Musculoskeletal Biomechanics in Critical Care Part 2: A Case Study

Conatus Athletics' Podcast

Musculoskeletal Biomechanics in Critical Care Part 2: A Case Study

The First Decision

In this episode, we discuss a special patient's medical care during a recent hospitalization focusing on the medical decisions and the role of musculoskeletal biomechanics. We question why the musculoskeletal system is not considered more during hospital admissions. Finally, we explore the negative effects of bed rest and its use in all but rare circumstances.

Specifically, the effects of bed rest in this case are compared to a review of medical research. Bed rest has a long list of negative of effects, however we focus specifically on blood clots.

We hope this information is helpful for hospital administrators, medical professionals, patients and their family members.

References and Resources

1. The profound negative effects of bed rest in the Dallas bed rest study
2. Duration of bed rest in the ICU was the single risk factor that was consistently associated with muscle weakness throughout the entire follow-up, with each additional day of bed rest having up to an 11% relative decrease in muscle strength at 24 month
3. Blood clots are common and often present without symptoms
4. Blood clots are especially common in the ICU
5. Blood clots are serious - In Europe, blood clots are the third most common cause of vascular death after heart attacks and stroke.
6. Yet, blood clots are the most common preventable cause of in-hospital death
   1. Prevention methods are very effective
   2. Prevention methods tend to be via drugs
   3. Mechanical prevention methods are also very effective - reduced risk of proximal venous thrombosis by 50% and pulmonary embolism by 40%.
      1. But typically recommendations only include socks and compression boots - not walking
      2. Walking is rarely discussed in the guidelines, unless you have a blood clot, or are healthy and traveling, or had GI surgery
7. Unfortunately, there is a low rate of patients world wide receiving preventative measures for blood clots - out of 68,183 patients only 40% of medical and 58% of surgical patients actually received blood clot preventative measures.
8. Bed rest is not indicated even if you have an acute blood clot - and in fact ambulation is a treatment at that time.

--Matt Sremba DPT, Kyle Ridgeway DPT, Paul Mitalski

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