What is Post-Intensive Care Syndrome and What Does PT Have To Do With It?

When you think about a person going into intensive care, you probably picture someone who's very ill and likely fighting for their life. They may be on a ventilator or other equipment that's keeping them alive. When you're in that situation, surviving would be a win. But what happens after these people survive? Do they recover and go back to life as it was? What's the road to recovery look like?


Fortunately, medical advances have led to higher survival rates for people who end up in intensive care units - it's now between 71% and 90%, which is great. But, survival is not the end goal, and getting out of the ICU is not the end of the battle. Many patients show significant losses of physical, mental and cognitive abilities after discharge. It makes sense - if you don't use it, you lose it! This cluster of problems is called Post-Intensive Care Syndrome or PICS.


PICS is now recognized as a public health burden. Interventions against PICS need to start in the ICU. Then they need to continue after discharge.
Physical declines often include significant losses of strength, endurance, and mobility. These can lead to serious difficulty completing basic daily tasks like getting to the bathroom, preparing a meal, or walking to the mailbox. This may keep some people from returning home. For others, it means they need a caregiver to safely return to their previous setting. 50% of ICU survivors have limitations in daily activities 1 year later, so this is a serious and long-lasting problem.


Mental health is also a very real concern for ICU survivors. They show significant rates of depression - the mean is 28%. 24% of survivors have anxiety and 21% report PTSD. Again, these conditions have a real impact on the quality of life after leaving the ICU.


Last, declines in cognitive abilities are very common in ICU survivors. 77% have cognitive impairments at 3 months post-discharge and 71% have impairments 1 year out. Cognitive issues after discharge can include poor memory, slower thinking, problems making decisions, or difficulty concentrating.


Physical therapists play a significant role in the fight against PICS. PT typically begins while the patient is in ICU, focusing on getting the patient up and walking early. Patients begin a progressive exercise program as soon as it's safe for them. We expect a rise in PICS due to the number of people who COVID-19 has put into critical care and/or on a ventilator.


While we can't prevent every problem that critical illness causes, recognizing the losses that remain after discharge from the ICU is an important step. Physical therapists play an important role in combating the effects of PICS and helping people return to higher-quality lives.

When should manual therapy be introduced for low back pain?

There are questions regarding when to introduce manual therapy for lower back pain.  New research has shown that the sooner it is introduced, the better. A report released by Workers' Compensation Research Institute found that manual therapy within the first two weeks of physical therapy for lower back pain was associated with lower temporary disability rates and overall costs of care compared with manual therapy initiated later in a study of more than two million workers' compensation claims across 28 states.

Additionally, this study builds on an earlier foundational study of physical therapist treatment for lower back pain that found early physical therapy to be associated with shortened disability periods and reduced utilization costs compared with physical therapy begun more than 14 days after the onset of lower back pain.

Overall - this is good news for manual therapy and lower back pain.  If you have any questions, please feel free to contact us.

Falling is not normal!

The first day of fall is known as National Falls Awareness Day

We know that our bodies change as we age, but falling is not a part of the normal aging process and the majority of falls are preventable.  Unfortunately according to the CDC millions of older adults, those over 65 years, fall each year.  In fact, one out of four older adults falls each year, but less than half actually tell their doctor.  Falling is the leading cause of both fatal and non-fatal injuries for people over 65 years of age.  Injuries can include hip fractures or other broken bones and traumatic brain injuries which can lead to long-term health issues and an increased likelihood of future falls.  Even experiencing a fall without an injury can make older adults fearful or depressed and cause them to decrease their activity level which also elevates their fall risk. 

As most falls are preventable, below are some of the common factors leading to falls in the older population:

  • Decreased balance and strength - our strength and balance decrease as we age, it is important to keep mobile and incorporate leg strengthening exercises and balance activities into our daily routine to stay strong.
  • Poor vision or vision changes - our balance is assisted by our reliance on our eyes to tell us about the world around us.  It’s important for older adults to have regular vision screenings to be sure their eyes are functioning normally and their eyeglass prescription is up to date. 
  • Medications - most older adults are on several different medications and many of those can cause side effects of dizziness and even dehydration.  It’s important to continue to talk to your doctor about which medications are necessary to continue and make modifications as needed.  
  • Incontinence Issues - frequent trips to the bathroom, especially at night can increase an older adults risk of falling. 
  • Environmental factors - there are lots of potential fall hazards both in the home and community.  Simple modifications in the home can go a long way to helping to reduce fall risk.  Some suggestions are removing throw rugs, using night lights in hallways and bathrooms, installing railings on stairs, utilizing shower chairs and hand-held showers, and installing grab bars in the bathroom.
  • Chronic conditions - having chronic conditions such as diabetes mellitus, stroke, arthritis and neuropathy can impact a person’s overall mobility, strength and balance which increases their fall risk. 

Physical therapy can help older adults reduce their fall risk by addressing strength, mobility, and balance deficits.  The therapist can also evaluate and educate individuals on their fall risk and provide education on modifications to their home environment.  Contact our office to schedule an evaluation and fall risk assessment. 

For more information on fall risk and how to stay independent check out these links:

Falls Free Check Up: https://ncoa.org/article/falls-free-checkup

My Mobility plan: https://www.cdc.gov/motorvehiclesafety/pdf/older_adult_drivers/CDC-AdultMobilityTool-9.27.pdf

 

Resources: 

Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014.MMWR Morb Mortal Wkly Rep 2016;65:993–998. DOI: http://dx.doi.org/10.15585/mmwr.mm6537a2

Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare Population. Am J Prev Med 2012;43:59–62.

O’Loughlin J et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American journal of epidemiology, 1993, 137:342-54.

www.cdc.gov

www.ncoa.org

 

Jennifer Buono, PT, DPT

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