title: Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Physical rehabilitation in the intensive care unit (ICU) may improve the outcomes of patients with acute respiratory failure.
  
  
  OBJECTIVE
  To compare standardized rehabilitation therapy (SRT) to usual ICU care in acute respiratory failure.
  
  
  METHODS
  Single-center, randomized clinical trial at Wake Forest Baptist Medical Center, North Carolina. Adult patients (mean age, 58 years; women, 55%) admitted to the ICU with acute respiratory failure requiring mechanical ventilation were randomized to SRT (n=150) or usual care (n=150) from October 2009 through May 2014 with 6-month follow-up.
  
  
  METHODS
  Patients in the SRT group received daily therapy until hospital discharge, consisting of passive range of motion, physical therapy, and progressive resistance exercise. The usual care group received weekday physical therapy when ordered by the clinical team. For the SRT group, the median (interquartile range [IQR]) days of delivery of therapy were 8.0 (5.0-14.0) for passive range of motion, 5.0 (3.0-8.0) for physical therapy, and 3.0 (1.0-5.0) for progressive resistance exercise. The median days of delivery of physical therapy for the usual care group was 1.0 (IQR, 0.0-8.0).
  
  
  METHODS
  Both groups underwent assessor-blinded testing at ICU and hospital discharge and at 2, 4, and 6 months. The primary outcome was hospital length of stay (LOS). Secondary outcomes were ventilator days, ICU days, Short Physical Performance Battery (SPPB) score, 36-item Short-Form Health Surveys (SF-36) for physical and mental health and physical function scale score, Functional Performance Inventory (FPI) score, Mini-Mental State Examination (MMSE) score, and handgrip and handheld dynamometer strength.
  
  
  RESULTS
  Among 300 randomized patients, the median hospital LOS was 10 days (IQR, 6 to 17) for the SRT group and 10 days (IQR, 7 to 16) for the usual care group (median difference, 0 [95% CI, -1.5 to 3], P = .41). There was no difference in duration of ventilation or ICU care. There was no effect at 6 months for handgrip (difference, 2.0 kg [95% CI, -1.3 to 5.4], P = .23) and handheld dynamometer strength (difference, 0.4 lb [95% CI, -2.9 to 3.7], P = .82), SF-36 physical health score (difference, 3.4 [95% CI, -0.02 to 7.0], P = .05), SF-36 mental health score (difference, 2.4 [95% CI, -1.2 to 6.0], P = .19), or MMSE score (difference, 0.6 [95% CI, -0.2 to 1.4], P = .17). There were higher scores at 6 months in the SRT group for the SPPB score (difference, 1.1 [95% CI, 0.04 to 2.1, P = .04), SF-36 physical function scale score (difference, 12.2 [95% CI, 3.8 to 20.7], P = .001), and the FPI score (difference, 0.2 [95% CI, 0.04 to 0.4], P = .02).
  
  
  CONCLUSIONS
  Among patients hospitalized with acute respiratory failure, SRT compared with usual care did not decrease hospital LOS.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00976833.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Morris
authors.affiliation: Department of Health and Exercise Science, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Berry
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: D Clark
authors.initials: DC
authors.lastname: Files
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: J Clifton
authors.initials: JC
authors.lastname: Thompson
authors.affiliation: Department of Health and Exercise Science, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Jordan
authors.initials: J
authors.lastname: Hauser
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Lori
authors.initials: L
authors.lastname: Flores
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dhar
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chmelo
authors.affiliation: Department of Biostatistical Sciences, Wake Forest University, Winston Salem, North Carolina.
authors.forename: James
authors.initials: J
authors.lastname: Lovato
authors.affiliation: Department of Biostatistical Sciences, Wake Forest University, Winston Salem, North Carolina.
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Case
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Rita N
authors.initials: RN
authors.lastname: Bakhru
authors.affiliation: Department of Neurology, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Aarti
authors.initials: A
authors.lastname: Sarwal
authors.affiliation: Physiotherapy Department, University of Melbourne, Melbourne, Australia.
authors.forename: Selina M
authors.initials: SM
authors.lastname: Parry
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Pamela
authors.initials: P
authors.lastname: Campbell
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Arthur
authors.initials: A
authors.lastname: Mote
authors.affiliation: Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Chris
authors.initials: C
authors.lastname: Winkelman
authors.affiliation: Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hite
authors.affiliation: Division of Geriatrics, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Barbara
authors.initials: B
authors.lastname: Nicklas
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Arjun
authors.initials: A
authors.lastname: Chatterjee
authors.affiliation: Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018737:Hand Strength; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010351:Patient Discharge; D026741:Physical Therapy Modalities; D055070:Resistance Training; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000534:rehabilitation* / Q000628:therapy