Intensive early rehabilitation in the Intensive Care Unit for liver transplant recipients: a randomised controlled trial

Publication date: Available online 6 March 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Pierre Maffei, Sandrine Wiramus, Laurent Bensoussan, Laurence Bienvenu, Eric Haddad, Sophie Morange, Mohamed Fathallah, Jean Hardwigsen, Jean-Michel Viton, Y. Patrice Le Treut, Jacques Albanese, Emilie Gregoire
ObjectiveTo validate the feasibility and tolerance of an intensive rehabilitation protocol initiated during the postoperative period in Intensive Care Unit (ICU) in liver transplant recipients.DesignProspective randomized studySettingIntensive Care Unit Post Liver TransplantationParticipantsand Interventions: This study compared two groups of liver transplant recipients over a period of one year: the control group (n=20) benefited from the usual treatment applied in the ICU (based on physician prescription for the physiotherapist and applied once a day), while the experimental group (n=20) followed a protocol of early and intensive rehabilitation (based on a written protocol validated by physicians and an evaluation by physiotherapist, with two sessions a day).Main Outcome MeasuresTolerance was assessed from the number of adverse events during rehabilitation sessions, and feasibility from the number of sessions discontinued and constituted our primary aimResultsThe results revealed a small percentage of adverse events (1.5 % in the control group versus 1.06% in the experimental group) that were considered to be of low intensity. Patients in the experimental group sat on the edge of their beds sooner (2.6 d versus 9.7 d; p=0.048) and their intestinal transit resumed earlier (5.6 d versus 3.7 d; p=0.015) than among patients in the control group. There was no significant difference between the two arms regarding length of stay (LOS) despite a decrease in the duration in the experimental groupConclusionThe introduction of an intensive early rehabilitation programme for liver transplant recipients was well tolerated and feasible in the ICU. We noted that the different activities proposed were introduced sooner in the experimental group. Moreover, there is a tendency to a decreased LOS in ICU for the experimental group. These results now need to be confirmed by studies at a larger scale.



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