OBJECTIVE: This study aims to determine whether a 6-month home physiotherapy program can improve outcomes in critical care survivors. DESIGN: Forty-eight consecutive patients were randomized. The treatment group underwent 2 sessions/day of breathing retraining and bronchial hygiene, physical activity (mobilization, sit-to-stand gait, limb strengthening), and exercise re-conditioning whereas controls underwent standard care. Maximum inspiratory/expiratory pressures (MIP/MEP), forced volumes, blood gases, dyspnea, respiratory rate, disability, peripheral force measurements, perceived health status (Euroquol-5D), patient adherence/satisfaction, safety, and costs were assessed. RESULTS: Outcomes of treatment versus controls: MIP 14 +/- 17 versus -0.2 +/- 14 cmH2O, MEP 27 +/- 27 versus 6 +/- 21 cmH2O both p < 0.03; in addition, quality of life (Euroquol-5D) (p = 0.04), FEV1 (p = 0.03), dyspnea (p = 0.002), and respiratory rate (p = 0.009) were significantly improved for treated cardiorespiratory patients only. Eighty-three percent of the treated patients were decannulated versus 14% of controls (p = 0.01). Compliance was high (74 +/- 25%) and there were no side effects. The majority (87.4%) expressed satisfaction with the program. Treatment cost was 459Euro;/patient/month. CONCLUSIONS: Carrying over regular bronchial hygiene techniques, physical activity, and exercise into the home after long critical care stays is safe and has a beneficial effect on respiratory muscles, decannulation, pulmonary function, and quality of life.

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