Summary of research on A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure
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ORIGINAL ARTICLE
A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure Marc Moss1, Amy Nordon-Craft2, Dan Malone2, David Van Pelt3, Stephen K. Frankel4, Mary Laird Warner4,
Wendy Kriekels2, Monica McNulty5, Diane L. Fairclough5, and Margaret Schenkman2
1
Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, 2Physical Therapy Program, and 5Colorado Health
Outcomes Group, University of Colorado School of Medicine, Aurora, Colorado; 3The Medical Center of Aurora, Aurora, Colorado;
and 4Division of Pulmonary Medicine, National Jewish Health, Denver, Colorado
Abstract
Rationale: Early physical therapy (PT) interventions may
bene?t patients with acute respiratory failure by preventing
or attenuating neuromuscular weakness. However, the
optimal dosage of these interventions is currently unknown.
Objectives: To determine whether an intensive PT program
signi?cantly improves long-term physical functional performance
compared with a standard-of-care PT program.
Methods: Patients who required mechanical ventilation for at
least 4 days were eligible. Enrolled patients were randomized
to receive PT for up to 4 weeks delivered in an intensive or
standard-of-care manner. Physical functional performance
was assessed at 1, 3, and 6 months in survivors who were
not currently in an acute or long-term care facility. The
primary outcome was the Continuous Scale Physical
Functional Performance Test short form (CS-PFP-10)
score at 1 month.
Each year in the United States, more than 300,000 patients develop acute respiratory failure that requires mechanical ventilation and admission to an intensive care unit (ICU) (1). As a result of recent advances in critical care, mortality rates associated with acute Measurements and Main Results: A total of 120 patients were enrolled from ?ve hospitals. Patients in the intensive PT group received 12.4 6 6.5 sessions for a total of 408 6 261 minutes compared with only 6.1 6 3.8 sessions for 86 6 63 minutes in the standard-of-care group (P , 0.001 for both analyses). Physical function assessments were available for 86% of patients at 1 month, for 76% at 3 months, and for 60% at 6 months. In both groups, physical function was reduced yet signi?cantly improved over time between 1, 3, and 6 months. When we compared the two interventions, we found no differences in the total CS-PFP-10 scores at all three time points (P = 0.73, 0.29, and 0.43, respectively) or in the
total CS-PFP-10 score trajectory (P = 0.71).
Conclusions: An intensive PT program did not improve long-term physical functional performance compared with a standard-of-care program.
Clinical trial registered with www.clinicaltrials.gov (NCT01058421).
Keywords: acute respiratory failure; critical care; mechanical ventilation; physical therapy respiratory failure continue to decline, and now over 80% of these patients
survive their hospitalization (2).