1
|
Woodbridge HR, McCarthy CJ, Jones M, Willis M, Antcliffe DB, Alexander CM, Gordon AC. Assessing the safety of physical rehabilitation in critically ill patients: a Delphi study. Crit Care 2024; 28:144. [PMID: 38689372 PMCID: PMC11061934 DOI: 10.1186/s13054-024-04919-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Physical rehabilitation of critically ill patients is implemented to improve physical outcomes from an intensive care stay. However, before rehabilitation is implemented, a risk assessment is essential, based on robust safety data. To develop this information, a uniform definition of relevant adverse events is required. The assessment of cardiovascular stability is particularly relevant before physical activity as there is uncertainty over when it is safe to start rehabilitation with patients receiving vasoactive drugs. METHODS A three-stage Delphi study was carried out to (a) define adverse events for a general ICU cohort, and (b) to define which risks should be assessed before physical rehabilitation of patients receiving vasoactive drugs. An international group of intensive care clinicians and clinician researchers took part. Former ICU patients and their family members/carers were involved in generating consensus for the definition of adverse events. Round one was an open round where participants gave their suggestions of what to include. In round two, participants rated their agreements with these suggestions using a five-point Likert scale; a 70% consensus agreement threshold was used. Round three was used to re-rate suggestions that had not reached consensus, whilst viewing anonymous feedback of participant ratings from round two. RESULTS Twenty-four multi-professional ICU clinicians and clinician researchers from 10 countries across five continents were recruited. Average duration of ICU experience was 18 years (standard deviation 8) and 61% had publications related to ICU rehabilitation. For the adverse event definition, five former ICU patients and one patient relative were recruited. The Delphi process had a 97% response rate. Firstly, 54 adverse events reached consensus; an adverse event tool was created and informed by these events. Secondly, 50 risk factors requiring assessment before physical rehabilitation of patients receiving vasoactive drugs reached consensus. A second tool was created, informed by these suggestions. CONCLUSIONS The adverse event tool can be used in studies of physical rehabilitation to ensure uniform measurement of safety. The risk assessment tool can be used to inform clinical practise when risk assessing when to start rehabilitation with patients receiving vasoactive drugs. Trial registration This study protocol was retrospectively registered on https://www.researchregistry.com/ (researchregistry2991).
Collapse
Affiliation(s)
- Huw R Woodbridge
- Imperial College Healthcare NHS Trust, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | | | | | - David B Antcliffe
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anthony C Gordon
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
2
|
Cusack R, Bates A, Mitchell K, van Willigen Z, Denehy L, Hart N, Dushianthan A, Reading I, Chorozoglou M, Sturmey G, Davey I, Grocott M. Improving physical function of patients following intensive care unit admission (EMPRESS): protocol of a randomised controlled feasibility trial. BMJ Open 2022; 12:e055285. [PMID: 35428629 PMCID: PMC9014051 DOI: 10.1136/bmjopen-2021-055285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Physical rehabilitation delivered early following admission to the intensive care unit (ICU) has the potential to improve short-term and long-term outcomes. The use of supine cycling together with other rehabilitation techniques has potential as a method of introducing rehabilitation earlier in the patient journey. The aim of the study is to determine the feasibility of delivering the designed protocol of a randomised clinical trial comparing a protocolised early rehabilitation programme including cycling with usual care. This feasibility study will inform a larger multicentre study. METHODS AND ANALYSIS 90 acute care medical patients from two mixed medical-surgical ICUs will be recruited. We will include ventilated patients within 72 hours of initiation of mechanical ventilation and expected to be ventilated a further 48 hours or more. Patients will receive usual care or usual care plus two 30 min rehabilitation sessions 5 days/week.Feasibility outcomes are (1) recruitment of one to two patients per month per site; (2) protocol fidelity with >75% of patients commencing interventions within 72 hours of mechanical ventilation, with >70% interventions delivered; and (3) blinded outcome measures recorded at three time points in >80% of patients. Secondary outcomes are (1) strength and function, the Physical Function ICU Test-scored measured on ICU discharge; (2) hospital length of stay; and (3) mental health and physical ability at 3 months using the WHO Disability Assessment Schedule 2. An economic analysis using hospital health services data reported with an embedded health economic study will collect and assess economic and quality of life data including the Hospital Anxiety and Depression Scales core, the Euroqol-5 Dimension-5 Level and the Impact of Event Score. ETHICS AND DISSEMINATION The study has ethical approval from the South Central Hampshire A Research Ethics Committee (19/SC/0016). All amendments will be approved by this committee. An independent trial monitoring committee is overseeing the study. Results will be made available to critical care survivors, their caregivers, the critical care societies and other researchers. TRIAL REGISTRATION NUMBER NCT03771014.
