Jump On It! The Association of Physical Therapy Timing and Frequency With Functional Outcomes in Patients Supported With Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Study.

Abstract

Importance: Physical therapy (PT) interventions for patients supported with extracorporeal membrane oxygenation (ECMO) is thought to help preserve independence, but the impact of PT frequency on ECMO recovery is not well understood.

Objectives: To explore the relationship between PT frequency and functional outcomes in patients supported with ECMO.

Design, setting, and participants: Retrospective, single-center study of patients supported with ECMO at a large volume ECMO referral center. Patients were grouped by PT frequency (high < 3 d, moderate 3-7 d, and low > 7 d between sessions).

Main outcomes and measures: The primary outcome was the final Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" Basic Mobility Score. For the subgroup of patients discharged alive, a multivariable logistic model was used to understand what affected a patient's odds of a final AM-PAC score greater than or equal to 18, indicating functional independence.

Results: One hundred forty-two subjects were included with a median age of 48 years (interquartile range, 35-58 yr). Patients received venovenous (55%, n = 78/142) or venoarterial (45%, n = 64/142) ECMO. Of the cohort, 61% (n = 86/142) were discharged alive. A final AM-PAC score of greater than or equal to 18 was seen in 30% of patients (n = 43/142) before discharge. High- and moderate-frequency groups were more likely to survive to hospital discharge (76%, n = 22/29 and 75%, n = 38/51 vs. 44%, n = 27/62; p = 0.001). Controlling for age, sex, PT frequency, and the number of PT sessions after ECMO, logistic regression showed the number of PT sessions on ECMO (odds ratio, 1.13; 95% CI, 1.02-1.28) significantly impacted the odds of a final AM-PAC score greater than or equal to 18.

Conclusions and relevance: In patients supported with ECMO, high- and moderate-frequency of PT and PT on ECMO were associated with improved functional outcomes at hospital discharge.