Discordance Between Distance Ambulated as Part of Usual Care and Functional Exercise Capacity in Survivors of Critical Illness Upon Intensive Care Discharge: Observational Study

Waters, Angela; Hill, Kylie; Jenkins, Sue; Johnston, Catherine; Mackney, Jennifer

doi:10.2522/ptj.20140282

Cited by 10 publications

(5 citation statements)

References 35 publications

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“…Specifically, earlier work in hospitalized adults has shown that the distance walked on the ward was, on average, less than 30% of what they achieved during an objective assessment of exercise capacity. 38 In this review, more than 70% of studies that prescribed either walking training or resistance training were based on the initial prescription on objective measures of physical function collected in each individual. Walking-based aerobic training programmes were most often prescribed based on the results of 6-minute walk test and resistance training programmes were most often prescribed based on the measure of a one-repetition maximum.…”

Section: Discussionmentioning

confidence: 99%

Exercise training for adults hospitalized with an acute respiratory condition: a systematic scoping review

et al. 2019

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Objective: In adults hospitalized with an acute or chronic respiratory condition, to determine what has been reported regarding exercise programmes in terms of content, tolerability, evaluation and adverse events. Data sources: A systematic search was conducted of electronic databases (PubMed, EMBASE, CINAHL, PEDro, The Cochrane Library), trial registries and conference abstracts (Thoracic Society of Australia and New Zealand Annual Scientific Meeting, the European Respiratory Society Congress, the American Thoracic Society International Conference). Review methods: Studies were included if they (1) recruited adults hospitalized with an acute or chronic respiratory condition, (2) described an exercise programme that targeted peripheral muscles and (3) reported that ⩾80% of the sample had initiated training within 72 hours of hospitalization. Results: The last search was conducted on 2 June 2019. Of the 6282 records identified, 20 met the study criteria. These described 18 separate studies (2018 participants). Studies were conducted in adults hospitalized with an exacerbation of chronic obstructive pulmonary disease or with community-acquired pneumonia. The content of exercise programmes included aerobic and/or resistance training, neuromuscular electrical stimulation, whole-body vibration or movement out of bed. In eight studies (44%), the initial session was prescribed using objective measures of exercise capacity, peripheral muscle force and the ability to undertake activities of daily living. Across 7420 training sessions, seven adverse events were reported. Conclusion: Methods used to prescribe and titrate exercise programmes in adults hospitalized with an acute or an exacerbation of a chronic respiratory condition were disparate. When reported, programmes were well tolerated and adverse events were infrequent.

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Section: Discussionmentioning

confidence: 99%

Exercise training for adults hospitalized with an acute respiratory condition: a systematic scoping review

et al. 2019

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“…The protocol used for the 6MWT has been published previously. 26 If participants were using walking aids and supplemental oxygen on the ward, these were used during the 6MWT. Any assistance that the participant required to mobilize (e.g.…”

Section: -Minute Walk Testmentioning

confidence: 99%

Survivors of Acute Lung Injury Have Greater Impairments in Strength and Exercise Capacity Than Survivors of Other Critical Illnesses as Measured Shortly After ICU Discharge

Mackney

Harrold

Jenkins

et al. 2020

J Intensive Care Med

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Purpose: To compare the physical function on ICU discharge in adults who survived an ICU admission for acute lung injury (ALI) with those admitted for a critical illness other than ALI. Materials and Methods: Two groups were recruited, (i) those who survived an ICU admission for ALI and, (ii) those who survived an ICU admission for a critical illness other than ALI. Within 7 days of discharge from ICU, in all participants, measures were collected of peripheral muscle strength, balance, walking speed and functional exercise capacity. Results: Recruitment was challenging and ceased prior to achieving the desired sample size. Participants with ALI (n = 22) and critical illness (n = 33) were of similar median age (50 vs. 57 yr, p = 0.09), sex proportion (males %, 45 vs. 58, p = 0.59) and median APACHE II score (21.5 vs. 23.0, p = 0.74). Compared with the participants with critical illness, those with ALI had lower hand grip (mean ± SD, 18 ± 9 vs. 13 ± 8 kg, p = 0.018) and shoulder flexion strength (10 ± 4 vs. 7 ± 3 kg, p = 0.047), slower 10-meter walk speed (median [IQR], 1.03 [0.78 to 1.14] vs. 0.78 [0.67 to 0.94] m/s, p = 0.039) and shorter 6-minute walk distance (265 [71 to 328] vs. 165 [53 to 220] m, p = 0.037). The Berg balance scores were similar in both groups. Conclusions: Compared with survivors of a critical illness that is not ALI, those with ALI are likely to have greater physical impairment when measured shortly after discharge to the ward.

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“…That cannot be due to not having enough time to provide these patients with sufficient walking for exercise, because they only needed 6 minutes to achieve the distance covered during the test. 7 When training our patients we must apply essential exercise principles such as overload. Exercise and activity are not therapeutic when the intensity and duration are insufficient, even when the exercise is provided by a PT or PTA.…”

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confidence: 99%

“…Too often we provide interventions that are insufficiently rigorous. An example was published by Waters et al, 7 where hospital inpatients were tested with the 6-minute walk test 1 week after discharge from an intensive care unit. Not surprising were the findings that administration of the test was feasible and that subjects had impaired performance.…”

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confidence: 99%

The Scope of Acute Care Physical Therapy

Smith¹

2014

Journal of Acute Care Physical Therapy

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In neurorehabilitation, praxis embodies establishing a goal, planning, taking action, analyzing the impact of the action, revising the plan, and reacting accordingly until the desired outcome is achieved. That is an apt metaphor for physical therapy, whether planning a single intervention for a patient, establishing a plan of care, or managing the trajectory of a career.Through reflections on goals, plans, and actions, this lecture presents challenges to physical therapists and physical therapist assistants to achieve praxis when providing rehabilitation and wellness services. Through reflections on the needs of patients and clients, this lecture proposes the value of the unique identity and services that are acute care physical therapy. Central to these themes, this lecture provides the challenge to embrace the honor that comes with being an acute care physical therapist and a physical therapist assistant.

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Discordance Between Distance Ambulated as Part of Usual Care and Functional Exercise Capacity in Survivors of Critical Illness Upon Intensive Care Discharge: Observational Study

Abstract: Most participants ambulated at a low percentage of their measured exercise capacity. The 6MWT appears to be a safe and useful test for inpatients recently discharged from the ICU.

Cited by 10 publications

References 35 publications

Exercise training for adults hospitalized with an acute respiratory condition: a systematic scoping review

Exercise training for adults hospitalized with an acute respiratory condition: a systematic scoping review

Survivors of Acute Lung Injury Have Greater Impairments in Strength and Exercise Capacity Than Survivors of Other Critical Illnesses as Measured Shortly After ICU Discharge

The Scope of Acute Care Physical Therapy

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