A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure
A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure
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DOI：
10.1164/rccm.201505-1039oc
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发表时间：
2016-05-15
影响因子：
24.7
通讯作者：
Schenkman, Margaret
中科院分区：
文献类型：
--
作者：
Moss, Marc;Nordon-Craft, Amy;Schenkman, Margaret
理论基础：早期物理治疗（PT）干预可能通过预防或减轻神经肌肉无力对急性呼吸衰竭患者有益。然而，这些干预措施的最佳剂量目前尚不清楚。目的：确定与标准护理PT方案相比，强化PT方案是否能显著改善长期身体功能表现。方法：需要机械通气至少4天的患者均符合条件。入组患者随机接受为期4周的强化或标准治疗方式的PT治疗。对目前不在急性或长期护理机构的幸存者在1、3和6个月时的身体功能表现进行评估。主要结果是连续量表物理。1个月功能表现测试简表（CS-PFP-10）评分。测量方法和主要结果：共纳入来自5家医院的120例患者。强化PT组患者接受12.4 +/- 6.5次治疗，共408 +/- 261分钟，而标准治疗组患者仅接受6.1 +/- 3.8次治疗，共86 +/- 63分钟（两项分析均P < 0.001）。86%的患者在1个月、76%的患者在3个月、60%的患者在6个月时进行了身体功能评估。在1、3和6个月的时间里，两组的身体功能都有所下降，但也有显著改善。当我们比较两种干预措施时，我们发现三个时间点的总CS-PFP-10评分（P分别为0.73、0.29和0.43）或总CS-PFP-10评分轨迹（P = 0.71）均无差异。结论：与标准治疗方案相比，强化PT方案并不能改善长期的身体功能表现。
Rationale: 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.Objectives: 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.Measurements and Main 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.