Early rehabilitation solutions by the bedside of rehabilitation beds - helping to enhance patients' quality of life, from "surviving" to "living well"
With the improvement of the level of critical care treatment, the survival rate of critically ill patients in the ICU has significantly increased. However, survival does not mean recovery - issues such as ICU-acquired weakness (ICUAW), cognitive dysfunction, and psychological disorders are becoming the main factors affecting the long-term quality of life of patients.
The clinical value of critical care rehabilitation has been gradually recognized under this background.
Why is it necessary to focus on critical care rehabilitation?
1. Epidemiological data indicate clear demand
China has entered a moderately aged society. Studies show that the proportion of elderly patients (≥80 years old) in ICUs worldwide has reached 9% to 20%. Elderly patients have more underlying diseases and poorer reserve functions, and are more prone to functional decline and complications during hospitalization.
At the same time, trauma, post-surgery orthopedic patients, and patients on mechanical ventilation also face muscle atrophy and joint function limitations caused by long-term bed rest. The applicable population for critical care rehabilitation is expanding, and it is no longer limited to patients with neurological diseases.
2. Accumulation of clinical evidence for early rehabilitation
Multiple clinical studies have shown that:
Early exercise intervention can reduce the incidence of ICU-acquired weakness;
Patients who receive early rehabilitation have shorter mechanical ventilation times and ICU hospital stays;
The incidence of complications such as ventilator-associated pneumonia, deep vein thrombosis, and pressure ulcers decreases;
The MRC muscle strength score and Barthel index of patients at the time of transfer out of the ICU improve more significantly.
Therefore, initiating rehabilitation as early as possible under the condition of allowable illness has become a clinical consensus both at home and abroad.
3. Clear policy orientation
In 2021, the National Health Commission of China issued the "Opinions on Accelerating the Development of Rehabilitation Medicine", requiring the rehabilitation medicine department of tertiary general hospitals to focus on providing rehabilitation services for patients with acute critical illnesses and complex diseases. In 2022, the "Standards for the Establishment of National Critical Care Medicine Centers and National Regional Critical Care Medical Centers" further included the ability of critical care rehabilitation services in the evaluation system.
The medical insurance payment policies in various regions are also gradually being standardized. Jiangsu and Zhejiang provinces have included critical care rehabilitation in bed-day payment or DRG/DIP management, providing institutional guarantees for the sustainable development of rehabilitation services.
The core content and implementation difficulties of critical care rehabilitation
1. Rehabilitation content covers multiple dimensions
The implementation of critical care rehabilitation includes but is not limited to:
Exercise rehabilitation: transfer training from lying to sitting, bedside sitting training, bed-chair transfer training, transfer from sitting to standing and walking training, etc.;
Joint range of motion maintenance: passive/active ROM training, etc.;
Respiratory rehabilitation: active respiratory airway clearance techniques, respiratory muscle training, etc.;
Neural regulation: arousal training, non-invasive brain stimulation, etc.;
Functional training: cognition, swallowing, speech therapy, etc.;
Complication prevention: prevention of deep vein thrombosis, pressure sores, and pneumonia from inactivity, etc.
Among them, exercise rehabilitation is generally regarded as the core content and is also the key direction of early bedside intervention.
Realistic implementation difficulties in clinical practice
|
难点 |
具体表现 |
|
安全边界 |
患者管路多、监护设备复杂，需要严格掌握适应证与禁忌证 |
人力资源 |
治疗师数量有限，个体化的床旁训练难以覆盖全部需求 |
缺乏辅助工具 |
徒手操作效率低，缺少适用于床旁场景的标准化训练设备 |
量化评估困难 |
肌力、关节活动度等指标的客观记录手段不足 |
The existence of these issues indicates that there is a need for bedside rehabilitation tools and process-based solutions that are more suitable for the ICU environment in clinical practice.
Early rehabilitation solution at the bedside for patients
Based on the above clinical needs, Renai Rehabilitation has launched an early rehabilitation solution at the bedside, providing integrated services for the entire cycle of early rehabilitation construction for hospitals at all levels across the country.
Preventive rehabilitation: Through scientific intervention, it aims to avoid or delay the occurrence of functional disorders, thereby improving long-term quality of life and independent living ability.
Passive rehabilitation: When patients have no active movement ability at all (such as deep sedation, coma, or extreme weakness), the rehabilitation activities are carried out by medical staff or rehabilitation therapists using external force.
Active rehabilitation: Active rehabilitation refers to the rehabilitation training that patients undertake actively and control with their own strength under the guidance and supervision of medical staff or therapists after they regain clear consciousness, relatively stable vital signs, and possess certain abilities to follow instructions and exert force. This is a key step to achieve substantive functional recovery.
Early rehabilitation solutions for patients beside the rehabilitation bed
Based on the clinical research data of similar devices, early multiple position changes and bedside active-passive training have shown positive effects in the following aspects:
Maintaining and improving joint range of motion;
Preventing deep vein thrombosis;
Promoting intestinal peristalsis and improving digestive function;
Reducing the risk of ICU-acquired weakness;
Establishing the basic conditions for subsequent standing and walking training.
Applicable population and usage timing
Appropriate population:
Neurological critical illness (stroke, brain injury, spinal cord injury, etc.) after surgery/stable period;
Patients with respiratory failure undergoing mechanical ventilation;
Patients with multiple injuries and post-surgery immobilization;
Elderly critically ill patients with significant muscle weakness;
Patients with long-term bed rest due to other reasons.
Starting timing reference:
Current clinical consensus suggests: under the condition of stable hemodynamics (no need for large doses of vasoactive drugs), no active bleeding, and controllable intracranial pressure, patients can be evaluated by rehabilitation therapists within 24-72 hours after admission to the ICU to determine if bedside passive or assisted active training is suitable to start. The specific timing needs to be jointly decided by the clinical team based on the individual patient's condition.
Summary
Severe rehabilitation is not an additional part of the medical process, but a necessary component that runs parallel to medical treatment during the treatment process. Who will carry it out, when to start it, and what tools to use are the three key issues that determine whether the rehabilitation effect can be implemented.
The "Renla Rehabilitation Bedside Early Rehabilitation Unit" series is clearly positioned: to provide an operational and quantifiable tool option for bedside movement rehabilitation in the ICU, in conjunction with the professional judgment of therapists, to help more critically ill patients reduce the risk of disability and shorten the time spent in bed.
If you need to know the specific models, technical parameters, and clinical configuration plans of the products, please consult the local sales team of Renla Rehabilitation or call the official service hotline.
Special reminder: This article is for reference only by clinical professionals. The formulation and implementation of specific rehabilitation plans need to be combined with the individual circumstances of the patients, and made by the attending physician and rehabilitation therapists together.
