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ForwardGW Medicine Bicentennial Faculty Lecture - Early Rehabilitation in the ICU: Revolutionary Opportunities for Our Third Century
A growing number of people are becoming critically ill due to an aging population with greater comorbidities. Advances in critical care medicine over the last two decades have improved survivorship rates. However, survivors of critical illness often experience long-lasting physical, cognitive, and/or mental health impairments, collectively known as Post-Intensive Care Syndrome (PICS). Early rehabilitation is a promising intervention to help mitigate these detrimental outcomes, particularly physical impairments. Foundational studies indicated early rehabilitation was safe and feasible and provided preliminary evidence supporting its efficacy which led to international adoption of early mobility programs in ICUs. However, recent studies evaluating early rehabilitation have yielded inconsistent findings. This lecture will summarize the state of the early rehabilitation literature and future directions for research on early rehabilitation in the ICU. Importantly, opportunities for the GW Academic Medical Enterprise to achieve goals within the Clinical Care and Research pillars by addressing current gaps will be highlighted.
Target Audience
The audience from this lecture is very wide. We hope to engage our SMHS community, including faculty, staff, students and local alumni. We've also invited members of our adjunct clinical PT faculty, who work out in the DC area to attend. We hope to attract as many of our faculty to attend by offering CME credit, similar to an endowed lecture or Grand Rounds.
Learning Objectives
Introduction/Background
▪ Define Post-Intensive Care Syndrome (PICS)
▪ Introduce immobility as a modifiable risk factor
▪ Highlight inconsistent findings regarding efficacy of early rehab
Early Rehab Studies
▪ Discuss the landmark randomized controlled trial by Schweickert et al. (Lancet
2009)
▪ Briefly highlight the variety of early rehab interventions (functional mobility,
Neuromuscular electrical stimulation, In-bed cycle ergometry, Functional
electrical stimulation, Robotic-assisted rehab, Tilt table/Dynamic tilt table,
Interactive video games, hydrotherapy, and functional activity)
▪ Briefly highlight the ICU liberation bundle
▪ Highlight society of critical care medicine PADIS (Pain, Agitation/Sedation,
Delirium, Immobility and Sleep Disruption) guidelines
Effects of Early Rehabilitation
▪ Discuss findings from Waldauf. et al. (Crit Care Medicine, 2020) meta-analysis:
treatment effect greater in patients with longer length of stay and lower severity
of illness (APACHE scores) for outcomes of: reduction in mechanical ventilation
duration and ICU length of stay; no effect on ICU mortality or end-of-study
mortality
▪ Discuss findings from Wang et al. (Crit Care Medicine, 2021) meta-analysis:
accounts for dose of early rehabilitation intervention by dividing control group
into high dose versus low dose.
▪ Patel et al. (Lancet Respir Med, 2023)- early rehab improves long-term cognitive
impairments in ICU survivors
Implementing/Sustaining an early rehabilitation program
▪ Discuss the importance of a structured quality improvement process
▪ Discuss common barriers to early rehab
▪ Discuss Hodgson et al. (Crit Care 2021)-10 strategies
▪ Highlight the latest safety guidelines
Gaps in Current Literature and Considerations for Future Studies
▪ Patient-related
▪ Intervention-related
o Discuss findings from my Scoping Review evaluating how early rehab
interventions are defined in the current literature (presented at the
American Thoracic Society Conference in May 2024)
o Discuss findings from my qualitative study on Physical Therapists’
prescription of early rehab in the ICU
▪ Comparator-related
▪ Outcome-related
Stephanie Hiser, PT, DPT, PhD is an Assistant Professor in the Department of Health, Human
Function, and Rehabilitation Sciences. She received her BS in Exercise Science at Lipscomb
University (2012), DPT at University of Miami (2015), and PhD in Clinical Investigation at The
Johns Hopkins Bloomberg School of Public Health (2023). She is a graduate of both The Johns
Hopkins and University of Delaware Acute Care Residency Program (2016) and Critical Care
Physical Therapy Fellowship program at Johns Hopkins Hospital (2017). Additionally, she is an
APTA Board Certified Cardiovascular and Pulmonary Specialist. Dr. Hiser’s early research work
focused on evaluating the psychometric properties of outcome measures frequently used
clinically and in research to evaluate patients in the ICU. Her thesis work focused more on
evaluating rehabilitation prescription in the ICU. Dr. Hiser has become an expert in the field of
early rehabilitation in the ICU through her training, clinical experience, and research. Dr. Hiser
has published and presented he research in peer reviewed forums regionally, nationally, and
internationally. She joined the faculty in the Department of Health, Human Function and
Rehabilitation Sciences 2022 and is excited to collaborate with faculty, scientists, and clinicians
within the GW Academic Medical Enterprise to expand knowledge within the field of early
rehabilitation in the ICU.
Available Credit
- 1.00 AMA PRA Category 1 Credit™The George Washington University School of Medicine and Health Sciences is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
- 1.00 Completion