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Davoudi A, Shickel B, Tighe PJ, Bihorac A, Rashidi P. Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit. Front Digit Health 2022; 4:773387. [PMID: 35656333 PMCID: PMC9152012 DOI: 10.3389/fdgth.2022.773387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Patients in critical care settings often require continuous and multifaceted monitoring. However, current clinical monitoring practices fail to capture important functional and behavioral indices such as mobility or agitation. Recent advances in non-invasive sensing technology, high throughput computing, and deep learning techniques are expected to transform the existing patient monitoring paradigm by enabling and streamlining granular and continuous monitoring of these crucial critical care measures. In this review, we highlight current approaches to pervasive sensing in critical care and identify limitations, future challenges, and opportunities in this emerging field.
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Affiliation(s)
- Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States,*Correspondence: Anis Davoudi
| | - Benjamin Shickel
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Patrick James Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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2
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Gandotra S, Files DC, Shields KL, Berry M, Bakhru RN. Activity Levels in Survivors of the Intensive Care Unit. Phys Ther 2021; 101:pzab135. [PMID: 34097055 PMCID: PMC8418209 DOI: 10.1093/ptj/pzab135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/12/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Limited data exist on the quantification of activity levels and functional status in critically ill patients as they transition from the intensive care unit (ICU) to the wards and, subsequently, back into the community. The physical activity of critically ill patients from their ICU stay until 7 days after hospital discharge was characterized, as well as correlate physical activity levels with an objective measure of physical function. METHODS This prospective observational study of previously independent adults aged 55 or older, undergoing mechanical ventilation for up to 7 days, recruited participants at the time of spontaneous breathing trials or less than 24 hours after extubation. Participants received an accelerometer at enrollment to wear until 1 week after discharge. RESULTS Twenty-two participants received accelerometers; 15 were suitable for analysis. Participants had a mean (SD) age of 68 (9.6) years; 47% were female. Mean step counts were 95 (95% CI = 15-173) in the 3 days before ICU discharge, 257 (95% CI = 114-400) before hospital discharge, 1223 (95% CI = 376-2070) in the first 3 days at home, and 1278 (95% CI = 349-2207) between day 4 and 6 post-hospital discharge. Physical activity was significantly higher post- compared with pre-hospital discharge. Short Physical Performance Battery scores were poor at ICU and hospital discharge; however, they correlated moderately with physical activity levels immediately upon return home. CONCLUSIONS Physical activity remained low as survivors of critical illness transitioned from ICU to hospital wards, but significantly increased upon return to the community. Despite poor Short Physical Performance Battery scores at both ICU and hospital discharge, participants were significantly more active immediately after discharge than in their last 3 days of hospitalization. This may represent rapid functional improvement or, conversely, constrained physical activity in hospital. IMPACT This study highlights the need for further evaluation of physical activity constraints in hospital and ways to augment physical activity and function upon discharge. LAY SUMMARY Physical activity (step counts) increased modestly as survivors of critical illness transitioned from ICU to hospital wards, but significantly increased upon return to the community. This study highlights the need for further evaluation of physical activity constraints in the hospital setting and ways to augment physical activity and function postdischarge.
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Affiliation(s)
- Sheetal Gandotra
- Pulmonary, Allergy, and Critical Care Medicine, University of Alabama, Birmingham, Alabama, USA
| | - D Clark Files
- Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina, USA
- Wake Forest Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston Salem, North Carolina, USA
| | - Katherine L Shields
- Department of Nutrition and Integrative Physiology, University of Utah Graduate School, Salt Lake City, Utah, USA
| | - Michael Berry
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, North Carolina, USA
| | - Rita N Bakhru
- Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, North Carolina, USA
- Wake Forest Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston Salem, North Carolina, USA
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3
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Rollinson TC, Connolly B, Berlowitz DJ, Berney S. Physical activity of patients with critical illness undergoing rehabilitation in intensive care and on the acute ward: An observational cohort study. Aust Crit Care 2021; 35:362-368. [PMID: 34389239 DOI: 10.1016/j.aucc.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND There are limited published data on physical activity of survivors of critical illness engaged in rehabilitation in hospital, despite it plausibly influencing outcome. OBJECTIVE The aims of this study were to measure physical activity of patients with critical illness engaged in rehabilitation in the intensive care unit (ICU) and on the acute ward and report discharge destination, muscle strength, and functional outcomes. METHODS This was a single-centre, prospective observational study. Adults with critical illness, who received ≥48 h of invasive mechanical ventilation, and who were awake and able to participate in rehabilitation were eligible. To record physical activity, participants wore BodyMedia SenseWear Armbands (BodyMedia Incorporated, USA), during daylight hours, from enrolment until hospital discharge or day 14 of ward stay (whichever occurred first). The primary outcome was time (minutes) spent performing physical activity at an intensity of greater than 1.5 Metabolic Equivalent Tasks. Secondary outcomes included discharge destination, muscle strength, and physical function. RESULTS We collected 807 days of physical activity data (363 days ICU, 424 days ward) from 59 participants. Mean (standard deviation) duration of daily physical activity increased from the ICU, 17.8 (22.8) minutes, to the ward, 52.8 (51.2) minutes (mean difference [95% confidence interval] = 35 [23.8-46.1] minutes, P < .001). High levels of activity in the ICU were associated with higher levels of activity on the ward (r = .728), n = 48, P < .001. CONCLUSIONS Patients recovering from critical illness spend less than 5% of the day being physically active throughout hospital admission, even when receiving rehabilitation. Physical activity increased after discharge from intensive care, but had no relationship with discharge destination. Only the absence of ICU-acquired weakness on awakening was associated with discharge directly home from the acute hospital. Future studies could target early identification of ICU-acquired weakness and the preservation of muscle strength to improve discharge outcomes.
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Affiliation(s)
- Thomas C Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, United Kingdom; Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, United Kingdom
| | - David J Berlowitz
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Sleep and Activity Patterns Are Altered During Early Critical Illness in Mechanically Ventilated Adults. Dimens Crit Care Nurs 2021; 40:29-35. [PMID: 33560633 DOI: 10.1097/dcc.0000000000000455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mechanically ventilated (MV) patients in the intensive care unit (ICU) often experience disturbed sleep and profound inactivity. OBJECTIVES The aim of this study was to report 5 consecutive days' descriptive analyses on sleep efficiency (SE), total sleep time (TST), daytime activity ratio (DAR), and hourly activity counts among critically ill MV adults from 9 ICUs across 2 hospitals. METHODS A secondary analysis was undertaken from our parent National Institutes of Health-funded randomized controlled trial (NIH R01 NR016702). Subjects included 31 critically ill patients from multiple ICUs. Wrist actigraphy estimated SE and TST. Mean DAR, an indicator of altered sleep-wake cycles, was calculated. Continuous 24-hour activity counts over 5 consecutive days were summarized. Descriptive analyses were used. RESULTS A total of 31 subjects with complete actigraphy data were included. Mean age was 59.6 (SD, 17.3) years; 41.9% were male; 83.9% were White, and 67.7% were Hispanic/Latino; and the mean APACHE III (Acute Physiology and Chronic Health Evaluation III) severity of illness score was 74.5 (SD, 25.5). The mean nighttime SE and TST over the 5-day ICU period were 83.1% (SD, 16.14%) and 6.6 (SD, 1.3) hours, respectively. The mean DAR over the 5-day ICU period was 66.5% (SD, 19.2%). The DAR surpassed 80% on only 17.5% of subject days. The majority of subjects' activity level was low, falling below 1000 activity counts per hour. CONCLUSION Our study revealed poor rest-activity cycle consolidation among critically ill MV patients during the early ICU period. Future interventional studies should promote quality sleep at nighttime and promote mobilization during the daytime.
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Quantifying Mobility in the ICU: Comparison of Electronic Health Record Documentation and Accelerometer-Based Sensors to Clinician-Annotated Video. Crit Care Explor 2020; 2:e0091. [PMID: 32426733 PMCID: PMC7188433 DOI: 10.1097/cce.0000000000000091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. To compare the accuracy of electronic health record clinician documentation and accelerometer-based sensors with a gold standard dataset derived from clinician-annotated video to quantify early mobility activities in adult ICU patients.
