Daniel J. Malone

The New Demands of Acute Care: Are We Ready?

Physical therapy practitioners in the acute care world have a challenge. The segment of the US population aged 65 years and older is projected to increase from 35 million in 2000 to an estimated 71 million in 2030.1 Incorporated into this demographic bulge is a substantial projected increase in the number of people aged 80 years and older, from 9.3 million in 2000 to 19.5 million in 2030.1 An aging population combined with a longer life expectancy will increase the prevalence of chronic diseases and conditions associated with aging, leading to increased hospitalizations and need for rehabilitation services.2 A frail, increasingly dependent population will place enormous strain on health care providers. Are physical therapists and physical therapist assistants who work in acute care prepared for this challenge? Do we have sufficiently streamlined, efficient work processes? Do therapists have the necessary skills? Do we have the staffing? In this issue of PTJ , 2 articles offer unique insights into acute care physical therapy and should be harbingers of continued dialogue and research. In “Development of a Unique Triage System for Acute Care Physical Therapy and Occupational Therapy Services: An Administrative Case Report,” Hobbs …

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.

Perfluorochemical Liquid-Adenovirus Suspensions Enhance Gene Delivery to the Distal Lung

We compared lung delivery methods of recombinant adenovirus (rAd): (1) rAd suspended in saline, (2) rAd suspended in saline followed by a pulse-chase of a perfluorochemical (PFC) liquid mixture, and (3) a PFC-rAd suspension. Cell uptake, distribution, and temporal expression of rAd were examined using A549 cells, a murine model using luciferase bioluminescence, and histological analyses. Relative to saline, a 4X increase in transduction efficiency was observed in A549 cells exposed to PFC-rAd for 2–4 h. rAd transgene expression was improved in alveolar epithelial cells, and the level and distribution of luciferase expression when delivered in PFC-rAd suspensions consistently peaked at 24 h. These results demonstrate that PFC-rAd suspensions improve distribution and enhance rAd-mediated gene expression which has important implications in improving lung function by gene therapy.

Commentary on supramaximal verification of peak oxygen uptake in adolescents with cystic fibrosis.

“How can I apply this information in adolescents with cystic fibrosis in my clinical practice?” Aerobic capacity and exercise testing are important tools within pediatric physical therapy practice, but often not a content area of comfort for the practicing pediatric physical therapist. Whereas cystic fibrosis (CF), a common pediatric disorder, requires a multidisciplinary approach, exercise testing and training, which has a critical role in the management of adolescents with CF, has received little attention. Studies have shown that higher peak VO2 and the time-dependent decline in peak VO2 assist in predicting survival in CF.1,2 Additionally, exercise training has been shown to improve aerobic fitness and is an important adjunct for mucociliary clearance.3−5 Physical therapists must continue to develop their expertise in the area of exercise testing and training, and this article describes a relatively simple means of determining exercise capacity in adolescents with CF. The accurate determination of V . O2 peak is critical in exercise testing and exercise prescription, yet the inconsistency between heart rate and VO2 raises some concerns that are addressed by this study. This study clarifies that V . O2 peak measured by traditional exercise testing does appear to reflect the true V . O2 peak. “What should I be mindful about in applying this information?” Pediatric therapists must continue to develop competence and expertise in the area of aerobic capacity and exercise testing. Clearly the authors are experienced with the technical aspects of exercise testing and metabolic analysis. This study specifically focused on stable adolescents with mild to moderate involvement. The clinician must be cautious to not generalize the findings to patients in other age groups or with different disease severities, including those with exercise induced hypoxemia, dysrhythmias, or patients being treated for a CF exacerbation. Whereas it is tempting to use the Steep Ramp test (SRT) as a measure of exercise capacity, additional validation of the SRT must be completed as noted by the authors. Until then, standard cardiopulmonary exercise testing (CPET) based on heart rate and work load increments should remain the standard of care.