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Effects of Early Exercise Rehabilitation on Functional Recovery in Patients with Severe Sepsis.
Yonsei Med J. 2018 Sep; 59(7):843-851.YM

Abstract

PURPOSE

Severe sepsis is associated with functional disability among patients surviving an acute phase of infection. Efforts to improve functional impairment are important. We assessed the effects of early exercise rehabilitation on functional outcomes in patients with severe sepsis.

MATERIALS AND METHODS

A prospective, single-center, case-control study was conducted between January 2013 and May 2014 at a tertiary care center in Korea. Patients with severe sepsis and septic shock were enrolled and randomized to receive standard sepsis treatment or intervention. Intervention involved early targeted physical rehabilitation with sepsis treatment during hospitalization. Participants were assessed at enrollment, hospital discharge, and 6 months after enrollment. Functional recovery was measured using the Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Instrumental Activities of Daily Living (IADL).

RESULTS

Forty participants (21 intervention patients) were included in an intention-to-treat analysis. There were no significant differences in baseline MBI, FIM, and IADL between groups. Intervention yielded greater improvement of MBI, FIM, and IADL in the intervention group at hospital discharge, but not significantly. Subgroup analysis of patients with APACHE II scores ≥10 showed significantly greater improvement of physical function at hospital discharge (MBI and FIM) in the intervention group, compared to the control group (55.13 vs. 31.75, p=0.048; 52.40 vs. 31.25, p=0.045). Intervention was significantly associated with improvement of MBI in multiple linear regression analysis (standardized coefficient 0.358, p=0.048).

CONCLUSION

Early physical rehabilitation may improve functional recovery at hospital discharge, especially in patients with high initial severity scores.

Authors+Show Affiliations

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea.Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea. seran@yuhs.ac.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30091317

Citation

Ahn, Jin Young, et al. "Effects of Early Exercise Rehabilitation On Functional Recovery in Patients With Severe Sepsis." Yonsei Medical Journal, vol. 59, no. 7, 2018, pp. 843-851.
Ahn JY, Song JE, Ann HW, et al. Effects of Early Exercise Rehabilitation on Functional Recovery in Patients with Severe Sepsis. Yonsei Med J. 2018;59(7):843-851.
Ahn, J. Y., Song, J. E., Ann, H. W., Jeon, Y., Ahn, M. Y., Jung, I. Y., Kim, M. H., Jeong, W., Jeong, S. J., Ku, N. S., Kim, J. M., Na, S., Cho, S. R., & Choi, J. Y. (2018). Effects of Early Exercise Rehabilitation on Functional Recovery in Patients with Severe Sepsis. Yonsei Medical Journal, 59(7), 843-851. https://doi.org/10.3349/ymj.2018.59.7.843
Ahn JY, et al. Effects of Early Exercise Rehabilitation On Functional Recovery in Patients With Severe Sepsis. Yonsei Med J. 2018;59(7):843-851. PubMed PMID: 30091317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Early Exercise Rehabilitation on Functional Recovery in Patients with Severe Sepsis. AU - Ahn,Jin Young, AU - Song,Je Eun, AU - Ann,Hea Won, AU - Jeon,Yongduk, AU - Ahn,Mi Young, AU - Jung,In Young, AU - Kim,Moo Hyun, AU - Jeong,Wooyoung, AU - Jeong,Su Jin, AU - Ku,Nam Su, AU - Kim,June Myung, AU - Na,Sungwon, AU - Cho,Sung Rae, AU - Choi,Jun Yong, PY - 2018/01/15/received PY - 2018/06/24/revised PY - 2018/06/26/accepted PY - 2018/8/10/entrez PY - 2018/8/10/pubmed PY - 2018/9/1/medline KW - Sepsis KW - exercise rehabilitation KW - functional outcome KW - functional recovery KW - septic shock SP - 843 EP - 851 JF - Yonsei medical journal JO - Yonsei Med J VL - 59 IS - 7 N2 - PURPOSE: Severe sepsis is associated with functional disability among patients surviving an acute phase of infection. Efforts to improve functional impairment are important. We assessed the effects of early exercise rehabilitation on functional outcomes in patients with severe sepsis. MATERIALS AND METHODS: A prospective, single-center, case-control study was conducted between January 2013 and May 2014 at a tertiary care center in Korea. Patients with severe sepsis and septic shock were enrolled and randomized to receive standard sepsis treatment or intervention. Intervention involved early targeted physical rehabilitation with sepsis treatment during hospitalization. Participants were assessed at enrollment, hospital discharge, and 6 months after enrollment. Functional recovery was measured using the Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Instrumental Activities of Daily Living (IADL). RESULTS: Forty participants (21 intervention patients) were included in an intention-to-treat analysis. There were no significant differences in baseline MBI, FIM, and IADL between groups. Intervention yielded greater improvement of MBI, FIM, and IADL in the intervention group at hospital discharge, but not significantly. Subgroup analysis of patients with APACHE II scores ≥10 showed significantly greater improvement of physical function at hospital discharge (MBI and FIM) in the intervention group, compared to the control group (55.13 vs. 31.75, p=0.048; 52.40 vs. 31.25, p=0.045). Intervention was significantly associated with improvement of MBI in multiple linear regression analysis (standardized coefficient 0.358, p=0.048). CONCLUSION: Early physical rehabilitation may improve functional recovery at hospital discharge, especially in patients with high initial severity scores. SN - 1976-2437 UR - https://www.unboundmedicine.com/medline/citation/30091317/Effects_of_Early_Exercise_Rehabilitation_on_Functional_Recovery_in_Patients_with_Severe_Sepsis_ L2 - https://www.eymj.org/DOIx.php?id=10.3349/ymj.2018.59.7.843 DB - PRIME DP - Unbound Medicine ER -