Collapse
Affiliation(s)
- Rebecca Cusack
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Bates
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kay Mitchell
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zoe van Willigen
- Department of Physiotherapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Linda Denehy
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Nicholas Hart
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Respiratory and Critical Care, King's College London, London, UK
| | - Ahilanandan Dushianthan
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Isabel Reading
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Gordon Sturmey
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Iain Davey
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Grocott
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
Newman ANL, Kho ME, Harris JE, Fox-Robichaud A, Solomon P. The experiences of cardiac surgery critical care clinicians with in-bed cycling in adult patients undergoing complex cardiac surgery. Disabil Rehabil 2021; 44:5038-5045. [PMID: 34027750 DOI: 10.1080/09638288.2021.1922515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE In-bed cycling is a novel modality that permits the early initiation of rehabilitation in the intensive care unit. We explored clinicians' experiences and perceptions of in-bed cycling with critically ill cardiac surgery patients. MATERIALS AND METHODS We used an interpretive description methodology. All critical care clinicians who had been present for at least 2 cycling sessions were eligible. Data were collected using semi-structured, audio-recorded, face-to-face interviews transcribed verbatim. Content analysis was used to identify themes. RESULTS Nine clinicians were interviewed. Our sample was predominantly female (77.8%) with a median [IQR] age of 40 [21.5] years. Critical care experience ranged from <5 years to ≥30 years. Acceptability was influenced by previous cycling experiences, identifying the "ideal" patient, and the timing of cycling within a patient's recovery. Facilitators included striving towards a common goal and feeling confident in the method. Barriers included inadequate staffing, bike size, and the time to deliver cycling. CONCLUSIONS Clinicians supported the use of in-bed cycling. Concerns included appropriate patient selection and timing of the intervention. Teamwork was integral to successful cycling. Strategies to overcome the identified barriers may assist with successful cycling implementation in other critical care environments.IMPLICATIONS FOR REHABILITATIONIn-bed cycling is a relatively novel rehabilitation modality that can help initiate physical rehabilitation earlier in a patient's recovery and reduce the iatrogenic effects of prolonged admissions to an intensive care unit.Clinicians found in-bed cycling to be an acceptable intervention with a population of critically ill cardiac surgery patients.Teamwork and interprofessional communication are important considerations for successful uptake of a relatively new rehabilitation modality.Identified barriers to in-bed cycling can assist with developing strategies to encourage cycling uptake in similar critical care environments.
Collapse
Affiliation(s)
- Anastasia N L Newman
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Hamilton Health Sciences, Hamilton, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Alison Fox-Robichaud
- Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| |
Collapse
|
4
|
Newman ANL, Kho ME, Harris JE, Zamir N, McDonald E, Fox-Robichaud A, Solomon P. CardiO Cycle: a pilot feasibility study of in-bed cycling in critically ill patients post cardiac surgery. Pilot Feasibility Stud 2021; 7:13. [PMID: 33407923 PMCID: PMC7788703 DOI: 10.1186/s40814-020-00760-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background In-bed cycling is a novel modality for the initiation of early mobilization in the intensive care unit. No study has investigated its use in the critically ill, off-track post cardiac surgery population. Before conducting an effectiveness trial, feasibility data are needed. The aim of this study was to determine the feasibility of in-bed cycling in a population of off-track cardiac surgery patients. Methods We conducted a prospective feasibility study in a 16-bed adult cardiac surgery intensive care unit in Ontario, Canada. Previously ambulatory adults (≥ 18 years) who were mechanically ventilated for ≥ 72 h were enrolled within 3 to 7 days post cardiac surgery. Twenty minutes of in-bed cycling was delivered by ICU physiotherapists 5 days/week. The primary outcome, feasibility, was the percent of patient-cycling sessions that occurred when cycling was appropriate. The secondary outcome was cycling safety, measured as cycling discontinuation due to predetermined adverse events. Results We screened 2074 patients, 29 met eligibility criteria, and 23 (92%) consented. Patients were male (78.26%) with a median [IQR] age of 76 [11] years, underwent isolated coronary bypass (39.1%), and had a median EuroScore II of 5.4 [7.8]. The mean (SD) time post-surgery to start of cycling was 5.9 (1.4) days. Patients were cycled on 80.5% (136/169) of eligible days, with limited physiotherapy staffing accounting for 48.5% of the missed patient-cycling sessions. During 136 sessions of cycling, 3 adverse events occurred in 3 individual patients. The incidence of an adverse event was 2.2 per 100 patient-cycling sessions (95% CI 0.50, 6.4). Conclusions In-bed cycling with critically ill cardiac surgery patients is feasible with adequate physiotherapy staffing and appears to be safe. Future studies are needed to determine the effectiveness of this intervention in a larger sample. Trial registration This trial was registered with Clinicaltrials.gov (NCT02976415). Registered November 29, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-020-00760-5.
