title: A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure.
abstract: BACKGROUND
  Early physical therapy (PT) interventions may benefit patients with acute respiratory failure by preventing or attenuating neuromuscular weakness. However, the optimal dosage of these interventions is currently unknown.
  
  
  OBJECTIVE
  To determine whether an intensive PT program significantly 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.
  
  
  RESULTS
  A total of 120 patients were enrolled from five hospitals. Patients in the intensive PT group received 12.4 ± 6.5 sessions for a total of 408 ± 261 minutes compared with only 6.1 ± 3.8 sessions for 86 ± 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 significantly 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).
authors.affiliation: 1 Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine.
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
authors.affiliation: 2 Physical Therapy Program, and.
authors.forename: Amy
authors.initials: A
authors.lastname: Nordon-Craft
authors.affiliation: 2 Physical Therapy Program, and.
authors.forename: Dan
authors.initials: D
authors.lastname: Malone
authors.affiliation: 3 The Medical Center of Aurora, Aurora, Colorado; and.
authors.forename: David
authors.initials: D
authors.lastname: Van Pelt
authors.affiliation: 4 Division of Pulmonary Medicine, National Jewish Health, Denver, Colorado.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Frankel
authors.affiliation: 4 Division of Pulmonary Medicine, National Jewish Health, Denver, Colorado.
authors.forename: Mary Laird
authors.initials: ML
authors.lastname: Warner
authors.affiliation: 2 Physical Therapy Program, and.
authors.forename: Wendy
authors.initials: W
authors.lastname: Kriekels
authors.affiliation: 5 Colorado Health Outcomes Group, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Monica
authors.initials: M
authors.lastname: McNulty
authors.affiliation: 5 Colorado Health Outcomes Group, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Fairclough
authors.affiliation: 2 Physical Therapy Program, and.
authors.forename: Margaret
authors.initials: M
authors.lastname: Schenkman
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012128:Respiratory Distress Syndrome / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: acute respiratory failure; critical care; mechanical ventilation; physical therapy