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Schwab KE, To AQ, Chang J, Ronish B, Needham DM, Martin JL, Kamdar BB. Actigraphy to Measure Physical Activity in the Intensive Care Unit: A Systematic Review. J Intensive Care Med 2019; 35:1323-1331. [PMID: 31331220 DOI: 10.1177/0885066619863654] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions to minimize inactivity are gaining popularity, highlighting actigraphy, a measure of activity involving a wristwatch-like accelerometer, as a method to inform these efforts. Therefore, we performed a systematic review of studies that used actigraphy to measure patient activity in the ICU setting. DATA SOURCES We searched PubMed, EMBASE, CINAHL, Cochrane Library, and ProQuest from inception until December 2016. STUDY SELECTION Two reviewers independently screened studies for inclusion. A study was eligible for inclusion if it was published in a peer-reviewed journal and used actigraphy to measure activity in ≥5 ICU patients. DATA EXTRACTION Two reviewers independently performed data abstraction and risk of bias assessment. Abstracted actigraphy-based activity data included total activity time and activity counts. RESULTS Of 16 studies (607 ICU patients) identified, 14 (88%) were observational, 2 (12%) were randomized control trials, and 5 (31%) were published after 2009. Mean patient activity levels per 15 to 60 second epoch ranged from 25 to 37 daytime and 2 to 19 nighttime movements. Actigraphy was evaluated in the context of ICU and post-ICU outcomes in 11 (69%) and 5 (31%) studies, respectively, and demonstrated potential associations between actigraphy-based activity levels and delirium, sedation, pain, anxiety, time to extubation, and length of stay. CONCLUSION Actigraphy has demonstrated that patients are profoundly inactive in the ICU with actigraphy-based activity levels potentially associated with important measures, such as delirium, sedation, and length of stay. Larger and more rigorous studies are needed to further evaluate these associations and the overall utility of actigraphy in the ICU setting.
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Affiliation(s)
- Kristin E Schwab
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, 8783University of California, Los Angeles, CA, USA
| | - An Q To
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, 8783University of California, Los Angeles, CA, USA
| | - Jennifer Chang
- Department of Medicine, David Geffen School of Medicine at UCLA, 8783University of California, Los Angeles, CA, USA
| | - Bonnie Ronish
- Division of Pulmonary and Critical Care Medicine, 7060University of Utah, Salt Lake City, UT, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L Martin
- Department of Medicine, David Geffen School of Medicine at UCLA, 8783University of California, Los Angeles, CA, USA.,Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego 8784(UCSD) School of Medicine, University of California, San Diego, CA, USA
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Orth K. Preventing Surgical Site Infections Related to Abdominal Drains in the Intensive Care Unit. Crit Care Nurse 2018; 38:20-26. [PMID: 30068717 DOI: 10.4037/ccn2018254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Surgical site infections are significant contributors to health care-associated infections. Nursing interventions may help decrease the incidence of surgical site infections, particularly in regards to the management of postsurgical abdominal drains. This comprehensive guide, compiled from evidence-based practice literature, is intended for nurses to use to reduce surgical site infections secondary to postsurgical abdominal drains. This article focuses on drain management in intensive care unit patients, who are at risk for infection because of their immunocompromised state.
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Affiliation(s)
- Krystal Orth
- Krystal Orth is a staff nurse in the neurological and surgical intensive care unit at St. Joseph Medical Center in Tacoma, Washington
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Barbalho M, Rocha AC, Seus TL, Raiol R, Del Vecchio FB, Coswig VS. Addition of blood flow restriction to passive mobilization reduces the rate of muscle wasting in elderly patients in the intensive care unit: a within-patient randomized trial. Clin Rehabil 2018; 33:233-240. [PMID: 30246555 DOI: 10.1177/0269215518801440] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: To evaluate the addition of blood flow restriction to passive mobilization in patients in the intensive care unit. DESIGN: The study was a within-patient randomized trial. SETTING: Two intensive care units in Belém, from September to October 2017. SUBJECTS: In total, 34 coma patients admitted to the intensive care unit sector, and 20 patients fulfilled the study requirements. INTERVENTIONS: All participants received the passive mobilization protocol for lower limbs, and blood flow restriction was added only for one side in a concurrent fashion. Intervention lasted the entire patient's hospitalization time. MAIN OUTCOME MEASUREMENT: Thigh muscle thickness and circumference. RESULTS: In total, 34 subjects were enrolled in the study: 11 were excluded for exclusion criteria, 3 for death, and 20 completed the intervention (17 men and 3 women; mean age: 66 ± 4.3 years). Despite both groups presented atrophy, the atrophy rate was lower in blood flow restriction limb in relation to the control limb (-2.1 vs. -2.8 mm, respectively, in muscle thickness; P = 0.001). In addition, the blood flow restriction limb also had a smaller reduction in the thigh circumference than the control limb (-2.5 vs. -3.6 cm, respectively; P = 0.001). CONCLUSION: The use of blood flow restriction did not present adverse effects and seems to be a valid strategy to reduce the magnitude of the rate of muscle wasting that occurs in intensive care unit patients.
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Affiliation(s)
- Matheus Barbalho
- 1 Faculdade de Educação Física e Dança, Universidade Federal de Goiás, Goiânia, Brasil.,2 Centro de Ciências Biológicas e da Saúde, Universidade da Amazônia, Belém, Brasil
| | - Angel Caroline Rocha
- 3 Centro de Ciências da Saúde, Universidade Católica de Pelotas, Pelotas, Brasil
| | | | - Rodolfo Raiol
- 4 Centro de Ciências Biológicas e da Saúde, Centro Universitário do Estado do Pará, Belém, Brasil
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Conceição TMAD, Gonzáles AI, Figueiredo FCXSD, Vieira DSR, Bündchen DC. Safety criteria to start early mobilization in intensive care units. Systematic review. Rev Bras Ter Intensiva 2018; 29:509-519. [PMID: 29340541 PMCID: PMC5764564 DOI: 10.5935/0103-507x.20170076] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/24/2017] [Indexed: 01/26/2023] Open
Abstract
Mobilization of critically ill patients admitted to intensive care units should
be performed based on safety criteria. The aim of the present review was to
establish which safety criteria are most often used to start early mobilization
for patients under mechanical ventilation admitted to intensive care units.
Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL
databases; randomized and quasi-randomized clinical trials, cohort studies,
comparative studies with or without simultaneous controls, case series with 10
or more consecutive cases and descriptive studies were included. The same was
performed regarding prospective, retrospective or cross-sectional studies where
safety criteria to start early mobilization should be described in the Methods
section. Two reviewers independently selected potentially eligible studies
according to the established inclusion criteria, extracted data and assessed the
studies' methodological quality. Narrative description was employed in data
analysis to summarize the characteristics and results of the included studies;
safety criteria were categorized as follows: cardiovascular, respiratory,
neurological, orthopedic and other. A total of 37 articles were considered
eligible. Cardiovascular safety criteria exhibited the largest number of
variables. However, respiratory safety criteria exhibited higher concordance
among studies. There was greater divergence among the authors regarding
neurological criteria. There is a need to reinforce the recognition of the
safety criteria used to start early mobilization for critically ill patients;
the parameters and variables found might contribute to inclusion into service
routines so as to start, make progress and guide clinical practice.
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Affiliation(s)
| | - Ana Inês Gonzáles
- Departamento de Fisioterapia, Universidade Federal de Santa Catarina - Araranguá, (SC), Brasil
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10
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Baldwin CE, Johnston KN, Rowlands AV, Williams MT. Physical Activity of ICU Survivors during Acute Admission: Agreement of the activPAL with Observation. Physiother Can 2018; 70:57-63. [PMID: 29434419 DOI: 10.3138/ptc.2016-61] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: We estimated the agreement of a thigh-worn accelerometer, the activPAL, used to measure activity and sedentary parameters, with observed mobility assessments of intensive care unit (ICU) survivors. Method: We prospectively compared activPAL measurements with direct observation during assessments at discharge from the ICU or acute hospital in eight participants with a median age of 56 (1st-3rd quartile 48-65) years and an Acute Physiology and Chronic Health Evaluation II score of 23 (1st-3rd quartile 17-24). Frequency of sit-to-stand transitions; time spent standing, stepping, upright (standing and stepping), and sedentary (lying/sitting); and total steps were described; analysis was performed using Bland-Altman plots and calculating the absolute percent error. Results: All sit-to-stand transitions were accurately detected. The mean difference on the Bland-Altman plots suggested an overestimation of standing time with the activPAL of 31 (95% CI: -9, 71) seconds and underestimation of stepping time by 25 (95% CI: -47, -3) seconds. The largest median absolute percent errors were for standing time (21.9%) and stepping time (18.7%); time spent upright (1.7%) or sedentary (0.3%) was more accurately estimated. The activPAL underestimated total steps per session, achieving the largest percent error (70.8%). Conclusion: Because it underestimated step count, the activPAL likely incorrectly recorded stepping time as standing time, so that time spent upright was the measure of activity with the smallest error. Sedentary behaviour, including frequency of transitions, was validly assessed.
