Literature Summary

Question 1

Khan & Hoffman. Systematic Review of multidisciplinary rehabilitation in patients with multiple trauma.

Answer 1

Low-level evidence from observational studies found functional ability/QoL improved following rehabilitation

Physiotherapy was effective in restoring daily life activities

Concluded rehab is expensive resource and evidence to support its justification is urgently needed

Question 2

Parry. Electrical Muscle Stimulation in the Intensive Care Setting: A Systematic Review

Answer 2

NMES is a promising intervention. However, conflicting evidence for its effectiveness when administered acutely.

Outcome measure at heterogenous, small sample sizes

Question 3

Neuromuscular Electrical Stimulation for Preventing Skeletal Muscle Weakness and Wasting in Critically Ill Patients: A Systematic Review

Answer 3

This systematic review provides evidence that adding NMES therapy to usual care is more effective than usual care alone or sham NMES in preventing ICUAW

There is inconclusive evidence about the effectiveness for the preservation of muscle mass in ICU patients.

Question 4

Kayambu. (2013). Physical Therapy for the Critically Ill in the ICU. A Systematic Review and Meta-Analysis

Answer 4

Physical therapy in the ICU appears to have significant benefit in improving QOL, physical function, peripheral and respiratory muscle strength, increasing ventilator free days and decreasing hospital and ICU stay

However, better quality and larger sample sizes are required to verify the strength of these results

Question 5

Hodgson. (2013) Clinical Review; Early Patient Mobilization in the ICU.

Answer 5

Several studies suggested that different forms of early mobilisation may be both safe and feasible in ICU patients, including those receiving mechanical ventilation

However, these studies had limitations such as having limited external validity and highly variable control treatments

EM may yield clinical benefits, but it is also labour-intensive and requires appropriate staffing and equipment

More research is required to identify optimal EM techniques and appropriate outcome measures before it can be introduced to routine care of critically ill patients

Question 6

Paulus. (2012). Benefits and Risks of Manual Hyperinflation in Intubated and mechanically ventilated intensive care unit patients: a systematic review.

Answer 6

Concluded studies have failed to show that MH benefits critically ill intubated and mechanically ventilated patients

But MH MAY improve pulmonary compliance, arterial oxygenation and clearance of airway secretions

Therefore, MH MAY benefit intubated and mechanically ventilated critically ill patients

Better evidence to support use of manual hyperinflation is required.

Question 7

Evidence Inspiratory Muscle Training

Answer 7

Significant improvements in strength but no significant differences in likelihood of weaning, duration of ventilation and survival.

Systematic Review -> moodie, julie

Question 8

passive movements for early mobs

Answer 8

evidence found passive loading saw a 35% higher specific forces in comparison with the unloaded leg