J Korean Med Sci.  2020 Apr;35(15):e101. 10.3346/jkms.2020.35.e101.

Relationship between Use of Rehabilitation Resources and ICU Readmission and ER Visits in ICU Survivors: the Korean ICU National Data Study 2008-2015

• Park YH
• Ko RE
• Kang D
• Park J
• Jeon K
• Yang JH
• Park CM
• Cho J
• Park YS
• Park H
• Cho J
• Guallar E
• Suh GY
• Chung CR

• KMID: 2500189
• DOI: http://doi.org/10.3346/jkms.2020.35.e101

Abstract

Background
Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes.
Methods
A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit.
Results
During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30-day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not (P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65–0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy (P < 0.001; HR, 0.83; 95% CI, 0.77–0.88).
Conclusion
In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.

Keyword

Nationwide Cohort Study; Intensive Care Units; Survivors; Rehabilitation; Readmission

Figure

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  Fig. 1 Flowchart of study participants.aHospitalization period including the first episode admission.ICU = intensive care unit.

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  Fig. 2 Trends in rehabilitation therapy in patients admitted to ICUs for the first time in Korea between January 2008 and May 2015. (A) Group 1 = all patients admitted to the ICU during the time period. (B) Group 2 = patients admitted to the ICU during the time period who had no neurologic or neuromuscular disorder during hospitalization or the first year after discharge. (C) Group 3 = patients admitted to the ICU during the time period who had cerebrovascular disease, paraplegia/hemiplegia, or brain/spinal cord tumor during hospitalization or the first year after discharge.ICU = intensive care unit, NMES = neuromuscular electrical stimulation.

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