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Affiliation(s)
- Claire E Baldwin
- Sansom Institute for Health Research, University of South Australia, Adelaide.,Flinders Medical Centre, Southern Adelaide Health Service, Bedford Park, S.A., Australia
| | - Kylie N Johnston
- Sansom Institute for Health Research, University of South Australia, Adelaide
| | - Alex V Rowlands
- Sansom Institute for Health Research, University of South Australia, Adelaide.,Diabetes Research Centre, University of Leicester.,Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, National Institute for Health Research, Leicester, United Kingdom.,Alliance for Research in Exercise, Nutrition and Activity (ARENA)
| | - Marie T Williams
- Sansom Institute for Health Research, University of South Australia, Adelaide.,Alliance for Research in Exercise, Nutrition and Activity (ARENA)
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Baldwin C, van Kessel G, Phillips A, Johnston K. Accelerometry Shows Inpatients With Acute Medical or Surgical Conditions Spend Little Time Upright and Are Highly Sedentary: Systematic Review. Phys Ther 2017; 97:1044-1065. [PMID: 29077906 DOI: 10.1093/ptj/pzx076] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 07/21/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Physical inactivity and sedentary behaviors have significant and independent effects on health. The use of wearable monitors to measure these constructs in people who are hospitalized with an acute illness is rapidly expanding, but has not been systematically described. PURPOSE The purpose of this study was to review the use of accelerometer monitoring with inpatients who are acutely ill, including what activity and sedentary behaviors have been measured and how active or sedentary inpatients are. DATA SOURCES Databases used were MEDLINE, EMBASE, CINAHL, and Scopus. STUDY SELECTION Quantitative studies of adults with an acute medical or surgical hospital admission, on whom an accelerometer was used to measure a physical activity or sedentary behavior, were selected. DATA EXTRACTION AND DATA SYNTHESIS Procedures were completed independently by 2 reviewers, with differences resolved and cross-checked by a third reviewer. Forty-two studies were identified that recruited people who had medical diagnoses (n = 10), stroke (n = 5), critical illness (n = 3), acute exacerbations of lung disease (n = 7), cardiac conditions (n = 7), or who were postsurgery (n = 10). Physical activities or sedentary behaviors were reported in terms of time spent in a particular posture (lying/sitting, standing/stepping), active/inactive, or at a particular activity intensity. Physical activity was also reported as step count, number of episodes or postural transitions, and bouts. Inpatients spent 93% to 98.8% (range) of their hospital stay sedentary, and in most studies completed <1,000 steps/day despite up to 50 postural transitions/day. No study reported sedentary bouts. Many studies controlled for preadmission function as part of the recruitment strategy or analysis or both. LIMITATIONS Heterogeneity in monitoring devices (17 models), protocols, and variable definitions limited comparability between studies and clinical groups to descriptive synthesis without meta-analysis. CONCLUSIONS Hospitalized patients were highly inactive, especially those with medical admissions, based on time and step parameters. Accelerometer monitoring of sedentary behavior patterns was less reported and warrants further research.
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Affiliation(s)
- Claire Baldwin
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia, City East Campus, Centenary Building, Adelaide, South Australia 5000, Australia
| | - Gisela van Kessel
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
| | - Anna Phillips
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
| | - Kylie Johnston
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
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Anderson JL, Green AJ, Yoward LS, Hall HK. Validity and reliability of accelerometry in identification of lying, sitting, standing or purposeful activity in adult hospital inpatients recovering from acute or critical illness: a systematic review. Clin Rehabil 2017; 32:233-242. [DOI: 10.1177/0269215517724850] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To investigate the validity and reliability of accelerometers to detect lying, sitting and standing postures or purposeful activity in hospitalized adults recovering from acute or critical illness. Data sources: CINAHL, MEDLINE, EMBASE, AMED, Cochrane Library, PEDro, PsycINFO and SPORTDiscuss were searched from inception to June 2017. Professional networks and reference lists of relevant articles were also searched. The main selection criteria were hospitalized adults with acute or critical illness and studies investigating the validity or reliability of accelerometers to identify body position or purposeful activity. Review methods: Two authors individually assessed study eligibility and independently undertook methodological quality assessment and data extraction from selected articles. A narrative synthesis of the data was undertaken. Results: Fifteen studies, collectively enrolling 385 hospitalized participants, were identified. Populations included stroke, the elderly, acute exacerbation of chronic respiratory disease, abdominal surgery and those recovering from critical illness. Correlations of r = 0.36 to 0.98 and levels of agreement of κ = 0.28 to 0.98 were reported for identification of lying, sitting or standing postures. Correlations of r = 0.4 to 0.8 with general activity were found, with r = 0.94 and 0.96 reported for step count. The reliability of accelerometry measurement was investigated in one study evaluating step count quantification (intraclass correlation coefficient (ICC) = 0.99, 95% confidence interval (CI) = 0.99–1.00). Conclusion: The validity of accelerometers to determine lying, sitting and standing postures or quantify purposeful activity within hospitalized acute or critically ill populations is variable. The reliability of accelerometry measurement within this setting remains largely unexplored.
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Affiliation(s)
- Jayne L Anderson
- Physiotherapy Department, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
- School of Health Sciences, York St John University, York, UK
| | - Angela J Green
- Physiotherapy Department, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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13
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Measurement of physical activity levels in the Intensive Care Unit and functional outcomes: An observational study. J Crit Care 2017; 40:189-196. [DOI: 10.1016/j.jcrc.2017.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 12/30/2022]
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14
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Connolly BA, Mortimore JL, Douiri A, Rose JW, Hart N, Berney SC. Low Levels of Physical Activity During Critical Illness and Weaning: The Evidence-Reality Gap. J Intensive Care Med 2017; 34:818-827. [PMID: 28675113 PMCID: PMC6716208 DOI: 10.1177/0885066617716377] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physical rehabilitation can benefit critically ill patients during intensive care unit (ICU) admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator weaning unit (VWU). Behavioral mapping is a sampling approach that allows detailed reporting of physical activity profiles. The objective of this study was to characterize the physical activity profile of critically ill patients in a UK ICU and VWU. METHODS Single-center, prospective observational study in a university teaching hospital. Patient observations, conducted Monday through Sunday from 08:30 am to 08:00 pm and for 1 minute every 10 minutes, included data points of patient location, people in attendance, and highest level of activity. Descriptive statistics were utilized to analyze and report data. RESULTS Forty-two ICU and 11 VWU patients were recruited, with 2646 and 693 observations, respectively, recorded. In the ICU, patients spent a median (interquartile range) of 100% (96%-100%) of the day (10.5 [10.0-10.5] hours) located in bed, with minimal/no activity for 99% (96%-100%) of the day (10.4 [9.7-10.5] hours). Nursing staff were most frequently observed in attendance with patients irrespective of ventilation or sedation status, although patients still spent approximately two-thirds of the day alone. Bed-to-chair transfer was the highest activity level observed. In the VWU, patients spent 94% (73%-100%) of the day (9.9 [7.7-10.5] hours) in bed and 56% (43%-60%) of time alone. Physical activity levels were higher and included ambulation. All physical activities occurred during physical rehabilitation sessions. CONCLUSIONS These profiles of low physical activity behavior across both patients in the ICU and VWU highlight the need for targeted strategies to improve levels beyond therapeutic rehabilitation and support for a culture shift toward providing patients with, and engaging them in, a multidisciplinary, multiprofessional environment that optimizes overall physical activity.
