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Published on: February 22, 2020
Factors Influencing Functional Recovery in People After Chronic Critical Illness During Early Neurological
Oliver Plechinger1,2, Petra Bauer1,3, Michaela Schunk1,3
1Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany.
Background:
Advances in intensive care have increased survival after critical illness, often accompanied by prolonged mechanical ventilation and the development of chronic critical illness (CCI) with persistent physical impairments. Physiotherapy in early rehabilitation is central to restoring function, though recovery is influenced by various (pre-)clinical factors. This study provides a systematic description of physiotherapy during early rehabilitation and explores how (pre-)clinical factors affect functional outcomes.
Methods:
This secondary analysis of the prospective cohort study CINAMOPS included participants after CCI with ≥5 days of invasive ventilation. Physiotherapeutic goals, interventions, and mobility milestones were recorded and analyzed descriptively. To quantify functional recovery, a study-specific, non-validated cumulative milestone score based on weighted physiotherapeutic mobility milestones was developed to capture nonlinear recovery trajectories. Multiple linear regression with backward elimination assessed the impact of age, sex, CIP/CIM, sepsis, ventilation duration, COVID-19, cerebral lesion, frailty, physical activity, comorbidities, and weekly physiotherapy sessions on milestone achievement.
Results:
A total of 237 participants after CCI (mean age 62 ± 14 years, 34% female, median ICU stay 57 days, median rehabilitation 67 days) were included. Severe mobility limitations were present at admission. High functional goals, such as walking (85%) and stair climbing (57%), were frequently defined. Mainly active, functionally oriented interventions were applied, particularly gait training (81%) and balance training (65%). All mobility milestones improved significantly until discharge (p < 0.001), though limitations persisted. Cerebral lesion (p = 0.018), CIP/CIM (p = 0.022), and sepsis (p = 0.046) were associated with lower milestone scores.
Conclusion:
This study provides a systematic overview of physiotherapeutic goals, interventions, and mobility milestones after CCI. Cerebral lesion, CIP/CIM, and sepsis were associated with lower functional recovery and may represent relevant factors for rehabilitation approaches. However, further research is needed to validate the cumulative milestone score and to further investigate rehabilitation trajectories after CCI.
