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Kathy Stiller, PhD
Author and Funding Information

From the Physiotherapy Department, Royal Adelaide Hospital.

Correspondence to: Kathy Stiller, PhD, Royal Adelaide Hospital, Physiotherapy Department, N Terrace, Adelaide, SA, Australia, 5000; e-mail: kathy.stiller@health.sa.gov.au


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):432. doi:10.1378/chest.13-2410
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To the Editor:

I thank Dr Davis and colleagues for their interest in my systematic review.1 I completely agree that patient mobilization should be a priority in adult ICUs for virtually all patients, not just those who are intubated and receiving mechanical ventilation. The study Dr Davis and colleagues have undertaken, showing that early mobilization is feasible and safe for patients with ischemic stroke within 13 to 24 h of receiving IV tissue plasminogen activator, is very welcome.2 The AVERT (A Very Early Rehabilitation Trial) series of trials by Bernhardt and colleagues,3 who are investigating the feasibility, safety, and effectiveness of very early rehabilitation for patients with stroke, offer further evidence of the importance of early progressive mobilization and rehabilitation for patients with neurologic conditions. Increasing evidence is also showing that early progressive mobilization is the most important physiotherapy intervention after major surgical procedures, such as upper abdominal surgery.4

My two systematic reviews1,5 deliberately focused on adult patients who are intubated and receiving mechanical ventilation in the ICU, hence, studies involving patients who were ventilating spontaneously were not considered. Although both reviews identified studies where patients with neurologic or neurosurgical conditions were specifically investigated, such studies were sparse. There clearly is a need for further research involving specific patient groups (eg, with specific neurologic conditions) regarding the feasibility and safety of early progressive mobilization and rehabilitation and to evaluate the effectiveness of early progressive mobilization and rehabilitation at improving functional outcomes, decreasing ICU and hospital lengths of stay, and reducing health-care costs.

References

Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144(3):825-847. [CrossRef] [PubMed]
 
Davis O, Mooney L, Dinkins M, Freeman WD, Arnold S. Early mobilization of ischemic stroke patients post intravenous tissue plasminogen activator [abstract]. Stroke. 2013;44:A121. [CrossRef]
 
Bernhardt J, Dewey H, Donnan G, et al. A Very Early Rehabilitation Trial (AVERT) phase III. The Florey website. http://www.florey.edu.au/research/stroke/a-very-early-rehabilitation-trial-avert-phase-iii. Accessed October 3, 2013.
 
Mackay MR, Ellis E, Johnston C. Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients. Aust J Physiother. 2005;51(3):151-159. [CrossRef] [PubMed]
 
Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000;118(6):1801-1813. [CrossRef] [PubMed]
 

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References

Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144(3):825-847. [CrossRef] [PubMed]
 
Davis O, Mooney L, Dinkins M, Freeman WD, Arnold S. Early mobilization of ischemic stroke patients post intravenous tissue plasminogen activator [abstract]. Stroke. 2013;44:A121. [CrossRef]
 
Bernhardt J, Dewey H, Donnan G, et al. A Very Early Rehabilitation Trial (AVERT) phase III. The Florey website. http://www.florey.edu.au/research/stroke/a-very-early-rehabilitation-trial-avert-phase-iii. Accessed October 3, 2013.
 
Mackay MR, Ellis E, Johnston C. Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients. Aust J Physiother. 2005;51(3):151-159. [CrossRef] [PubMed]
 
Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000;118(6):1801-1813. [CrossRef] [PubMed]
 
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