Occupational Therapy in the Intensive Care Unit: A Retrospective Cohort Study.
So Hyun Jeon, Sung Eun Hyun, Chae Hyeon Lee and 1 others
ICU occupational therapy (cognitive, upper-limb, and daily-living training) was delivered safely — one adverse event in 656 sessions — but 65.2% of patients did not complete the planned five sessions, mostly due to transfer out of the ICU.
No effectiveness was measured.
Key findings
1Across 656 sessions delivered to 158 patients, only one adverse event (0.6%) occurred: a patient with a history of tension pneumothorax and chylothorax experienced orthostatic hypotension when positioned for treatment. The treating ICU physician attributed the episodes to the patient's underlying pleural pathology, not to the OT intervention, and the OT prescription was subsequently terminated.
2Of 828 patients referred for ICU rehabilitation, 184 (22%) met the eligibility criteria and 158 initiated OT. Only 55 (34.8%) completed all five prescribed sessions; the 65.2% interruption rate was driven mainly by transfer to the general ward (93 patients, 58.9%). Forty-seven patients (29.7%) continued OT after transfer, indicating unmet rehabilitation needs beyond the ICU.
3Based on initial functional assessment, 81.6% of patients (129 of 158) required a combined programme of cognitive, upper-limb functional, and ADL training; only 3.8% needed cognitive training alone and 14.6% needed functional/ADL training alone.
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What it does not show
Single centre, single therapist: the programme was delivered by one OT, which limits generalisability and meant only five sessions could be prescribed, a dose the authors acknowledge may be insufficient for patients' functional needs. No control group and no effectiveness outcomes: the study was explicitly not designed to measure whether OT improved function, cognition, or ADL performance, so no causal or comparative conclusions can be drawn. Retrospective design with no structured follow-up: data were pulled from existing medical records, and the unpredictable timing of ICU-to-ward transfer meant standardised reassessments at discharge or programme end could not be performed consistently. Selection bias in eligibility: patients likely to refuse therapy (severe pain, fatigue, anxiety, delirium, poor cooperation) were excluded at screening, so the observed acceptability and safety may overestimate what would be seen in a broader ICU population. No subgroup analyses: the sample was not large enough to support reliable comparisons across diagnoses, functional levels, or ICU types. The 65.2% interruption rate, while largely driven by transfer, means most patients did not receive the full planned programme, limiting the interpretation of the feasibility metrics.
Declared interests
Funded by a grant from the Research Year of Inje University in 2023 (Grant No. 20240001). The authors declare no conflicts of interest.
The easy way to misread this
Do not read this as evidence that ICU occupational therapy improves cognitive, motor, or ADL outcomes. The authors state plainly that the study was not designed to evaluate treatment effectiveness, no control group was included, and no functional-outcome changes over time were measured. The one adverse event was attributed by the treating physician to the patient's underlying pleural pathology, not to the OT session, so it should not be cited as a safety risk of the intervention itself. The 65.2% interruption rate reflects the reality of ICU transfers and staffing, not a failure of the OT programme, but it does mean most patients did not receive the full planned dose.
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