Protocolo de reabilitação funcional baseado na progressão de atividades em pacientes criticamente doentes: um ensaio clínico aleatório

Abstract

Bed rest in the Intensive Care Unit brings significant loss in musculoskeletal status, causing muscle weakness in critically ill patients. This weakness leads to loss in functionality and quality of life of these individuals. The objective of this study is to evaluate whether early mobilization (EM) of the critically ill patient would impact the functionality at discharge from intensive care. We conducted a randomized clinical trial and patients were randomized into two groups. The control group (CG) received usual care and the experimental group (EG) was subjected to a protocol of progressive EM divided into five phases. 33 patients entered in the study, 16 in the EG and 17 in the CG. The functionality was measured by the Functional Independence Measure (FIM) by occupational therapists blinded to the intervention. Patients who received the treatment progression of activities obtained at the end of the study, less decrease in FIM score, with statistically significant results in relation to self-care (p = 0.017) and mobility (p = 0.045). A larger number of patients in GE got orthostatism and were able to walk 30 meters at discharge from intensive care. The improvement of the FIM was significantly correlated with patient age, number of outputs of the bed and standing. In this study we can conclude that the systematic completion of a rehabilitation protocol established early in the ICU, based on individual assessments to the bedside of the patient, improving its functionality at discharge from Intensive Care.