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Affiliation(s)
- Bronwen A Connolly
- 1 Lane Fox Clinical Respiratory Physiology Research Centre, London, United Kingdom.,2 NIHR Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.,3 Centre for Human and Aerospace Physiological Sciences, King's College London, London, United Kingdom.,4 Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica L Mortimore
- 1 Lane Fox Clinical Respiratory Physiology Research Centre, London, United Kingdom.,5 Department of Physiotherapy, King's College London, London, United Kingdom
| | - Abdel Douiri
- 6 Department of Primary Care and Public Health Science, King's College London, London, United Kingdom
| | - Joleen W Rose
- 7 Physiotherapy Department, Austin Health, Heidelberg, Victoria, Australia
| | - Nicholas Hart
- 1 Lane Fox Clinical Respiratory Physiology Research Centre, London, United Kingdom.,2 NIHR Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.,8 Department of Asthma, Allergy and Lung Biology, King's College London, London, United Kingdom
| | - Susan C Berney
- 4 Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,7 Physiotherapy Department, Austin Health, Heidelberg, Victoria, Australia.,9 The Institute of Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
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Kamdar BB, Kadden DJ, Vangala S, Elashoff DA, Ong MK, Martin JL, Needham DM. Feasibility of Continuous Actigraphy in Patients in a Medical Intensive Care Unit. Am J Crit Care 2017; 26:329-335. [PMID: 28668919 DOI: 10.4037/ajcc2017660] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Poor sleep and immobility are common in patients in the medical intensive care unit (MICU) and are associated with adverse outcomes. Interventions to promote sleep and mobilization in the MICU are gaining popularity, but feasible instruments to measure their effectiveness are lacking. Actigraphy may be useful for large-scale, continuous measurement of sleep and activity, but its feasibility in MICU patients has not been rigorously evaluated. OBJECTIVE To evaluate the feasibility of continuous actigraphy measurement in consecutive MICU patients. METHODS Wrist and ankle actigraphy data were collected for 48 hours in consenting MICU patients. Actigraphy-based measures of estimated sleep and activity were summarized by using descriptive statistics. Agreement between wrist and ankle measurements was evaluated using Cohen κ statistics (for sleep quantity) and intraclass correlation coefficients (for activity). RESULTS Overall, 35 of 48 (73%) eligible patients were enrolled, including 10 requiring mechanical ventilation. Of these patients, 34 (97%) completed the 48-hour actigraphy period; 20 (57%) found the devices comfortable. Wrist devices logged a mean (SD) of 33.4 (8.8) hours of estimated sleep (72% [19%] of recording period) and 19.6 (17.2) movements per 30-second epoch. Ankle devices recorded 43.2 (4.1) hours of estimated sleep (93% [7%] of recording period) and 5.1 (6.0) movements per 30 seconds. CONCLUSIONS Uninterrupted actigraphy is feasible and generally well tolerated by MICU patients and may be considered for future large-scale studies. Wrist and ankle actigraphy measurements of sleep and activity in this setting agree poorly and cannot be used interchangeably.
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Affiliation(s)
- Biren B Kamdar
- Biren B. Kamdar is an assistant professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. Daniel J. Kadden is a medical student at the Medical College of Wisconsin, Milwaukee, Wisconsin. Sitaram Vangala is principal statistician, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA. David A. Elashoff is a professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California. Michael K. Ong is an associate professor in residence, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a staff physician, VA Greater Los Angeles Healthcare System, Los Angeles, California. Jennifer L. Martin is an associate professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a research scientist and psychologist, VA Greater Los Angeles Healthcare System. Dale M. Needham is a professor, Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
| | - Daniel J Kadden
- Biren B. Kamdar is an assistant professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. Daniel J. Kadden is a medical student at the Medical College of Wisconsin, Milwaukee, Wisconsin. Sitaram Vangala is principal statistician, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA. David A. Elashoff is a professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California. Michael K. Ong is an associate professor in residence, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a staff physician, VA Greater Los Angeles Healthcare System, Los Angeles, California. Jennifer L. Martin is an associate professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a research scientist and psychologist, VA Greater Los Angeles Healthcare System. Dale M. Needham is a professor, Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Sitaram Vangala
- Biren B. Kamdar is an assistant professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. Daniel J. Kadden is a medical student at the Medical College of Wisconsin, Milwaukee, Wisconsin. Sitaram Vangala is principal statistician, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA. David A. Elashoff is a professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California. Michael K. Ong is an associate professor in residence, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a staff physician, VA Greater Los Angeles Healthcare System, Los Angeles, California. Jennifer L. Martin is an associate professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a research scientist and psychologist, VA Greater Los Angeles Healthcare System. Dale M. Needham is a professor, Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - David A Elashoff
- Biren B. Kamdar is an assistant professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. Daniel J. Kadden is a medical student at the Medical College of Wisconsin, Milwaukee, Wisconsin. Sitaram Vangala is principal statistician, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA. David A. Elashoff is a professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California. Michael K. Ong is an associate professor in residence, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a staff physician, VA Greater Los Angeles Healthcare System, Los Angeles, California. Jennifer L. Martin is an associate professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a research scientist and psychologist, VA Greater Los Angeles Healthcare System. Dale M. Needham is a professor, Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Michael K Ong
- Biren B. Kamdar is an assistant professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. Daniel J. Kadden is a medical student at the Medical College of Wisconsin, Milwaukee, Wisconsin. Sitaram Vangala is principal statistician, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA. David A. Elashoff is a professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California. Michael K. Ong is an associate professor in residence, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a staff physician, VA Greater Los Angeles Healthcare System, Los Angeles, California. Jennifer L. Martin is an associate professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a research scientist and psychologist, VA Greater Los Angeles Healthcare System. Dale M. Needham is a professor, Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer L Martin
- Biren B. Kamdar is an assistant professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. Daniel J. Kadden is a medical student at the Medical College of Wisconsin, Milwaukee, Wisconsin. Sitaram Vangala is principal statistician, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA. David A. Elashoff is a professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California. Michael K. Ong is an associate professor in residence, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a staff physician, VA Greater Los Angeles Healthcare System, Los Angeles, California. Jennifer L. Martin is an associate professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a research scientist and psychologist, VA Greater Los Angeles Healthcare System. Dale M. Needham is a professor, Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Dale M Needham
- Biren B. Kamdar is an assistant professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. Daniel J. Kadden is a medical student at the Medical College of Wisconsin, Milwaukee, Wisconsin. Sitaram Vangala is principal statistician, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA. David A. Elashoff is a professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California. Michael K. Ong is an associate professor in residence, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a staff physician, VA Greater Los Angeles Healthcare System, Los Angeles, California. Jennifer L. Martin is an associate professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA and a research scientist and psychologist, VA Greater Los Angeles Healthcare System. Dale M. Needham is a professor, Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
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The MOVIN' project (Mobilisation Of Ventilated Intensive care patients at Nepean): A quality improvement project based on the principles of knowledge translation to promote nurse-led mobilisation of critically ill ventilated patients. Intensive Crit Care Nurs 2017; 42:36-43. [PMID: 28552258 DOI: 10.1016/j.iccn.2017.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/19/2017] [Accepted: 04/25/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Prospective quality improvement project to evaluate the impact of a training programme to promote nurse-led mobilisation of intubated critically ill patients. METHODS This project involved an educational programme to upskill nurses and overcome the barriers/challenges to nurse-led mobilisation. Initial strategies focused on educating and upskilling nurses to attain competency in active mobilisation. Subsequent strategies focused on positive reinforcement to achieve a culture shift. A pre- and post-intervention audit was used to evaluate its effectiveness. RESULTS A baseline audit showed that ∼9% of ventilated patients were mobilised. Several barriers were identified. Twenty-three nurses underwent training in actively mobilising ventilated patients. This increased their confidence levels and there was reduction in reported barriers. However, the rate of active mobilisation remained low (9.7%). Subsequently, a programme of positive reinforcement with rewards and visual reminders was introduced, which saw an increase in the number of nurse-led mobilisations of both ventilated patients (from 9.7% to 34.8%; p=0.0003), and non-ventilated patients (29.5% versus 62.9%; p=<0.0001). CONCLUSION It is safe and feasible to train nurses to perform active mobilisation of ventilated patients. However, to promote a culture change, training and competency must be combined with a multi-pronged approach including reminders, positive reinforcement and rewards.
