Amy Nordon-Craft

Physical Therapy Utilization in Intensive Care Units: Results from a National Survey

Objective:Patients who survive admission to the intensive care unit (ICU) commonly complain of fatigue, weakness, and poor functional status. This study sought to determine the utilization of inpatient physical therapy (PT) for patients recovering from critical illness. Design:Surveys were mailed to 984 physical therapists from across the United States. Each survey included questions concerning staffing and availability of physical therapists for ICU patients, and the utilization of PT for six patient scenarios requiring ICU admission and mechanical ventilation. Main Results:Overall, 482 physical therapists completed their survey. The majority of hospitals (89%) at which the physical therapists were employed require a physician consultation to initiate PT for ICU patients. Established hospital criteria for the initiation of PT in the ICU were present at only 10% of the hospitals. Community hospitals were more likely to routinely provide PT on weekends compared with academic hospitals (p = 0.03). The likelihood of routine PT involvement varied significantly with the clinical scenario (highest 87% status postcerebrovascular accident, lowest 64% chronic obstructive pulmonary disease, p < 0.001). The most common types of PT that would be performed on these critically ill patients were functional mobility retraining and therapeutic exercise. The type of PT identified by the physical therapists as having the most positive impact also significantly varied according to the clinical scenario (p < 0.001). Conclusions:PT is commonly administered to ICU patients during the recovery from critical illness in the United States. However, the frequency and the type of PT significantly varies based on the type of hospital and the clinical scenario.

Physical therapy management and patient outcomes following ICU-acquired weakness: a case series.

Background and Purpose: Individuals with critical illness experience dysfunction of many body systems including the neuromuscular system. Neuromuscular impairments result in a syndrome referred to as intensive care unit (ICU)–acquired weakness, which may lead to difficulty with activities and participation. The purposes of this case series were to (1) describe safety and feasibility of physical intervention in individuals with ICU-acquired weakness mechanically ventilated for at least 7 days and (2) characterize physical therapist management and patient outcomes. Case Description: Nineteen patients with ICU-acquired weakness who required mechanical ventilation for at least 7 days were enrolled over a 1-year period. Intervention: Physical therapy (PT) was provided 5 d/wk for 30 minutes per session. Outcomes: Outcome measures included manual muscle tests and item scores from the Functional Independence Measure. Participants completed 170 PT sessions. Only 20 sessions (12%) were stopped before 30 minutes. Seventeen participants survived to discharge; no PT-related adverse events occurred. At discharge, participants who went home showed a trend toward greater independence and strength than those who were discharged to another level of care. Median total hospital days was 28 for those discharged to home and 22 for those discharged to other level of care. Discussion: This case series demonstrates safety and feasibility of PT intervention for patients with ICU-acquired weakness requiring mechanical ventilation for at least 7 days. The examination and intervention procedures are described and could be implemented with other similar individuals in the hospital setting. Future studies should investigate frequency and duration of physical intervention, both during hospitalization and postdischarge, and how these factors influence outcomes.

Patient and family perceptions of physical therapy in the medical intensive care unit.

PURPOSE Patient and family member perceptions of physical therapy (PT) in the intensive care unit and the factors that influence their degree of satisfaction have not been described. METHODS A panel of experts developed a questionnaire that assessed patient and family perceptions of PT. Critically ill patients and their family members were asked to complete the survey. Patient and family member scores were compared and stratified by age, sex, and mechanical ventilation for greater than 14 days compared to 14 days or less. RESULTS A total of 55 patients and 49 family members completed the survey. Patients and family members reported that PT was necessary and beneficial to recovery, despite associating PT with difficulty, exertion, and discomfort. Patient perceptions were similar regardless of age or sex. Family members underestimated a patients enjoyment of PT (P = .03). For individuals who required prolonged mechanical ventilation (>14 days), patients reported that PT was more difficult (P = .03) and less enjoyable (P = .049), and family members reported PT as causing greater discomfort (P = .005). In addition, family members of patients who required prolonged mechanical ventilation felt that PT was less beneficial (P = .01). CONCLUSIONS Physical therapy is perceived as necessary and beneficial to recovery by critically ill patients and family members.

Using an exercise program to improve activity tolerance in a female with postural orthostatic tachycardia syndrome: A case report

ABSTRACT The incidence of postural orthostatic tachycardia syndrome (POTS) is estimated to be at least 500,000 in the United States and is most commonly found in premenopausal females. This syndrome shares clinical features with orthostatic hypotension (OH); however, the inclusion criteria and clinical features for POTS are not well known. The purposes of this case report are to: 1) describe the common clinical features of POTS and highlight the differences to orthostatic hypotension and 2) discuss physical therapy management of patients with POTS using exercise. A 34-year-old female with a POTS exacerbation completed a 4-week physical therapy endurance and strengthening ‘reconditioning’ program. Initial symptoms included the following: dyspnea with mild exertion, light-headedness, fatigue, leg “heaviness,” and the inability to perform normal work duties. One-mile track walk test (1-MWT) estimated VO2max improved from the 45–50th percentile to the 65–70th percentile at 8 weeks post-discharge. She returned to work full-time and resumed all previous fitness activities. The patient demonstrated clinically meaningful improvements in estimated VO2max after the “reconditioning” training. Physical therapists should be able to recognize the clinical features and inclusion criteria for POTS as part of a differential diagnosing process for patients complaining of orthostatic symptoms.

A Case Report Describing Multiple System Effects of Breast Cancer, Bilateral Mastectomy, and Reconstruction: Implications for Physical Therapist Practice

Background: Medical management after breast cancer diagnosis often includes, but is not limited to, medical procedures including biopsy and mastectomy, radiation therapy, chemotherapy, and other medication use, and finally breast reconstruction. Because of the number of procedures performed annually and the historical prevalence of breast reconstruction, physical therapists may encounter individuals years or even decades after the reconstruction, with new or lingering reports of pain and dysfunction. Purpose: This case report describes the physical therapy management of a female 4.5 years after initial breast cancer diagnosis and 2 years after conclusion of breast cancer surgical and medical management. In addition, this case addresses the importance of altered anatomy and biomechanics, as well as the impact of medications on the physical therapy plan of care and physical therapy outcomes in this case. Study Design: Case Report: Case Description/Outcomes: A 64-year-old woman, 4.5 years following breast cancer diagnosis, presented with neck, shoulder, and thoracic pain and upper extremity sensory complaints. She responded favorably to a 10-visit multimodal physical therapy intervention approach. Upon completion of her course of care, she was pain free and functioning without limitation. Discussion: A physical therapist must consider the linkage between past breast cancer–related intervention, presenting symptoms, and information related to anatomical and biomechanical alterations and disease- and intervention-related side effects in developing a safe and effective physical therapy plan of care.