Collapse
Affiliation(s)
- Anastasia N L Newman
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. .,Hamilton General Hospital, Hamilton, Ontario, Canada.
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nasim Zamir
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ellen McDonald
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Alison Fox-Robichaud
- Hamilton General Hospital, Hamilton, Ontario, Canada.,Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
5
|
Martí JD, McWilliams D, Gimeno-Santos E. Physical Therapy and Rehabilitation in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit. Semin Respir Crit Care Med 2020; 41:886-898. [PMID: 32725615 DOI: 10.1055/s-0040-1709139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that affects a person's ability to exercise and undertake normal physical function due to breathlessness, poor physical fitness, and muscle fatigue. Patients with COPD often experience exacerbations due to pulmonary infections, which result in worsening of their symptoms, more loss of function, and often require hospital treatment or in severe cases admission to intensive care units. Recovery from such exacerbations is often slow, and some patients never fully return to their previous level of activity. This can lead to permanent disability and premature death.Physical therapists play a key role in the respiratory management and rehabilitation of patients admitted to intensive care following acute exacerbation of COPD. This article discusses the key considerations for respiratory management of patients requiring invasive mechanical ventilation, providing an evidence-based summary of commonly used interventions. It will also explore the evidence to support the introduction of early and structured programs of rehabilitation to support recovery in both the short and the long term, as well as active mobilization, which includes strategies to minimize or prevent physical loss through early retraining of both peripheral and respiratory muscles.
Collapse
Affiliation(s)
- Joan Daniel Martí
- Cardiovascular Surgery Intensive Care Unit, Hospital Clínic de Barcelona, Spain
| | - David McWilliams
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | - Elena Gimeno-Santos
- Respiratory Department, Hospital Clinic de Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| |
Collapse
|
6
|
Nickels MR, Aitken LM, Barnett AG, Walsham J, King S, Gale NE, Bowen AC, Peel BM, Donaldson SL, Mealing STJ, McPhail SM. Effect of in-bed cycling on acute muscle wasting in critically ill adults: A randomised clinical trial. J Crit Care 2020; 59:86-93. [PMID: 32585438 DOI: 10.1016/j.jcrc.2020.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/17/2020] [Accepted: 05/24/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine whether in-bed cycling assists critically ill adults to reduce acute muscle wasting, improve function and improve quality of life following a period of critical illness. MATERIALS AND METHODS A single-centre, two-group, randomised controlled trial with blinded assessment of the primary outcome was conducted in a tertiary ICU. Critically ill patients expected to be mechanically ventilated for at least 48 h were randomised to 30 min daily in-bed cycling in addition to usual-care physiotherapy (n = 37) or usual-care physiotherapy (n = 37). The primary outcome was muscle atrophy of rectus femoris cross-sectional area (RFCSA) measured by ultrasound at Day 10 following study enrolment. Secondary outcomes included manual muscle strength, handgrip strength, ICU mobility score, six-minute walk test distance and health-related quality of life up to six-months following hospital admission. RESULTS Analysis included the 72 participants (mean age, 56-years; male, 68%) who completed the study. There were no significant between-group differences in muscle atrophy of RFCSA at Day 10 (mean difference 3.4, 95% CI -6.9% to 13.6%; p = .52), or for secondary outcomes (p-values ranged p = .11 to p = .95). CONCLUSIONS AND RELEVANCE In-bed cycling did not reduce muscle wasting in critically ill adults, but this study provides useful effect estimates for large-scale clinical trials. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12616000948493.