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17
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Hopkins RO, Choong K, Zebuhr CA, Kudchadkar SR. Transforming PICU Culture to Facilitate Early Rehabilitation. J Pediatr Intensive Care 2015; 4:204-211. [PMID: 27134761 PMCID: PMC4849412 DOI: 10.1055/s-0035-1563547] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 12/16/2022] Open
Abstract
Children who survive a critical illness are at risk of developing significant, long-lasting morbidities that may include neuromuscular weakness, cognitive impairments, and new mental health disorders. These morbidities, collectively known as post-intensive care syndrome (PICS), may lead to functional impairments, difficulty in school and social settings, and reduced quality of life. Interventions aimed at rehabilitation such as early mobilization, sedation minimization and prevention of ICU-acquired weakness, delirium, and posttraumatic stress disorder may lead to improved clinical outcomes and functional recovery in critically ill children. Acute rehabilitation is challenging to implement in a pediatric intensive care unit (PICU), and a culture change is needed to effect widespread transformation in this setting. Our objectives in this article are to review the evidence on PICS in children and strategies for affecting culture change to facilitate early rehabilitation in the PICU.
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Affiliation(s)
- Ramona O. Hopkins
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, United States
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, Utah, United States
| | - Karen Choong
- Department of Pediatrics and Critical Care Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Carleen A. Zebuhr
- Department of Pediatrics, Section of Critical Care, Children's Hospital Colorado, Aurora, Colorado, United States
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine and Pediatrics, Johns Hopkins University School of Medicine, The Charlotte R. Bloomberg Children's Center, Baltimore, Maryland, United States
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18
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Verceles AC, Hager ER. Use of Accelerometry to Monitor Physical Activity in Critically Ill Subjects: A Systematic Review. Respir Care 2015; 60:1330-6. [PMID: 25852167 PMCID: PMC4582462 DOI: 10.4187/respcare.03677] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Medical management of critically ill patients often incorporates prolonged bed rest, which, in combination with the underlying illness, results in global muscle weakness and atrophy. Recent evidence has demonstrated improvements in clinical and functional outcomes when exercise and physical activity are incorporated early in the management of ICU patients. Accurate monitoring of ICU patients' physical activity is essential for proper prescription and escalation of activity levels. Accelerometry is a technique used to measure physical activity and has been validated in several ambulatory populations. However, its use in critically ill, hospitalized patients with poor functional mobility is limited. In this review, we focus on the few studies assessing the use of accelerometry to measure physical activity in the care of mechanically ventilated adult ICU patients. The selected literature demonstrates that accelerometry correlates well with direct observation in reporting frequency and duration of various types of physical activity (rolling, sitting up, transferring, walking), but cannot differentiate various intensities of activity or whether movements are voluntary or involuntary with respect to effort. Thus, although accelerometry may serve as a useful adjunct in reporting temporality of physical activity in critically ill patients, other objective information may be needed to accurately record frequency, duration, and intensity of activity in this population.
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Affiliation(s)
| | - Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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19
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Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours. J Crit Care 2015; 30:658-63. [DOI: 10.1016/j.jcrc.2015.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/03/2015] [Accepted: 03/08/2015] [Indexed: 11/22/2022]
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20
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Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc AMIA Symp 2014; 27:203-7. [PMID: 24982559 DOI: 10.1080/08998280.2014.11929108] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Growing evidence shows that early mobilization of patients in the intensive care unit (ICU) is a safe and cost-effective strategy to improve patient outcomes. However, in ICUs where early mobilization has not been practiced, its adoption requires culture change by the multidisciplinary team, including physical therapists, nurses, respiratory therapists, and physicians. We describe a physical therapist-led program to introduce such changes in a medical-surgical and a cardiovascular ICU. Interdisciplinary and multidisciplinary meetings and education sessions informed critical care team members about early mobilization and encouraged knowledge sharing for safety and effectiveness. A lead physical therapist was appointed to advocate for early mobility and developed solutions to overcome the identified barriers. After the initiation of this program, the number of ICU patients receiving physical therapy evaluations increased from 364 in 2011-2012 to 542 in 2012-2013. In this article, we describe our experience from 21 patients who underwent early mobilization. A physical therapist-led initiative can help establish an ICU culture that supports early mobilization, but the change is slow and requires interdisciplinary collaboration to identify and overcome barriers.
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Affiliation(s)
- Christy L Harris
- Department of Physical Medicine and Rehabilitation, Baylor All Saints Medical Center, Fort Worth, Texas (Harris); and the Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas (Shahid)
| | - Shafi Shahid
- Department of Physical Medicine and Rehabilitation, Baylor All Saints Medical Center, Fort Worth, Texas (Harris); and the Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas (Shahid)
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21
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Measurement of bed turning and comparison with age, gender, and body mass index in a healthy population: application of a novel mobility detection system. BIOMED RESEARCH INTERNATIONAL 2014; 2014:819615. [PMID: 24877137 PMCID: PMC4021992 DOI: 10.1155/2014/819615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/28/2014] [Indexed: 11/17/2022]
Abstract
We developed a mobility detection system to analyze pressure changes over time during side-turns in 29 healthy volunteers (17 males and 12 females) with a mean age of 46.1 ± 19.64 years (ranging from 23 to 86 years) in order to determine the effect of gender, age, and BMI on performance during bed postural change. Center of gravity (COG) location, peak pressure of counteraction, and time to reach peak pressure were the main outcomes used to gauge the ability to make a spontaneous side-turn. Men exhibited significantly higher side-turning force (P = 0.002) and back-turning force (P = 0.002) compared with women. Subjects with BMI ≥27 kg/m2 had significantly higher side-turning force (P = 0.007) and back-turning force (P = 0.007) compared with those with BMI < 27 kg/m2. After adjusting for other covariates, age positively correlated with back-turning time (P = 0.033) and negatively correlated with side-turning speed (P = 0.005), back-turning speed (P = 0.014), side-turning force (P = 0.010), and back-turning force (P = 0.016), respectively. Turning times negatively correlated with time to reach peak pressure (P = 0.008). Our system was effective in detecting changes in turning swiftness in the bed-ridden subject.
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Casey CM, Bennett JA, Winters-Stone K, Knafl GJ, Young HM. Measuring activity levels associated with rehabilitative care in hospitalized older adults. Geriatr Nurs 2014; 35:S3-10. [DOI: 10.1016/j.gerinurse.2014.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Professional experience and wisdom have taught us that immobility is a risk factor for various adverse outcomes, such as deep vein thrombosis, joint contractures, pulmonary dysfunction, and bone demineralization to name a few. Balancing bed rest and mobility may improve both short- and long-term outcomes for our patients. Moreover, early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, improves muscle strength, and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving through the use of a standardized mobility protocol. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The activities are grounded in the evidence and well thought out to prevent complications and promote mobilization. The purpose of this article was to present the science behind the development of a multidisciplinary protocol for early mobilization of critically ill patients that can be adapted to any intensive care unit patient with minor modifications.
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Potential effect of physiotherapeutic treatment on mortality rate in patients with severe sepsis and septic shock: a retrospective cohort analysis. J Crit Care 2013; 28:954-8. [PMID: 23958242 DOI: 10.1016/j.jcrc.2013.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/25/2013] [Accepted: 06/28/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to examine the onset and frequency of physiotherapeutic interventions (PTI) and their potential effects on the intensive care unit (ICU) mortality rate in patients with severe sepsis or septic shock. MATERIAL AND METHODS Retrospective data analysis. Univariate and multivariate Cox proportional-hazards regression analyses were performed. RESULTS About 6.2% of all patients (n = 999, length of ICU stay 12 days, averaged SOFA score 14) developed sepsis within three years. Of these, 77% received at least once PTI. The relative number of PTI (RNPTI index, individually calculated by the number of PTI/length of stay) in patients with sepsis was 42%. The first physiotherapeutic treatment was five days after ICU admission. Cox regression multivariate analysis adjusted by disease severity scores, sedation state and other clinical variables found RNPTI index as significant risk factor for the ICU mortality rate (hazard ratio, 0.982; 95% confidence interval, 0.974-0.990; P < .001). CONCLUSIONS Physiotherapists routinely assess and treat patients with sepsis. The frequency of PTI was associated with an improved outcome. Prospective studies are necessary to confirm the potential favorable impact.
