Skip to main content

Randomized, controlled pilot study of early rehabilitation strategies in acute respiratory failure


Optimal patient evaluations of ICU rehabilitation therapy remain unclear.


One hundred ICU patients with acute respiratory failure were randomized to receive early rehabilitation (ER) or usual-care (UC). Cohort 1 (n = 50) received ER as one physical therapy (PT) session/day versus UC; Cohort 2 (n = 50) received ER as 2 PT/day with the second session resistance training, versus UC. UC was without ER. Blood was drawn for cytokines through days 7. Cohort 2 underwent strength and physical functional assessments using the Short Physical Performance Battery (SPPB), a valid and reliable measure of physical function consisting of walking speed, balance, and repeated chair stands. It is a well-studied composite measure in older persons, but has not been used in ICU survivors. Small changes of 0.5 to 0.6 points in the SPPB have been shown to be clinically meaningful.


Baseline parameters were similar between groups. Median days from enrollment to first PT were 4 (IQR 1 to 7.25). Deaths occurred in eight UC subjects and four in ER (P = 0.22). For both arms, ventilator days, ICU days and hospital days were not statistically different. ER had ventilator-free days of 22, 95% CI = 19.9 to 24.6, where UC had 22.3 days, 19.9 to 24.6, P = 0.99. ICU-free days for ER was 21, 95% CI = 19.1 to 23.6, and that for UC was 21.0, 18.8 to 23.2, P = 0.84. Similarly, hospital days for ER was 16.7, 95% CI = 11.8 to 21.4, and for UC was 18.2, 13.8 to 22.7, P = 0.45. TNF, IL-6 and IL-8 through days 7 were not different between groups. Despite similar baseline acuity and inflammatory profiles, Cohort 2 ER group strength scores were numerically but not statistically higher. Grip strength, as a percentage of predicted for ER was 66 versus 39 for UC, P = 0.06. Dynamometry for ER was 211 versus 181 lbs for UC, P = 0.124. Although the difference in SPPB values for ER versus UC (5 vs. 3, P = 0.172) was not statistically different, it was greater than the minimal clinically significant difference. There were no differences in adverse events.


In this pilot study, early ICU rehabilitation was safe, and was associated with numerically although not statistically shorter hospital stay, greater strength and improved functional scores. Particularly, the SPPB demonstrated discriminatory ability in groups of ICU survivors with low physical function. Future early ICU rehabilitation studies should consider ICU survivor assessments using the SPPB due to its ease, reproducibility and discriminatory ability following ICU and hospital discharge.


Supported by NIH grants 1R011186-01 and P30 AG21332.

Author information



Corresponding author

Correspondence to D Files.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Files, D., Morris, P., Shrestha, S. et al. Randomized, controlled pilot study of early rehabilitation strategies in acute respiratory failure. Crit Care 17, P540 (2013).

Download citation


  • Resistance Training
  • Acute Respiratory Failure
  • Discriminatory Ability
  • Short Physical Performance Battery
  • Early Rehabilitation