Collapse
Affiliation(s)
- Marc R Nickels
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia; Australian Centre for Health Services Innovation for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, London, United Kingdom; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - James Walsham
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Scott King
- Department of Radiology, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
| | - Nicolette E Gale
- Department of Radiology, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
| | - Alicia C Bowen
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
| | - Brent M Peel
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
| | - Samuel L Donaldson
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
| | - Stewart T J Mealing
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.
| | - Steven M McPhail
- Australian Centre for Health Services Innovation for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia; Clinical Informatics, Metro South Health, Brisbane, Australia.
| |
Collapse
|
7
|
McCaskell DS, Molloy AJ, Childerhose L, Costigan FA, Reid JC, McCaughan M, Clarke F, Cook DJ, Rudkowski JC, Farley C, Karachi T, Rochwerg B, Newman A, Fox-Robichaud A, Herridge MS, Lo V, Feltracco D, Burns KE, Porteous R, Seely AJE, Ball IM, Seczek A, Kho ME. Project management lessons learned from the multicentre CYCLE pilot randomized controlled trial. Trials 2019; 20:532. [PMID: 31455384 PMCID: PMC6712681 DOI: 10.1186/s13063-019-3634-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background Clinical trials management can be studied using project management theory. The CYCLE pilot randomized controlled trial (RCT) was conducted to determine the feasibility of a future rehabilitation trial of early in-bed cycling in the intensive care unit (ICU). In-bed cycling is a novel intervention, not typically available in ICUs. Implementation of this intervention requires personnel with specialized clinical expertise caring for critically ill patients and use of the in-bed cycle. Our objective was to describe the implementation and conduct of our pilot RCT using a project management approach. Methods We retrospectively reviewed activities, timelines, and personnel involved in the trial. We organized activities into four project management phases: initiation, planning, execution, and monitoring and controlling. Data sources included Methods Centre documents used for trial coordination and conduct, and the trial data set. We report descriptive statistics as counts and proportions and also medians and quartiles, and we summarize the lessons learned. Results Seven ICUs in Canada participated in the trial. Time from research ethics board and contracts submission to first enrolment was a median (first quartile, third quartile) of 185 (146, 209) and 162 (114, 181) days, respectively. We trained 128 personnel on the CYCLE pilot RCT protocol, and 80 (63%) completed trial-related activities. Four sites required additional training after start-up due to staff turnover and leaves of absence. Over 15 months, we screened 864 patients: 256 were eligible and 66 were enrolled. Despite an 85% consent rate, 74% (190/256) of eligible patients were not randomized, largely (80% [152/190]) due to physiotherapist availability. Thirteen percent of recruitment weeks were lost due to physiotherapist staffing shortages. We highlight five key lessons learned: (1) prepare and anticipate site needs; (2) communicate regularly; (3) proactively analyse and act on process measure data; (4) develop contingency plans; (5) express appreciation to participating sites. Conclusions Our analysis highlights the scope of relevant activities, rigorous training and monitoring, number and types of required personnel, and time required to conduct a multicentre ICU rehabilitation intervention trial. Our lessons learned can help others interested in implementing complex intervention trials, such as rehabilitation. Trial registration ClinicalTrials.gov, NCT02377830. Registered prospectively on 4 March 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3634-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Devin S McCaskell
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Alexander J Molloy
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Laura Childerhose
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.,Department of Health Research Methods, Evidence and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - F Aileen Costigan
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Julie C Reid
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Magda McCaughan
- Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - France Clarke
- Department of Health Research Methods, Evidence and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Deborah J Cook
- Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.,Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jill C Rudkowski
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Christopher Farley
- Juravinski Hospital, Hamilton, 711 Concession St, Hamilton, ON, L8V 1C3, Canada
| | - Tim Karachi
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Anastasia Newman
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.,Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | | | - Vincent Lo
- Department of Physical Therapy, University of Toronto, Rehabilitation Sciences Centre, 8th Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Deanna Feltracco
- St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Karen Ea Burns
- St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | | | | | - Ian M Ball
- Department of Medicine and Department of Epidemiology and Biostatistics, Western University, Critical Care Trauma Centre, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Amy Seczek
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Michelle E Kho
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada. .,McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada. .,Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.
