title: Does 6-Month Home Caregiver-Supervised Physiotherapy Improve Post-Critical Care Outcomes?: A Randomized Controlled Trial.
abstract: This study aims to determine whether a 6-month home physiotherapy program can improve outcomes in critical care survivors.
  
  
  
  Forty-eight consecutive patients were randomized. The treatment group underwent 2 sessions/day of breathing retraining and bronchial hygiene, physical activity (mobilization, sit-to-stand gait, limb strengthening), and exercise re-conditioning whereas controls underwent standard care. Maximum inspiratory/expiratory pressures (MIP/MEP), forced volumes, blood gases, dyspnea, respiratory rate, disability, peripheral force measurements, perceived health status (Euroquol-5D), patient adherence/satisfaction, safety, and costs were assessed.
  
  
  
  Outcomes of treatment versus controls: MIP 14 ± 17 vs. -0.2 ± 14 cm H2O, MEP 27 ± 27 vs. 6 ± 21 cm H2O both P < 0.03; in addition, quality of life (Euroquol-5D) (P = 0.04), FEV1 (P = 0.03), dyspnea (P = 0.002), and respiratory rate (P = 0.009) were significantly improved for treated cardiorespiratory patients only. Eighty-three percent of the treated patients were decannulated versus 14% of controls (P = 0.01). Compliance was high (74 ± 25%) and there were no side effects. The majority (87.4%) expressed satisfaction with the program. Treatment cost was 459&OV0556;/patient/month.
  
  
  
  Carrying over regular bronchial hygiene techniques, physical activity, and exercise into the home after long critical care stays is safe and has a beneficial effect on respiratory muscles, decannulation, pulmonary function, and quality of life.
authors.affiliation: From the Divisione di Pneumologia Riabilitativa (MV, LB, MP), Neurologia Riabilitativa (FV, AL), Servizio di Continuità Assistenziale Ospedaliera (PB), and Cardiologia Riabilitativa (AG), Fondazione Salvatore Maugeri, IRCCS Lumezzane, Brescia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Vitacca
authors.forename: Luca
authors.initials: L
authors.lastname: Barbano
authors.forename: Fabio
authors.initials: F
authors.lastname: Vanoglio
authors.forename: Alberto
authors.initials: A
authors.lastname: Luisa
authors.forename: Palmira
authors.initials: P
authors.lastname: Bernocchi
authors.forename: Amerigo
authors.initials: A
authors.lastname: Giordano
authors.forename: Mara
authors.initials: M
authors.lastname: Paneroni
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D016638:Critical Illness; D004417:Dyspnea / Q000534:rehabilitation; D005260:Female; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D010349:Patient Compliance; D010359:Patient Readmission / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000534:rehabilitation; D017741:Survivors; D015300:Ventilator Weaning