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| An intensive physiotherapy program improves mobility for trauma patients |
| Calthorpe S, Barber EA, Holland AE, Kimmel L, Webb MJ, Hodgson C, Gruen RL |
| Journal of Trauma and Acute Care Surgery 2014 Jan;76(1):101-106 |
| clinical trial |
| 6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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BACKGROUND: Physiotherapy is integral to modern trauma care. Early physiotherapy and mobility have been shown to improve outcomes in patients with isolated injuries; however, the optimal intensity of physiotherapy in the multitrauma patient population has not yet been examined. The primary aim of this study was to determine whether an intensive physiotherapy program resulted in improved inpatient mobility. METHODS: We conducted a single-center prospective randomized controlled study of 90 consecutive patients admitted to the Alfred Hospital (a level 1 trauma center) in Australia between October 2011 and June 2012 who could participate in ward-based physiotherapy. Participants were allocated to either usual care (daily physiotherapy treatment, approximately 30 minutes) or intensive physiotherapy (usual care plus two additional 30-minute treatments each day). The primary outcome measure was the modified Iowa Level of Assistance (mILOA) score, collected by a blinded assessor at days 3 and 5 (or earlier if discharged). Secondary measures included physical readiness for discharge, hospital and rehabilitation length of stay, a patient confidence and satisfaction scale, and quality of life at 6 months. RESULTS: Groups were comparable at baseline. Participants in the intensive physiotherapy group achieved significantly improved mILOA scores on day 3 (median 7 points compared with 10 points; p = 0.02) and day 5 (median 7.5 points compared with 16 points; p = 0.04) and were more satisfied with their care (p = 0.01). There was no difference between groups in time to physical readiness, discharge destination, length of stay, or quality-of-life measures. CONCLUSION: Intensive physiotherapy resulted in improved mobility in trauma inpatients. Further studies are required to determine if specific groups benefit more from intensive physiotherapy and if this translates to long-term improvements in outcomes. LEVEL OF EVIDENCE: Therapeutic study, level 1.
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