| |
Collapse
|
8
|
Zang K, Chen B, Wang M, Chen D, Hui L, Guo S, Ji T, Shang F. The effect of early mobilization in critically ill patients: A meta-analysis. Nurs Crit Care 2019; 25:360-367. [PMID: 31219229 DOI: 10.1111/nicc.12455] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this meta-analysis was to assess if early mobilization and rehabilitation in the intensive care unit (ICU) could reduce ICU-acquired weakness (ICU-AW), improve functional recovery, improve muscle strength, shorten the length of ICU and hospital stays, and reduce the mortality rate. METHODS A comprehensive literature search in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and National Knowledge Infrastructure, China (CNKI) was performed. Results were expressed as a risk ratio (RR) with 95% confidence intervals (95% CIs) or weight mean difference (WMD) with 95% CIs. Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among studies. RESULTS Fifteen randomized controlled trials involving a total of 1941 patients were included in this meta-analysis. Pooled estimates suggested that early mobilization significantly reduced the incidence of ICU-AW (RR = 0.49, 95% CI: 0.26, 0.91; P = .025), shortened the length of ICU (WMD = -1.82 days, 95% CI: -2.88, -0.76; P = .001) and hospital (WMD = -3.90 days, 95% CI: -5.94, -1.85; P < .001) stays, and improved the Medical Research Council score (WMD = 4.47, 95% CI: 1.43, 7.52; P = .004) and Barthel Index score at hospital discharge (WMD = 21.44, 95% CI: 10.97, 31.91; P < .001). Moreover, early mobilization also decreased complications such as deep vein thrombosis (RR = 0.16, 95% CI: 0.04, 0.59; P = .006), ventilator-associated pneumonia (RR = 0.26, 95% CI: 0.11, 0.63; P = .003), and pressure sores (RR = 0.14, 95% CI: 0.04, 0.44; P = .001). However, early mobilization did not reduce the ICU mortality rate (RR = 1.31, 95% CI: 0.97, 1.76; P = .074), improve the handgrip strength (WMD = 4.03 kg, 95% CI: -0.68, 8.74; P = .094), and shorten the duration of mechanical ventilation (WMD = 0.20 days, 95% CI: -0.10, 0.50; P = .194). CONCLUSION This study indicated that early mobilization was effective in preventing the occurrence of ICU-AW, shortening the length of ICU and hospital stay, and improving the functional mobility. However, it had no effect on the ICU mortality rate and ventilator-free days. RELEVANCE TO CLINICAL PRACTICE ICU-AW is a common neuromuscular complication of critical illness, and it is predictive of adverse outcomes. Early mobilization of critically ill patients is a candidate intervention to reduce the incidence and severity of ICU-AW. Some clinical studies have demonstrated this, whereas others found opposite results. The aim of our study is to assess if early mobilization and rehabilitation in the ICU could reduce the ICU-AW, improve functional recovery, improve muscle strength, shorten length of ICU and hospital stay, and reduce the mortality rate.
