Electronic poster

1060 - THE EFFECT OF A STRUCTURED REHABILITATION PROGRAMME FOR PATIENTS ADMITTED TO CRITICAL CARE
D.J. McWilliams1, E.V. Westlake1
1Central Manchester Foundation Trust, Platt 1 Rehabilitation, Manchester, United Kingdom
Berlin 2011
Abstract
INTRODUCTION. The negative effects of mechanical ventilation and the associated bed rest are well documented. To counteract these effects there has been an increasing move towards early rehabilitation on Intensive Care units (ICU), with some evidence suggesting shortened lengths of stay (LOS) in response to these interventions (1, 2). In 2008 a structured rehabilitation programme was implemented at CMFT with the aim of decreasing overall LOS and subsequently improve functional outcomes. This was in line with recent NICE guidance for critical illness which highlighted the importance of structured rehabilitation for patients admitted to critical care.
METHODS. All patients admitted > 5 days and surviving to ICU discharge in a large UK based intensive care unit between 1st June and 30th September from 2007 to 2010 were included in the study. A more structured programme of rehabilitation was implemented at the beginning of 2008. This was achieved through structured and documented rehabilitation plans and weekly goal setting meetings, coupled with specific MDT training and education sessions. Primary outcome measures used were mean physical function at ICU discharge, assessed via the Manchester Mobility Score (MMS), with secondary measures of mean ICU and post ICU LOS. Baseline data was obtained retrospectively, with annual figures presented for the three years following the introduction of the rehabilitation programme. Data were analysed using students t-test.
RESULTS. In the year prior to the introduction of the structured rehabilitation programme the mean MMS was 2.9, defined as being a hoist for transfers to the chair. In this year mean ICU and ward LOS for was 18.1 and 53 days respectively. Each year there was a significant improvement in all outcomes, with mean MMS increasing to 4.4 in 2010, suggesting the average patient was now standing or transferring to a chair. This was associated with significant reductions in both ICU (p< 0.01) and post ICU LOS (p< 0.01) for each of the years observed


  2007 2008 2009 2010
n 26 30 38 36
APACHE II 15.4 15.9 16.9 19.2
Mean MMS 2.9 3.3 4.0 4.4
Mean ICU LOS 18.1 17.5 15.2 11.9
Mean ward LOS 53.0 42.9 29.8 21.2
[Annual figures observed]


CONCLUSIONS. Structured programmes of rehabilitation can significantly increase the functional status of patients at ICU discharge. This improvement was associated with a significant reduction in both ICU and ward length of stay. This is at a time when patient acuity was observed to be higher with a yearly increase to APACHE II scores.
REFERENCE(S).
1. Chang et al, (2006) Effects of Physical Training on Functional Status in Patients With Prolonged Mechanical Ventilation. Physical Therapy, 86; 9: 1271-1281
2. McWilliams DJ, Pantelides KP (2007) Does Physiotherapy led early mobilization affect length of stay on ICU. Intensive Care Medicine. 33; 2
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