Yonsei Med J.  2018 Sep;59(7):843-851. 10.3349/ymj.2018.59.7.843.

Effects of Early Exercise Rehabilitation on Functional Recovery in Patients with Severe Sepsis

• Ahn JY
• Song JE
• Ann HW
• Jeon Y
• Ahn MY
• Jung IY
• Kim MH
• Jeong W
• Jeong SJ
• Ku NS
• Kim JM
• Na S
• Cho SR
• Choi JY

• KMID: 2428910
• DOI: http://doi.org/10.3349/ymj.2018.59.7.843

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.

Keyword

Sepsis; septic shock; exercise rehabilitation; functional outcome; functional recovery

MeSH Terms

Activities of Daily Living
APACHE
Case-Control Studies
Hospitalization
Humans
Korea
Linear Models
Prospective Studies
Rehabilitation*
Sepsis*
Shock, Septic
Tertiary Care Centers

Figure

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  Fig. 1 Flow chart of the study participation.

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  Fig. 2 Distribution of MBI grades over time according to study group. Numbers within bars represent the number of participants. MBI, Modified Barthel Index.

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  Fig. 3 Change in functional outcome (MBI, FIM, and IADL) scores during the study period in the intervention and control groups. (A) Changes in mean MBI score. (B) Changes in mean FIM score. (C) Changes in mean IADL score. Means were calculated and compared between groups at each time point using a linear mixed model. Error bars represent standard error. MBI, Modified Barthel Index; FIM, Functional Independence Measure; IADL, Instrumental Activity of Daily Living.

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