1.Association Between Mobilization Level And Activity of Daily Living Independence in Critically Ill Patients
Shinichi WATANABE ; Keibun LIU ; Ryo KOZU ; Daisetsu YASUMURA ; Kota YAMAUCHI ; Hajime KATSUKAWA ; Keisuke SUZUKI ; Takayasu KOIKE ; Yasunari MORITA
Annals of Rehabilitation Medicine 2023;47(6):519-527
Objective:
To examine the association between the mobilization level during intensive care unit (ICU) admission and independence in activity of daily living (ADL), defined as Barthel Index (BI)≥70.
Methods:
This was a post-hoc analysis of the EMPICS study involving nine hospitals. Consecutive patients who spend >48 hours in the ICU were eligible for inclusion. Mobilization was performed at each hospital according to the shared protocol and the highest ICU mobility score (IMS) during the ICU stay, baseline characteristics, and BI at hospital discharge. Multiple logistic regression analysis, adjusted for baseline characteristics, was used to deter-mine the association between the highest IMS (using the receiver operating characteristic [ROC]) and ADL.
Results:
Of the 203 patients, 143 were assigned to the ADL independence group and 60 to the ADL dependence group. The highest IMS score was significantly higher in the ADL independence group than in the dependence group and was a predictor of ADL independence at hospital discharge (odds ratio, 1.22; 95% confidence interval, 1.07–1.38; adjusted p=0.002). The ROC cutoff value for the highest IMS was 6 (specificity, 0.67; sensitivity, 0.70; area under the curve, 0.69).
Conclusion
These results indicate that, in patients who were in the ICU for more than 48 hours, that patients with good function in the ICU also exhibit good function upon discharge. However, prospective, multicenter trials are needed to confirm this conclusion.
2.Early Rehabilitation Interventions by Physical Therapists for Severe COVID-19 Patients Were Associated With Decreased Incidence of Post-ICU Physical Impairment
Shinya OKU ; Junji HATAKEYAMA ; Keibun LIU ; Kentaro TOJO ; Masafumi IDEI ; Shigeaki INOUE ; Kazuma YAMAKAWA ; Takeshi NISHIDA ; Shinichiro OHSHIMO ; Satoru HASHIMOTO ; Shuhei MARUYAMA ; Yoshitaka OGATA ; Daisuke KAWAKAMI ; Hiroaki SHIMIZU ; Katsura HAYAKAWA ; Yuji FUJINO ; Taku OSHIMA ; Tatsuya FUCHIGAMI ; Hironori YAWATA ; Kyoji OE ; Akira KAWAUCHI ; Hidehiro YAMAGATA ; Masahiro HARADA ; Yuichi SATO ; Tomoyuki NAKAMURA ; Kei SUGIKI ; Takahiro HAKOZAKI ; Satoru BEPPU ; Masaki ANRAKU ; Noboru KATO ; Tomomi IWASHITA ; Hiroshi KAMIJO ; Yuichiro KITAGAWA ; Michio NAGASHIMA ; Hirona NISHIMAKI ; Kentaro TOKUDA ; Osamu NISHIDA ; Kensuke NAKAMURA
Annals of Rehabilitation Medicine 2025;49(1):49-59
Objective:
To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment.
Methods:
An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors.
Results:
The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006).
Conclusion
Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.
3.Early Rehabilitation Interventions by Physical Therapists for Severe COVID-19 Patients Were Associated With Decreased Incidence of Post-ICU Physical Impairment
Shinya OKU ; Junji HATAKEYAMA ; Keibun LIU ; Kentaro TOJO ; Masafumi IDEI ; Shigeaki INOUE ; Kazuma YAMAKAWA ; Takeshi NISHIDA ; Shinichiro OHSHIMO ; Satoru HASHIMOTO ; Shuhei MARUYAMA ; Yoshitaka OGATA ; Daisuke KAWAKAMI ; Hiroaki SHIMIZU ; Katsura HAYAKAWA ; Yuji FUJINO ; Taku OSHIMA ; Tatsuya FUCHIGAMI ; Hironori YAWATA ; Kyoji OE ; Akira KAWAUCHI ; Hidehiro YAMAGATA ; Masahiro HARADA ; Yuichi SATO ; Tomoyuki NAKAMURA ; Kei SUGIKI ; Takahiro HAKOZAKI ; Satoru BEPPU ; Masaki ANRAKU ; Noboru KATO ; Tomomi IWASHITA ; Hiroshi KAMIJO ; Yuichiro KITAGAWA ; Michio NAGASHIMA ; Hirona NISHIMAKI ; Kentaro TOKUDA ; Osamu NISHIDA ; Kensuke NAKAMURA
Annals of Rehabilitation Medicine 2025;49(1):49-59
Objective:
To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment.
Methods:
An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors.
Results:
The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006).
Conclusion
Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.
4.Early Rehabilitation Interventions by Physical Therapists for Severe COVID-19 Patients Were Associated With Decreased Incidence of Post-ICU Physical Impairment
Shinya OKU ; Junji HATAKEYAMA ; Keibun LIU ; Kentaro TOJO ; Masafumi IDEI ; Shigeaki INOUE ; Kazuma YAMAKAWA ; Takeshi NISHIDA ; Shinichiro OHSHIMO ; Satoru HASHIMOTO ; Shuhei MARUYAMA ; Yoshitaka OGATA ; Daisuke KAWAKAMI ; Hiroaki SHIMIZU ; Katsura HAYAKAWA ; Yuji FUJINO ; Taku OSHIMA ; Tatsuya FUCHIGAMI ; Hironori YAWATA ; Kyoji OE ; Akira KAWAUCHI ; Hidehiro YAMAGATA ; Masahiro HARADA ; Yuichi SATO ; Tomoyuki NAKAMURA ; Kei SUGIKI ; Takahiro HAKOZAKI ; Satoru BEPPU ; Masaki ANRAKU ; Noboru KATO ; Tomomi IWASHITA ; Hiroshi KAMIJO ; Yuichiro KITAGAWA ; Michio NAGASHIMA ; Hirona NISHIMAKI ; Kentaro TOKUDA ; Osamu NISHIDA ; Kensuke NAKAMURA
Annals of Rehabilitation Medicine 2025;49(1):49-59
Objective:
To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment.
Methods:
An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors.
Results:
The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006).
Conclusion
Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.