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Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther 2013; 93:975-85. [PMID: 23559525 DOI: 10.2522/ptj.20110420] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. OBJECTIVE The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. DESIGN This study was a 9-month retrospective analysis of a quality improvement project. METHODS An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. RESULTS From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. LIMITATIONS This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. CONCLUSIONS The improvements in outcomes demonstrated the value and feasibility of a physical therapist-led early mobilization program.
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26
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Amidei C, Sole ML. Physiological responses to passive exercise in adults receiving mechanical ventilation. Am J Crit Care 2013; 22:337-48. [PMID: 23817823 DOI: 10.4037/ajcc2013284] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Critical illness may weaken muscles, with long-term consequences. OBJECTIVE To assess physiological responses to an early standardized passive exercise protocol to prevent muscle weakness in adults receiving mechanical ventilation. METHODS A quasi-experimental within-subjects repeated-measures design was used. Within 72 hours of intubation, 30 patients had 20 minutes of bilateral passive leg movement delivered by continuous-passive-motion machines at a standardized rate and flexion-extension. Heart rate, mean blood pressure, oxygen saturation, and cytokine levels were measured before, during, and after the intervention. The Behavioral Pain Scale was used to measure patients' comfort. Repeated-measures analysis of variance was used to analyze the effect of the exercise on independent variables. RESULTS Patients were mostly white men with a mean age of 56.5 years (SD, 16.9) with moderate mortality risk and illness severity. Heart rate, mean blood pressure, and oxygen saturation did not differ from baseline at any time measured. Pain scores were significantly reduced (F(2.43,70.42) = 4.08; P = .02) 5 and 10 minutes after exercise started and remained reduced at the end of exercise and 1 hour later. Interleukin 6 levels were significantly reduced (F(1.60,43.1) = 4.35; P = .03) at the end of exercise but not after the final rest period. Interleukin 10 levels did not differ significantly. Ratios of interleukin 6 to interleukin 10 decreased significantly (F(1.61,43.38) = 3.42; P = .05) at the end of exercise and again after 60 minutes' rest. CONCLUSION The exercise was well tolerated, and comfort improved during and after the intervention. Cytokine levels provided physiological rationale for benefits of early exercise.
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Affiliation(s)
- Christina Amidei
- Christina Amidei is an advanced practice research nurse, Department of Neuro-Oncology, University of Chicago, Chicago, Illinois. Mary Lou Sole is a professor, University of Central Florida, College of Nursing, Orlando, Florida
| | - Mary Lou Sole
- Christina Amidei is an advanced practice research nurse, Department of Neuro-Oncology, University of Chicago, Chicago, Illinois. Mary Lou Sole is a professor, University of Central Florida, College of Nursing, Orlando, Florida
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Casey CM. The study of activity in older ICU patients: an integrative review. J Gerontol Nurs 2013; 39:12-25; quiz 26-7. [PMID: 23758116 DOI: 10.3928/00989134-20130603-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/09/2013] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to review relevant literature on activity of older critically ill patients, including activity interventions conducted in this population, with a focus on activity measurement and technology. Literature published between 1996 and 2012 was reviewed using keywords older adults, inactivity, mobility, progressive mobility, rehabilitation, ambulation, early mobilization, ICU (intensive care unit), and accelerometry using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews. Previous relevant research is discussed and includes intervention and nonintervention studies. Although studies have demonstrated the benefits of early mobilization in the ICU setting, this research has not focused on the high-risk older adult ICU population, nor has it addressed how best to quantify these clinical activities. Current technologies, such as accelerometry, may assist in measuring patient activity and in mobilizing high-risk patients during acute, critical illness.
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Affiliation(s)
- Colleen M Casey
- Oregon Health & Science University, Portland, OR 97239, USA.
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28
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Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther 2013; 93:216-28. [PMID: 23329555 DOI: 10.2522/ptj.20110463] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Rehabilitation of patients in critical care environments improves functional outcomes. This finding has led to increased implementation of intensive care unit (ICU) rehabilitation programs, including early mobility, and an associated increased demand for physical therapists practicing in ICUs. Unfortunately, many physical therapists report being inadequately prepared to work in this high-risk environment. Simulation provides focused, deliberate practice in safe, controlled learning environments and may be a method to initiate academic preparation of physical therapists for ICU practice. OBJECTIVE The purpose of this study was to examine the effect of participation in simulation-based management of a patient with critical illness in an ICU setting on levels of confidence and satisfaction in physical therapist students. DESIGN A one-group, pretest-posttest, quasi-experimental design was used. METHODS Physical therapist students (N=43) participated in a critical care simulation experience requiring technical (assessing bed mobility and pulmonary status), behavioral (patient and interprofessional communication), and cognitive (recognizing a patient status change and initiating appropriate responses) skill performance. Student confidence and satisfaction were surveyed before and after the simulation experience. RESULTS Students' confidence in their technical, behavioral, and cognitive skill performance increased from "somewhat confident" to "confident" following the critical care simulation experience. Student satisfaction was highly positive, with strong agreement the simulation experience was valuable, reinforced course content, and was a useful educational tool. LIMITATIONS Limitations of the study were the small sample from one university and a control group was not included. CONCLUSIONS Incorporating a simulated, interprofessional critical care experience into a required clinical course improved physical therapist student confidence in technical, behavioral, and cognitive performance measures and was associated with high student satisfaction. Using simulation, students were introduced to the critical care environment, which may increase interest in working in this practice area.
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Abstract
PURPOSE OF REVIEW Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early rehabilitation of ICU patients has recently been identified as an important focus for interdisciplinary ICU teams. However, the amount of rehabilitation performed in ICUs is often inadequate. The scope of the review is to discuss recent developments in application of assessment tools and rehabilitation in critically ill patients within an interdisciplinary approach. RECENT FINDINGS ICU-based rehabilitation has become an important evidence-based component in the management of patients with critical illness. The assessment and evidence-based treatment of these patients should include a focus on prevention and treatment of deconditioning (muscle weakness, joint stiffness, impaired functional performance) and weaning failure (respiratory muscle weakness) to identify targets for rehabilitation. A variety of modalities for assessment and early ICU rehabilitation are supported by emerging clinical research and must be implemented according to the stage of critical illness, comorbidities, and consciousness and cooperation of the patient. SUMMARY Daily evaluation of every critically ill patient should include evaluation of the need for bedrest and immobility, and assessment of the potential for early rehabilitation interventions. Early ICU rehabilitation is an interdisciplinary team responsibility, involving physical therapists, occupational therapists, nurses and medical staff.
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Financial Implications of Starting a Mobility Protocol in a Surgical Intensive Care Unit. Crit Care Nurs Q 2013; 36:120-6. [DOI: 10.1097/cnq.0b013e3182753725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grap MJ, McFetridge B. Critical care rehabilitation and early mobilisation: an emerging standard of care. Intensive Crit Care Nurs 2012; 28:55-7. [PMID: 22445174 DOI: 10.1016/j.iccn.2012.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 02/11/2012] [Indexed: 11/17/2022]
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Winkelman C, Johnson KD, Hejal R, Gordon NH, Rowbottom J, Daly J, Peereboom K, Levine AD. Examining the positive effects of exercise in intubated adults in ICU: a prospective repeated measures clinical study. Intensive Crit Care Nurs 2012; 28:307-18. [PMID: 22458998 DOI: 10.1016/j.iccn.2012.02.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol. We examined the effects of exercise on vital signs and inflammatory biomarkers and the effects of the nurse-initiated mobility protocol on outcomes. METHODS Prospective, repeated measures study with a control (standard care) and intervention (protocol) period. RESULTS 75 heterogeneous subjects admitted to a Medical or Surgical intensive care unit (ICU) were enrolled. In <5% of exercise periods, there was a concerning alteration in respiratory rate or peripheral oxygen saturation; no other adverse events occurred. Findings suggested the use of a protocol with one 20 minute episode of exercise daily for 2 or more days reduced ICU length of stay. Duration of exercise was linked to increased IL-10, suggesting brief episodes of low intensity exercise positively altered inflammatory dysregulation in this sample. CONCLUSION A growing body of evidence demonstrates that early, progressive exercise has significant benefits to intubated adults. These results should encourage clinicians to add mobility protocols to the care of ICU adults and lead to future studies to determine optimal "dosing" of exercise in ICU patients.
