From rehabilitation to optimal function: role of clinical exercise therapy.

Purpose Of Review: Increasing numbers of critically ill and injured patients are surviving their initial hospitalization. The immobilization associated with long-term critical care can lead to deterioration of the musculoskeletal system within 6 h of bed rest, and muscle strength can decline by as much as 40% within a week of immobilization.

Recent Findings: The physical, emotional, and social deficits consequent to immobilization persist despite current rehabilitation, and a substandard quality of life following the event ensues for as long as 7 years post-trauma. The cause of decline in quality of life is believed to stem most directly from the physical impact of illness, resulting in such impairments as weakness, fatigue, and difficulty in mobilization.

Summary: Physical therapy is a necessary component of the rehabilitation process. Although physical therapy often succeeds in restoration of the activities of daily life, patients are often unequipped to resume their pretrauma level of activity or functional capacity, including return to work or school. We opine that a vigorous program of physical training implemented soon after discharge from physical therapy is a logical and cost-effective extension of the continuum of rehabilitation after critical illness. Such extension, supervised by an advanced exercise specialist, addresses many physical limitations that persist after critical illness and limit functional recovery.