A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure

TLDR

Early physical therapy may reduce neuromuscular weakness in acute respiratory failure, but the optimal dosage of such interventions remains unknown. The study aimed to determine whether an intensive PT program improves long‑term physical functional performance compared with standard‑of‑care PT. Patients requiring ≥4 days of mechanical ventilation were randomized to receive up to 4 weeks of intensive or standard PT, with the Continuous Scale Physical Functional Performance Test short form (CS‑PFP‑10) measured at 1 month as the primary outcome and followed at 3 and 6 months. The intensive PT group received twice as many sessions and minutes, yet there were no significant differences in CS‑PFP‑10 scores at 1, 3, or 6 months, indicating no improvement in long‑term physical function. Clinical trial registered at www.clinicaltrials.gov (NCT01058421).

Abstract

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.To determine whether an intensive PT program significantly improves long-term physical functional performance compared with a standard-of-care PT program.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.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).An intensive PT program did not improve long-term physical functional performance compared with a standard-of-care program. Clinical trial registered with www.clinicaltrials.gov (NCT01058421).