The Absence of Rehabilitation During the ICU Stay of Elderly Patients is Associated with a Decreased Long-Term Autonomy

Background: The intensive care unit (ICU) stay is associated with a loss of autonomy, especially for elderly patients. We therefore conducted a study to estimate the impact of the rehabilitation performed during the ICU stay on the loss of autonomy at 6 months. Methods: We conducted an ancillary study of the multicenter FRAGIREA study, including patients between April 2018 and January 2019 aged over 70 years, admitted in ICU for an expected length of stay of more than 48 hours. We excluded the patients who died before day 180, who were lost to follow-up, and for whom the baseline autonomy (ADL) score was not available. We collected the baseline characteristics of patients, the ICU stay characteristics, and the 6-month follow-up. Were also collected the detailed rehabilitation therapy carried out during the ICU stay (passive mobilization, upright sitting, transfer to chair, standing, walking, and cycle ergometers.). Patients were classified into the rehabilitation (out of bed) or non-rehabilitation group, and the impact of rehabilitation on the decreased 6-month autonomy (loss of ADL score >1 point) was estimated after the selection of 17 potential confounders. Results: Among the 548 patients of the FRAGIREA cohort, 276 were included in the present study. Among them, 226 were rehabilitated and 50 were not. 220/276 (80%) patients benefited from the transfer to chair as rehabilitation therapy, passive mobilization and transfer to upright sitting were also frequently performed. A decrease in the 6-month autonomy was observed for 63 (23%) patients. After the elimination of potential confounders, non-rehabilitated patients had a greater risk of 6-month decreased autonomy (adjusted Odds Ratio 2.43, 95% confidence interval [1.18; 4.98]). Conclusions: Rehabilitation during the ICU stay of elderly ICU patient survivors was associated with a lower decreased autonomy at 6 months. Tweet: The absence of rehabilitation during the ICU stay of elderly patients is associated with 2.4 higher risk of a decreased 6 month autonomy