RESUMO
BACKGROUND: Patients in the intensive care unit (ICU) often experience extended periods of immobility. Following hospital discharge, many face impaired mobility and never return to their baseline function. Although the benefits of physical and occupational rehabilitation are well established in non-ICU patients, a paucity of work describes effective practices to alleviate ICU-related declines in mobility. OBJECTIVE: To assess how rehabilitation with physical and occupational therapy (PT-OT) during ICU stays affects patients' mobility, self-care, and length of hospital stay. DESIGN: Retrospective cohort study. SETTING: Inpatient ICU. PARTICIPANTS: A total of 6628 adult patients who received physical rehabilitation across multiple sites (Arizona, Florida, Minnesota, and Wisconsin) of a single institution between January 2018 and December 2021. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Descriptive statistics, linear regression models, and gradient boosting machine methods were used to determine the relationship between the amount of PT-OT received and outcomes of hospital length of stay (LOS), Activity Measure for Post-Acute Care Daily Activity and Basic Mobility scores. RESULTS: The 6628 patients who met inclusion criteria received an average (median) of 23 (range: 1-89) minutes of PT-OT per day. Regression analyses showed each additional 10 minutes of PT-OT per day was associated with a 1.0% (95% confidence interval [CI]: 0.41-1.66, p < .001) higher final Basic Mobility score, a 1.8% (95% CI: 1.30%-2.34%, p < .001) higher final Daily Activity score, and a 1.2-day (95% CI: -1.28 to -1.09, p < .001) lower hospital LOS. One-dimensional partial dependence plots revealed an exponential decrease in predicted LOS as minutes of PT-OT received increased. CONCLUSION: Higher rehabilitation minutes provided to patients in the ICU may reduce the LOS and improve patients' functional outcomes at discharge. The benefits of rehabilitation increased with increasing amounts of time of therapy received.
Assuntos
Terapia Ocupacional , Adulto , Humanos , Tempo de Internação , Estudos Retrospectivos , Unidades de Terapia Intensiva , HospitaisAssuntos
American Recovery and Reinvestment Act , Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Classificação Internacional de Doenças , Patient Protection and Affordable Care Act , Administração da Prática Médica/legislação & jurisprudência , Reforma dos Serviços de Saúde , Humanos , Uso Significativo/legislação & jurisprudência , Estados UnidosAssuntos
Registros Eletrônicos de Saúde/organização & administração , Administração da Prática Médica/organização & administração , Centers for Medicare and Medicaid Services, U.S. , Registros Eletrônicos de Saúde/economia , Registros Eletrônicos de Saúde/legislação & jurisprudência , Regulamentação Governamental , Humanos , Medicare/economia , Motivação , Administração da Prática Médica/economia , Administração da Prática Médica/legislação & jurisprudência , Estados UnidosRESUMO
UNLABELLED: This self-directed learning module highlights the social and economic implications of aging. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine. This article specifically focuses on the epidemiology of aging, the economics of aging, informal and formal social support systems, ageism and societal issues, and care and treatment settings. OVERALL ARTICLE OBJECTIVE: To summarize the social and economic implications of aging in the context of physical medicine and rehabilitation.
Assuntos
Envelhecimento/psicologia , Dinâmica Populacional , Reabilitação/economia , Reabilitação/tendências , Idoso , Gastos em Saúde , Humanos , Medicare/economia , Apoio Social , Estados UnidosRESUMO
UNLABELLED: This self-directed learning module highlights physical medicine and rehabilitation (PM and R) interventions for common disorders that cause disability in older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in PM and R and geriatric medicine. This article specifically focuses on PM and R interventions for arthritides, fractures, cardiovascular disorders, peripheral vascular disease, amputations, pulmonary disorders, cancer, stroke, traumatic brain injury, Parkinson's disease, spinal cord injury, peripheral neuropathies, and diabetic complications. OVERALL ARTICLE OBJECTIVE: To summarize the physical medicine and rehabilitation interventions for commonly disabling conditions of older adults.
Assuntos
Pessoas com Deficiência/reabilitação , Idoso , Nefropatias Diabéticas/reabilitação , Fraturas Ósseas/reabilitação , Humanos , Infarto do Miocárdio/reabilitação , Osteoartrite/reabilitação , Doença de Parkinson/reabilitação , Doença Pulmonar Obstrutiva Crônica/reabilitação , Dor de Ombro/reabilitaçãoRESUMO
UNLABELLED: This self-directed learning module highlights the societal aspects of disability and the older adult. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine. This article specifically focuses on ethical issues, including capacity, psychodynamics, sexuality, community integration, work, leisure skills, and the issue of driving a motor vehicle. OVERALL ARTICLE OBJECTIVE: To summarize the societal aspects of disability and the older adult.
