Victor D. Dinglas, Elizabeth Colantuoni, Nancy Ciesla, Pedro A. Mendez-Tellez, Carl Shanholtz, Dale M. Needham; Occupational Therapy for Patients With Acute Lung Injury: Factors Associated With Time to First Intervention in the Intensive Care Unit. Am J Occup Ther 2013;67(3):355-362. doi: 10.5014/ajot.2013.007807.
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© 2018 American Occupational Therapy Association
OBJECTIVE. Very early occupational therapy intervention in the intensive care unit (ICU) improves patients’ physical recovery. We evaluated the association of patient, ICU, and hospital factors with time to first occupational therapy intervention in ICU patients with acute lung injury (ALI).
METHOD. We conducted a prospective cohort study of 514 consecutive patients with ALI from 11 ICUs in three hospitals in Baltimore, MD.
RESULTS. Only 30% of patients ever received occupational therapy during their ICU stay. Worse organ failure, continuous hemodialysis, and uninterrupted continuous infusion of sedation were independently associated with delayed occupational therapy initiation, and hospital study site and admission to a trauma ICU were independently associated with earlier occupational therapy.
CONCLUSION. Severity of illness and ICU practices for sedation administration were associated with delayed occupational therapy. Both hospital study site and type of ICU were independently associated with timing of occupational therapy, indicating modifiable environmental factors for promoting early occupational therapy in the ICU.
In this multisite study of patients with ALI, we found that only a small proportion of patients had any occupational therapy intervention during their ICU stay.
Severity of patients’ critical illness was a barrier to initiating occupational therapy interventions in the ICU.
Even after adjusting for severity of illness, ICU and hospital factors were associated with timing of occupational therapy initiation, suggesting that the ICU and hospital environment may be modifiable factors to successfully introduce early rehabilitation in the ICU.
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