.

In addition, QOL scores specific to OSA improved in both patients and bed partners.

'It is unclear why initial reports from bed partners indicated normal  QOL. It is possible that over time, patients and partners adapt to  their poor sleep and believe that it is normal or expected,' said Dr.  Parish.

'Patients,  as well as their bed partners, should not endure the effects of sleep  apnea but rather share the responsibility in seeking treatment for this  serious but manageable condition.'

Overall physical and mental QOL was categorized by physical  functioning, role limitations due to physical health (role-physical),  bodily pain, general health, vitality, social functioning, role  limitations due to emotional problems (role-emotional), and mental  health.

QOL  categories specific to OSA included daily functioning, social  interactions, emotional functioning, symptoms, and treatment-related  symptoms.

'When left untreated, sleep disorders such as sleep apnea can lead to  more serious conditions, including hypertension, heart disease, and  other cardiovascular complications,' said Udaya B. S. Prakash, MD,  FCCP, President of the American College of Chest Physicians.

'Sleep  medicine has greatly improved in recent years with new methods for  diagnosing and treating sleep disorders. It is important for primary  care and specialty physicians to educate patients on the health effects  of sleep disorders and to inform them of the treatment options  available.'

CHEST is a peer-reviewed journal published by the ACCP. It is  available on-line each month at http://www.chestjournal.org. ACCP  represents more than 15,000 members who provide clinical, respiratory,  and cardiothoracic patient care in the United States and throughout the  world. ACCP's mission is to promote the prevention and treatment of  diseases of the chest through leadership, education, research, and  communication.

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