PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2010

Clinical Scenario

The patient who led me to pursue this question is a 25 y/o female with a diagnosis of acute renal failure and sepsis secondary to multiple drug overdoses. Problems identified include immobility and weakness.

Clinical Question

Does early physical therapy for patients in the ICU decrease their hospital length of stay?

Clinical Bottom Line

Based on the outcomes from Schweickert et al. and Needham et al., whether or not early physical therapy decreases hospital length of stay remains undetermined. Schweickert et al. (PEDro score 7/10 with 104 subjects) determined that early physical and occupational therapy during interruptions in sedation did not decrease hospital length of stay compared to a control group. The most significant threat to this study’s internal validity was not having information concerning how sick the patients were. If one group had patients with overall more favorable prognoses, the results could have been influenced. In contrast, Needham et al. (PEDro score 3/10 with 576 subjects) determined that early physical and occupational therapy during interruptions in sedation as part of a quality improvement project significantly decreased hospital length of stay by 3.1 days compared to a control group. However, this study has poor internal validity (PEDro score 3/10); the most significant threat concerns how much early physical and occupational therapy (the independent variable of interest) truly affected hospital length of stay. Given that early rehabilitation (physical and occupational therapy) was only one part of a larger quality improvement project, it is impossible to determine the effect of early physical and occupational therapy alone. Based on the results of these two studies, I am unable to answer my clinical question. More literature needs to be evaluated to determine whether or not early physical therapy decreases hospital length of stay. Early physical therapy vs. physical therapy when patients are no longer sedated should be the only variable manipulated, so study results can be attributed to this one intervention. Also, more patient information should be obtained regarding diagnosis/prognosis to provide a more accurate comparison between groups at baseline.

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