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Affiliation(s)
- Chris Winkelman
- Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Ave, Cleveland, OH 44016, USA.
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Amidei C. Mobilisation in critical care: a concept analysis. Intensive Crit Care Nurs 2012; 28:73-81. [PMID: 22326102 DOI: 10.1016/j.iccn.2011.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 11/30/2011] [Accepted: 12/12/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this paper is to analyse the concept of mobilisation within the context of the critical care setting. Mobilisation is a widely used term that belies the complexity of its use in practice. Whilst facilitating movement is a significant nursing concern, mobilisation practices vary widely amongst nurses, perhaps due to conceptual incongruence. METHODS Evolutionary methodology was used in this concept analysis. Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews and PsycInfo databases were searched from 1966 to present. Search terms included mobilisation, mobility and passive exercise, yielding 61 articles suitable for analysis. FINDINGS Findings indicate that mobilisation is an interdisciplinary, goal-directed therapy used to facilitate movement and improve outcomes. It involves energy expenditure and has both physical and psychological domains. Disciplines vary in applications of mobilisation and therapy parameters are essentially undefined. The energy expenditure attribute has been well-exemplified in physical therapy literature, but only to a minimal degree in nursing literature. CONCLUSION In spite of the wide use of mobilisation, the concept requires further development, particularly in the critical care setting. Barriers to mobilisation require further delineation as does the psychological domain. Ongoing concept analysis can be used to inform practice and guide research activities.
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Affiliation(s)
- Christina Amidei
- University of Central Florida, College of Nursing, Orlando, FL 32816, United States.
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Abstract
Mortality in the ICU has dramatically decreased over the past decades because of a clearer understanding of disease pathophysiology, improved technology, and novel therapies. This success has led to the new challenge of treating patients with chronic disabilities resulting from prolonged ICU stays. In this review, the authors ( a) describe the emerging understanding of the basis for ICU-acquired weakness, including contributing factors such as prolonged bed rest; ( b) provide the background for the safety and efficacy of early mobilization; and ( c) give practical guidance for the implementation of ICU early mobilization based on their experience over the past 8 years.
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Affiliation(s)
| | | | - Kellen Smith
- Department of Physical Therapy, University of Virginia Medical Center, Charlottesville, Virginia
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Norrenberg M, Vincent JL. Rééducation motrice dans le cadre d’un séjour en réanimation. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0320-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Doherty N, Steen CD. Critical illness polyneuromyopathy (CIPNM); rehabilitation during critical illness. Therapeutic options in nursing to promote recovery: a review of the literature. Intensive Crit Care Nurs 2011; 26:353-62. [PMID: 20971010 DOI: 10.1016/j.iccn.2010.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 07/17/2010] [Accepted: 08/24/2010] [Indexed: 12/13/2022]
Abstract
Following critical illness requiring prolonged mechanical ventilation and sedation, intensive care patients often present with neuromuscular weakness. This results from critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). A lack of diagnostic criteria for each syndrome complicates prevention and treatment. Consequently the term critical illness polyneuromyopathy (CIPNM) has emerged and is characterised by severe weakness, reduced or absent limb reflexes and marked muscle wasting. Although clinical trials report a high incidence of CIPNM, in clinical practice it often remains undetected. The pathophysiological mechanisms that lead to neuromuscular weakness are not entirely clear, however several risk factors have been identified and will be discussed. To date, there are no specific treatments or interventions available to reduce the onset or impact of CIPNM. This paper will review the strategies employed that are supportive and aimed at controlling the associated risk factors.
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Affiliation(s)
- Nicola Doherty
- Critical Care Sister, Lancashire Teaching Trust, Preston, United Kingdom.
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Abstract
Along with the well-known pharmacological and technological advances in the treatment of the critically ill, nurses have made significant contributions in the realm of more holistic approaches to care, advancing well-known nursing therapies such as physical activity, music, and relationship-based care. The purpose of this article is to review current literature regarding adjunctive therapies used for the care for the critically ill, and, by extension, the chronically critically ill. The review describes the application of interventions using physical activity, spirituality, music, complementary and alternate therapies, relationship-focused care, and pet visitation. The authors conducted a multidisciplinary review of literature published between 1990 and 2009, using the Cochrane Database system and PubMed. The main focus was intervention studies; articles in which authors reviewed evidence and made suggestions for practice or further research were also examined.
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Winkelman C, Chiang LC. Manual Turns in Patients Receiving Mechanical Ventilation. Crit Care Nurse 2010; 30:36-44. [DOI: 10.4037/ccn2010106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Chris Winkelman
- Chris Winkelman is an assistant professor at Frances Payne Bolton School of Nursing, Case Western Reserve University, in Cleveland Ohio
| | - Ling-Chun Chiang
- Ling-Chun Chiang is a doctoral candidate at Frances Payne Bolton School of Nursing, Case Western Reserve University, in Cleveland Ohio
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Winkelman C. Investigating activity in hospitalized patients with chronic obstructive pulmonary disease: a pilot study. Heart Lung 2010; 39:319-30. [PMID: 20561844 PMCID: PMC2897943 DOI: 10.1016/j.hrtlng.2009.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 09/11/2009] [Accepted: 09/14/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study examined therapeutic mobility activity, and investigated whether serum levels of inflammatory biomarkers interleukin (IL)-6 and IL-10 varied between periods of rest and activity. METHODS This observational, exploratory study took place in a medical intensive care unit and in stepdown units at an urban, academic medical center managed by intensivists. Our sample included 17 adults with exacerbations of chronic obstructive pulmonary disease (COPD). RESULTS Our results indicate that activity can occur for about 20 minutes, early during a hospitalization, among critically ill adults with COPD exacerbations, and activity can progress safely over 2 days in an intensive-care or stepdown setting. Physical activity was low in intensity, as measured by actigraphy. CONCLUSION Although no significant differences were evident between serum inflammatory biomarkers at rest vs after activity in this small sample, trend-related data indicate that low-intensity activity has the potential to alter the inflammatory profile of hospitalized COPD adults.
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Affiliation(s)
- Chris Winkelman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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40
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Zanni JM, Korupolu R, Fan E, Pradhan P, Janjua K, Palmer JB, Brower RG, Needham DM. Rehabilitation therapy and outcomes in acute respiratory failure: An observational pilot project. J Crit Care 2010; 25:254-62. [DOI: 10.1016/j.jcrc.2009.10.010] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 10/16/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
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Clavet H, Hébert PC, Fergusson DA, Doucette S, Trudel G. Joint contractures in the intensive care unit: association with resource utilization and ambulatory status at discharge. Disabil Rehabil 2010; 33:105-12. [PMID: 20450246 DOI: 10.3109/09638288.2010.486468] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The objectives of our study were (1) to explore the link between joint contractures acquired in the ICU and the ambulatory status of patients at discharge home, to determine (2) when and how many patients received physiotherapy services in ICU and on the hospital ward, and (3) the differences in the use of hospital resources in the presence or absence of joint contractures. METHOD Data on ICU joint contractures were extracted from an existing contracture database containing information on 155 Canadian patients with a tertiary ICU stay of 14 days or more. RESULTS Of 155 patients, 115 (74.2%) received a range of motion assessment in the ICU. The assessment took place a median of 7 days (IQR 0-36) after ICU admission. Significantly fewer patients with joint contractures than without joint contractures were mobilized on the hospital ward (21/38 [55.3%] vs. 27/34 [79.4%], P = 0.03). At discharge home, more patients with joint contractures had a low ambulatory status (38 [64.4%]) compared with patients without joint contractures (26 [51.0%]; P = 0.002). CONCLUSION The median delay of 7 days before musculoskeletal assessment in the ICU together with failure to assess 26% of patients may have allowed the development of contractures, which affected the patients' ambulatory status at discharge from hospital.
