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Title: Low Levels of Physical Activity During Critical Illness and Weaning: The Evidence-Reality Gap.
Austin Authors: Connolly, Bronwen A;Mortimore, Jessica L;Douiri, Abdel;Rose, Joleen W ;Hart, Nicholas;Berney, Susan C 
Affiliation: Department of Asthma, Allergy and Lung Biology, King's College London, London, United Kingdom
Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Department of Primary Care and Public Health Science, King's College London, London, United Kingdom
Department of Physiotherapy, King's College London, London, United Kingdom
Lane Fox Clinical Respiratory Physiology Research Centre, London, United Kingdom
NIHR Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
Centre for Human and Aerospace Physiological Sciences, King's College London, London, United Kingdom
Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Oct-2019 2017-01-01
Publication information: Journal of intensive care medicine 2019; 34(10): 818-827
Abstract: Physical rehabilitation can benefit critically ill patients during intensive care unit (ICU) admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator weaning unit (VWU). Behavioral mapping is a sampling approach that allows detailed reporting of physical activity profiles. The objective of this study was to characterize the physical activity profile of critically ill patients in a UK ICU and VWU. Single-center, prospective observational study in a university teaching hospital. Patient observations, conducted Monday through Sunday from 08:30 am to 08:00 pm and for 1 minute every 10 minutes, included data points of patient location, people in attendance, and highest level of activity. Descriptive statistics were utilized to analyze and report data. Forty-two ICU and 11 VWU patients were recruited, with 2646 and 693 observations, respectively, recorded. In the ICU, patients spent a median (interquartile range) of 100% (96%-100%) of the day (10.5 [10.0-10.5] hours) located in bed, with minimal/no activity for 99% (96%-100%) of the day (10.4 [9.7-10.5] hours). Nursing staff were most frequently observed in attendance with patients irrespective of ventilation or sedation status, although patients still spent approximately two-thirds of the day alone. Bed-to-chair transfer was the highest activity level observed. In the VWU, patients spent 94% (73%-100%) of the day (9.9 [7.7-10.5] hours) in bed and 56% (43%-60%) of time alone. Physical activity levels were higher and included ambulation. All physical activities occurred during physical rehabilitation sessions. These profiles of low physical activity behavior across both patients in the ICU and VWU highlight the need for targeted strategies to improve levels beyond therapeutic rehabilitation and support for a culture shift toward providing patients with, and engaging them in, a multidisciplinary, multiprofessional environment that optimizes overall physical activity.
DOI: 10.1177/0885066617716377
ORCID: 0000-0002-5676-5497
PubMed URL: 28675113
Type: Journal Article
Subjects: behavior
critical illness
intensive care unit
physical activity
weaning unit
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