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Can early rehabilitation on the general ward after an intensive care unit stay reduce hospital length of stay in survivors of critical illness: a randomized controlled trial
Gruther W, Pieber K, Steiner I, Hein C, Hiesmayr JM, Paternostro-Sluga T
American Journal of Physical Medicine & Rehabilitation 2017 Sep;96(9):607-615
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: The aim of this study was to evaluate if an early rehabilitation program for survivors of critical illness improves functional recovery, reduces length of stay, and reduces hospital costs. DESIGN: This was a prospective randomized controlled trial. Fifty-three consecutive survivors of critical illness were included in the study. After discharge from the intensive care unit, the intervention group received an early rehabilitation program, and the standard-care group received physical therapy as ordered by the primary care team. Length of stay at the general ward after transfer from the intensive care unit was recorded. In addition, Early Rehabilitation Barthel Index, visual analog scale for pain, 3-minute walk test, Beck Depression Inventory, State-Trait Anxiety Inventory, and Medical Research Council scale were used. RESULTS: In the per-protocol analysis, length of stay at the general ward was a median 14 days (interquartile range (IQR) 12 to 20 days) in the early rehabilitation and 21 days (IQR 13 to 34 days) in the standard-care group. This significant result could not be confirmed by the intention-to-treat analysis (16 days (IQR 13 to 23 days) versus 21 days (IQR 13 to 34 days)). Secondary outcomes were similar between the groups. Hospital costs were lower in the intervention group. No adverse effects were detected. CONCLUSIONS: An early rehabilitation program in survivors of critical illness led to an earlier discharge from the hospital, improved functional recovery, and was also cost-effective and safe.

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