Passive Movements Do not Appear to Prevent or Reduce Joint Stiffness in Medium to Long-Stay ICU Patients: A Randomized, Controlled, Within-Participant Trial.

OBJECTIVES: ICU patients have an increased risk of joint stiffness because of their critical illness and reduced mobility. There is a paucity of evidence evaluating the efficacy of passive movements (PMs). We investigated whether PMs prevent or reduce joint stiffness in ICU patients. DESIGN: A randomized, controlled, within-participant, assessor-blinded study. SETTING: A 48-bed tertiary care adult ICU. PATIENTS: Intubated patients who were expected to be invasively mechanically ventilated for greater than 48 hours with an ICU length of stay greater than or equal to 5 days, and unable to voluntarily move their limbs through full range of motion (ROM). INTERVENTIONS: The ankle and elbow on one side of each participant's body received PMs (10 min each joint, morning and afternoon, 5 d/wk). The other side acted as the control. The PMs intervention continued for as long as clinically indicated to a maximum of 4 weeks. MEASUREMENTS: The primary outcome was ankle dorsiflexion ROM at cessation of PMs. Plantarflexion, elbow flexion and extension ROM, and participant-reported joint pain and stiffness (verbal analog scale [VAS]) were also measured. Outcomes were recorded at baseline and cessation of PMs. For participants whose PMs intervention ceased early due to recovery, additional post-early-cessation of PMs review measurements were undertaken as near as possible to 4 weeks. MAIN RESULTS: We analyzed data from 25 participants with a median (interquartile range) ICU stay of 15.6 days (11.3-25.4). The mean (95% CI) between-side difference for dorsiflexion ROM (with knee extension) at cessation of PMs was 0.4 degrees (-4.4 to 5.2; p = 0.882), favoring the intervention side, indicating there was not a clinically meaningful effect of 5 degrees. No statistically significant differences were found between the intervention and control sides for any ROM or VAS data. CONCLUSIONS: PMs, as provided to this sample of medium to long-stay ICU patients, did not prevent or reduce joint stiffness.

Orthopedic inpatients' ability to accurately reproduce partial weight bearing orders.

Partial weight bearing is often prescribed for patients with orthopedic injuries. Patients' ability to accurately reproduce partial weight bearing orders is variable, and its impact on clinical outcomes is unknown. This observational study measured patients' ability to reproduce partial weight bearing orders, factors influencing this, patients' and physiotherapists' ability to gauge partial weight bearing accuracy, and the effect of partial weight bearing accuracy on long-term clinical outcomes. Fifty-one orthopedic inpatients prescribed partial weight bearing were included. All received standard medical/nursing/physiotherapy care. Physiotherapists instructed patients in partial weight bearing using the hand-under-foot, bathroom scales, and/or verbal methods of instruction. Weight bearing was measured on up to 3 occasions during hospitalization using a force-sensitive insole. Factors that had the potential to influence partial weight bearing accuracy were recorded. Patients and their physiotherapists rated their perception of partial weight bearing accuracy. Three-month clinical follow-up data were retrieved from medical records. The majority of patients (72% or more) exceeded their target load, with mean peak weight bearing as high as 19.3 kg over target load (285% of target load). Weight bearing significantly increased over the 3 measurement occasions (P<.001) and was significantly associated with greater body weight (P=.04). Patients and physiotherapists were unable to accurately gauge partial weight bearing accuracy. The incidence of clinically important complications at 3 months was 9% and not significantly associated with partial weight bearing accuracy during hospitalization (P≥.45). Patients are unable to accurately reproduce partial weight bearing orders when trained with the hand-under-foot, bathroom scales, or verbal methods of instruction.

A physiotherapy service to an emergency extended care unit does not decrease admission rates to hospital: a randomised trial.

BACKGROUND: One of the reasons physiotherapy services are provided to emergency departments (EDs) and emergency extended care units (EECUs) is to review patients' mobility to ensure they are safe to be discharged home. AIM: To investigate whether a physiotherapy service to an EECU altered the rate of hospital admission, rate of re-presentation to the ED, visits to community healthcare practitioners, return to usual work/home/leisure activities and patient satisfaction. METHODS: A randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis was undertaken in an EECU. The sample comprised 186 patients (mean age 70 years, 123 (66%) female patients, 130 (70%) trauma) who were referred for physiotherapy assessment/intervention. Referral occurred at any stage of the patients' EECU admission. All participants received medical/nursing care as required. The physiotherapy group also received physiotherapy assessment/intervention. RESULTS: The physiotherapy group had a 4% (95% CI -18% to 9%) lower rate of admission to hospital than the control group and a 4% (95% CI -6% to 13%) higher rate of re-presentation to the ED, which were statistically non-significant (p≥0.45). Differences between groups for use of community healthcare resources, return to usual work/home/leisure activities and satisfaction with their EECU care were small and not significant. CONCLUSION: A physiotherapy service for EECU patients, as provided in this study, did not reduce the rate of hospital admission, rate of re-presentation to the ED, use of community healthcare resources, or improve the rate of return to usual work/home/leisure activities or patient satisfaction. Trial registration number ANZCTRN12609000106235.

Are bed exercises necessary following hip arthroplasty?

This study investigated whether a program of bed exercises increased the effectiveness of a mobility regimen during the acute period of hospitalisation, for patients who had undergone primary hip arthroplasty. Forty-two patients were randomly allocated, using a concealed allocation procedure, to one of two groups. Patients in the control group were mobilised according to a standard post-operative protocol. Patients in the exercise group were also mobilised using this protocol but in addition received a program of bed exercises. Severity of pain, range of active hip flexion and hip abduction, and a functional assessment were measured by a blinded assessor on the third or fourth post-operative day and again on the seventh or eighth post-operative day. Significant improvements were found in all outcome measures from the third or fourth post-operative day to the seventh or eighth post-operative day. No significant differences were seen between groups for any outcome measures at either measurement time. Bed exercises do not appear to be of additional benefit to a mobility regimen during the period of acute hospitalisation after primary hip arthroplasty.