Body-weight support gait training in neurological intensive care: safety, feasibility, and delays before walking with or without suspension.
Claire Jourdan, Fanny Pradalier, Kevin Chalard and 10 others
PMID 38093374WHAT IT FOUND
In a neurological ICU, 78 suspended walking sessions on 33 brain-injury patients were tolerated with transient interruptions only.
Suspension could support walking when patients were too weak to stand, but staffing and device barriers stopped 45 eligible patients.
Key findings
0133 patients received 78 body-weight support walking sessions. Sessions were generally tolerated, with 8 premature interruptions and no adverse event requiring medical intervention or causing clinical consequences other than session interruption.
02Most patients could not sit unsupported and had weak quadriceps, yet median walking time was 8 minutes and median walking distance was 17 m, usually requiring two or three caregivers.
0345 patients with indication for body-weight support walking did not receive it. Reported reasons included early ICU discharge, limited weekend staff, high workload, device battery failure, and patient-related barriers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a single-center observational study with no control group, so it cannot show that body-weight support walking caused faster walking or better recovery. The study sample was small and selected: 33 patients received body-weight support walking, while 45 patients with indication did not, often because of discharge, staffing, workload, device, or patient barriers. Patients who did not receive body-weight support walking had a shorter delay from weaning to ICU discharge than beneficiaries, which may reflect a different clinical course. Session data were collected by the treating physiotherapist without blinding, and patient data were collected retrospectively from records. The paper did not collect gait training after ICU discharge, and post-hospital walking information was unavailable for 2 patients, whose data were censored at discharge. The population was very specific: severe brain injuries, mostly strokes, and all requiring invasive ventilation, so results may not apply to less acute or non-neurological ICU patients.
The easy way to misread this
Do not conclude that body-weight support walking improves outcomes or causes faster walking. This was a single-center observational study without a comparison group, and the authors state it did not allow conclusions about benefits on patient outcomes. The median 11-day interval between suspended and unsuspended walking describes sequence in these patients, not a causal effect.