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Affiliation(s)
- Heidi Clavet
- The Bone and Joint Laboratory, University of Ottawa, Ottawa, Ontario, Canada
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Critical illness neuromyopathy and muscle weakness in patients in the intensive care unit. AACN Adv Crit Care 2009; 20:243-53. [PMID: 19638746 DOI: 10.1097/nci.0b013e3181ac2551] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuromuscular complications of critical illness are common and can be severe and persistent in some patients. Neuromyopathy from critical illness and disuse atrophy from prolonged immobility contribute to muscle weakness acquired while in the intensive care unit. Although various risk factors (eg, severity of illness, corticosteroids, neuromuscular blocking agents) have been implicated in critical illness neuromyopathy (CINM), the evidence supporting these associations is inconsistent. Hyperglycemia may be an important risk factor for CINM, with tight glycemic control through intensive insulin therapy reducing the incidence of CINM. Early mobility in the intensive care unit may minimize disuse atrophy and possibly CINM, through exercise training and its anti-inflammatory effects. Although emerging data have demonstrated the safety, feasibility, and benefit of early mobility in critically ill patients, randomized controlled trials are needed to thoroughly evaluate its potential benefits on patients' muscle strength, physical function, and quality of life. Future studies are needed to elucidate the multiple mechanisms by which immobility, CINM, and other aspects of critical illness lead to muscle loss and neuromuscular dysfunction.
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Abstract
Bed rest is a common intervention for critically ill adults. Associated with both benefits and adverse effects, bed rest is undergoing increasing scrutiny as a therapeutic option in the intensive care unit. Bed rest has molecular and systemic effects, ultimately affecting functional outcomes in healthy individuals as well as in those with acute and critical illnesses. Using empirical sources, the purpose of this article was to describe the consequences of bed rest and immobility, especially consequences with implications for critically ill adults in the intensive care unit. This review uses body systems to cluster classic and current results of bed rest studies, beginning with cardiovascular and including pulmonary, renal, skin, nervous, immune, gastrointestinal/ metabolic, and skeletal systems. It concludes with effects on muscles, a system profoundly affected by immobility and bed rest.
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Affiliation(s)
- Chris Winkelman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA.
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Truong AD, Fan E, Brower RG, Needham DM. Bench-to-bedside review: mobilizing patients in the intensive care unit--from pathophysiology to clinical trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:216. [PMID: 19664166 PMCID: PMC2750129 DOI: 10.1186/cc7885] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As the mortality from critical illness has improved in recent years, there has been increasing focus on patient outcomes after hospital discharge. Neuromuscular weakness acquired in the intensive care unit (ICU) is common, persistent, and often severe. Immobility due to prolonged bed rest in the ICU may play an important role in the development of ICU-acquired weakness. Studies in other patient populations have demonstrated that moderate exercise is beneficial in altering the inflammatory milieu associated with immobility, and in improving muscle strength and physical function. Recent studies have demonstrated that early mobility in the ICU is safe and feasible, with a potential reduction in short-term physical impairment. However, early mobility requires a significant change in ICU practice, with reductions in heavy sedation and bed rest. Further research is required to determine whether early mobility in the ICU can improve patients' short-term and long-term outcomes.
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Affiliation(s)
- Alex D Truong
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Abstract
Turning critically ill, mechanically ventilated patients every 2 hours is a fundamental nursing intervention to reduce the negative impact of prolonged immobility from preventable pulmonary complications such as ventilator-associated pneumonia and atelectasis. Unfortunately, when coupled with positive pressure ventilation, the benefits of turning may come at the expense of cardiovascular function. Clinicians should closely monitor the hemodynamic response to turning mechanically ventilated patients, and if compromise is observed, the degree and duration of compromise may provide guidance to the appropriate intervention.
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Salvatore P, Ghidini S, Zita G, De Panfilis C, Lambertino S, Maggini C, Baldessarini RJ. Circadian activity rhythm abnormalities in ill and recovered bipolar I disorder patients. Bipolar Disord 2008; 10:256-65. [PMID: 18271904 DOI: 10.1111/j.1399-5618.2007.00505.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Most physiological indicators of bipolar disorder (BPD) reflect current acute illness, and rarely have proved to be state-independent. Activity rhythms are highly abnormal in acute phases of BPD; we compared circadian activity rhythms in BPD I patients during ill and recovered states to those of normal controls to test the hypothesis that some abnormalities may persist. METHODS We compared 36 adult DSM-IV BPD I patients during acute mania or mixed states, and during full and sustained clinical recovery, to 32 healthy controls of similar age and sex distribution, using wrist-worn, piezoelectric actigraphic monitoring for 72 h and computed cosinor analysis of circadian activity rhythms. RESULTS We verified expected major differences between manic or mixed-state BPD I patients and matched normal controls, including phase advances averaging 2.1 h in ill BPD I patients and 1.8 h in recovered patients. Moreover, recovered BPD patients differed highly significantly from controls in several measures, including acrophase advance, higher percentage of nocturnal sleep, and lower average daily activity (mesor). Actigraphic measures among recovered BPD patients were independent of ratings of mania (on the Young Mania Rating Scale), depression (on the Hamilton Depression Rating Scale), or rating-scale scored subjective distress, as well as the type and dose of concurrent psychotropic medication. CONCLUSIONS These findings suggest that abnormal activity rhythms, including sustained phase advances, may represent enduring (trait) characteristics of BPD patients even during clinical recovery. If verified, such indices may be useful in supporting diagnoses and as an objective phenotype for genetic or other biological studies.
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Affiliation(s)
- Paola Salvatore
- Schizophrenia and Bipolar Disorder Program and International Consortium for Bipolar Disorder Research, Mailman Research Center, McLean Division of Massachusetts General Hospital, Belmont, MA 02478-9106, USA.
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Abstract
Although the complications of immobility are well-described in the literature, critically ill patients are often subjected to prolonged periods of bed rest. Nurses, by virtue of their expertise in preventing iatrogenic complications, are in an ideal position to prevent the adverse outcomes associated with immobility. This article describes how nurses can use a mobility protocol to increase the activity of critically ill patients in a timely manner that may prevent the infirmity and suffering that is caused by unnecessarily long periods of bed rest.
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Affiliation(s)
- Rosemary A Timmerman
- Adult Critical Care Unit, Providence Alaska Medical Center, Anchorge, Alaska 99508, USA.
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49
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Johnson KL. Neuromuscular complications in the intensive care unit: critical illness polyneuromyopathy. AACN Adv Crit Care 2007; 18:167-80; quiz 181-2. [PMID: 17473545 DOI: 10.1097/01.aacn.0000269260.99169.70] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Critical illness polyneuromyopathy, a complication of critical illness, is a primary axonal degeneration of motor and sensory fibers that leads to skeletal muscle weakness. It significantly contributes to the unexplained difficulty in weaning from mechanical ventilation and to their prolonged rehabilitation and poor quality of life after discharge. This article will discuss the diagnosis of critical illness polyneuromyopathy, identify risk factors, review several pathomechanisms that have been proposed, and discuss the implications for practice.
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Affiliation(s)
- Karen L Johnson
- School of Nursing, University of Maryland, 655 W Lombard St, Baltimore, MD 21201, USA.
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Winkelman C, Higgins PA, Chen YJK, Levine AD. Cytokines in chronically critically ill patients after activity and rest. Biol Res Nurs 2007; 8:261-71. [PMID: 17456587 DOI: 10.1177/1099800406298168] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inflammation, a common problem for patients in the intensive care unit (ICU), frequently is associated with serious and prolonged critical illnesses. To date, no study has examined whether physical activity influences inflammatory factors in critically ill adults. The objectives of this study were to (a) examine the relationships between type and duration of physical activity and serum levels of interleukin 6 (IL-6), a proinflammatory cytokine; IL-10, an anti-inflammatory cytokine; and their ratio and (b) determine if there are associations between cytokines or their ratio and activity or outcomes. This descriptive feasibility study investigated the approaches to measuring levels of physical activity and its relationship to serum levels of IL-6 and IL-10 and the ratio between them in patients with prolonged mechanical ventilation during periods of activity and rest. Measurements included serum IL-6 and IL-10 levels, direct observation and actigraphy, and prospective chart review. Ten critically ill patients who were mechanically ventilated for an average of 10 days in a large, urban, teaching hospital were enrolled. The average ratio of IL-6 to IL-10 improved after an average of 14.7 min of passive physical activity, typically multiple in-bed turns associated with hygiene. IL-6, IL-10, and their ratio were not associated with patient outcomes of weaning success or length of stay. High levels of IL-6 were associated with mortality. Cytokine balance may be improved by low levels of activity among patients with prolonged critical illness. The pattern of cytokines produced after activity may improve patients' recovery from prolonged critical illness and mechanical ventilation.
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Affiliation(s)
- Chris Winkelman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44118-3601, USA.
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