Physical therapy for patients in the Intensive Care Unit: Towards safe and purposeful physical therapy practice for critically ill patients

Along with improving medical treatment, the survival rate of patients admitted to an Intensive Care Unit (ICU) rises, leading to an increasing number of patients with long term physical and psychological impairments. Many ICU survivors develop muscle weakness and reduced exercise tolerance. Early rehabilitation for ICU patients has been advocated to prevent physical deterioration. Ideally, in order to improve physical functioning, the training load of physical therapy should be sufficient. At the same time, exercise sessions should be safe and physiological overload should be avoided. However, knowledge on safe and effective physical therapy in ICU patients is lacking. The aim of this thesis was to contribute to the gaps in knowledge about physiological changes and muscle activity in ICU patients during exercise, and to develop a clinical guideline for safe and effective physical therapy in the ICU. Based on the studies in this thesis, we developed evidence based recommendations for physical therapy for patients in the ICU. These include safety criteria to guide physical therapy, guidance for the use of applicable and valid instruments to measure physical impairments in order to determine the goalsetting and interventions of physical therapy. The studies about physiological changes during incremental exercise testing, and muscle activity using surface electromyography EMG (sEMG) during bed cycling, found that a physiological response and muscle activity could be measured safely. Finally, a new method of early rehabilitation, ambulation training with a body weight supporting treadmill, was investigated and proved to be feasible, safe and potentially effective.