Collapse
Affiliation(s)
- Kui Zang
- Department of Intensive Care Unit, The Affiliated Huaian No. 1 People's Hospital, Nanjing Medical University, Huaian, China
| | - Beibei Chen
- Department of Intensive Care Unit, The Affiliated Huaian No. 1 People's Hospital, Nanjing Medical University, Huaian, China
| | - Min Wang
- Department of Intensive Care Unit, The Affiliated Huaian No. 1 People's Hospital, Nanjing Medical University, Huaian, China
| | - Doudou Chen
- Department of Intensive Care Unit, The Affiliated Huaian No. 1 People's Hospital, Nanjing Medical University, Huaian, China
| | - Liangliang Hui
- Department of Intensive Care Unit, The Affiliated Huaian No. 1 People's Hospital, Nanjing Medical University, Huaian, China
| | - Shiguang Guo
- Department of Intensive Care Unit, The Affiliated Huaian No. 1 People's Hospital, Nanjing Medical University, Huaian, China
| | - Ting Ji
- Department of Intensive Care Unit, The Affiliated Huaian No. 1 People's Hospital, Nanjing Medical University, Huaian, China
| | - Futai Shang
- Department of Intensive Care Unit, The Affiliated Huaian No. 1 People's Hospital, Nanjing Medical University, Huaian, China
| |
Collapse
|
9
|
Kho ME, Molloy AJ, Clarke FJ, Reid JC, Herridge MS, Karachi T, Rochwerg B, Fox-Robichaud AE, Seely AJE, Mathur S, Lo V, Burns KEA, Ball IM, Pellizzari JR, Tarride JE, Rudkowski JC, Koo K, Heels-Ansdell D, Cook DJ. Multicentre pilot randomised clinical trial of early in-bed cycle ergometry with ventilated patients. BMJ Open Respir Res 2019; 6:e000383. [PMID: 30956804 PMCID: PMC6424272 DOI: 10.1136/bmjresp-2018-000383] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/29/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction Acute rehabilitation in critically ill patients can improve post-intensive care unit (post-ICU) physical function. In-bed cycling early in a patient's ICU stay is a promising intervention. The objective of this study was to determine the feasibility of recruitment, intervention delivery and retention in a multi centre randomised clinical trial (RCT) of early in-bed cycling with mechanically ventilated (MV) patients. Methods We conducted a pilot RCT conducted in seven Canadian medical-surgical ICUs. We enrolled adults who could ambulate independently before ICU admission, within the first 4 days of invasive MV and first 7 days of ICU admission. Following informed consent, patients underwent concealed randomisation to either 30 min/day of in-bed cycling and routine physiotherapy (Cycling) or routine physiotherapy alone (Routine) for 5 days/week, until ICU discharge. Our feasibility outcome targets included: accrual of 1-2 patients/month/site; >80% cycling protocol delivery; >80% outcomes measured and >80% blinded outcome measures at hospital discharge. We report ascertainment rates for our primary outcome for the main trial (Physical Function ICU Test-scored (PFIT-s) at hospital discharge). Results Between 3/2015 and 6/2016, we randomised 66 patients (36 Cycling, 30 Routine). Our consent rate was 84.6 % (66/78). Patient accrual was (mean (SD)) 1.1 (0.3) patients/month/site. Cycling occurred in 79.3% (146/184) of eligible sessions, with a median (IQR) session duration of 30.5 (30.0, 30.7) min. We recorded 43 (97.7%) PFIT-s scores at hospital discharge and 37 (86.0%) of these assessments were blinded. Discussion Our pilot RCT suggests that a future multicentre RCT of early in-bed cycling for MV patients in the ICU is feasible. Trial registration number NCT02377830.
Collapse
Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada,Physiotherapy Department, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Alexander J Molloy
- Physiotherapy Department, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - France J Clarke
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Julie C Reid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Margaret S Herridge
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Timothy Karachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alison E Fox-Robichaud
- Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Andrew JE Seely
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Vincent Lo
- Department of Physical Therapy, Toronto General Hospital, Toronto, Ontario, Canada
| | - Karen EA Burns
- Interdepartmental Division of Critical Care and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ian M Ball
- Department of Medicine, Western University, London, Ontario, Canada,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Joseph R Pellizzari
- Consultation-Liaison Psychiatry Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jill C Rudkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karen Koo
- Swedish Medical Group, Seattle, Washington, USA,Department of Medicine, Western University, London, ON, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
10
|
Paton M, Lane R, Hodgson CL. Early Mobilization in the Intensive Care Unit to Improve Long-Term Recovery. Crit Care Clin 2018; 34:557-571. [DOI: 10.1016/j.ccc.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
11
|
Wojkowski S, Unger J, McCaughan M, Cole B, Kho ME. Development, Implementation, and Outcomes of an Acute Care Clinician Scientist Clinical Placement: Case Report. Physiother Can 2017; 69:318-322. [PMID: 30369699 DOI: 10.3138/ptc.2016-45e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This article presents the development, implementation, and outcomes of an innovative clinician scientist (CS) placement for a 2nd-year, entry-level MSc(PT) student at McMaster University. Client Description: All physiotherapy students participating in the third 6-week clinical placement at McMaster University were eligible to apply for one CS placement. A placement description and expectations were developed collaboratively by the clinical site and the MSc(PT) programme before placement matching. Intervention: A shared supervisory model between one acute care physiotherapist and a critical care CS was developed to provide supervision in both clinical and research-related activities during the placement. Measures and Outcomes: The first CS clinical placement in the MSc(PT) Program at McMaster was completed between November and December 2015. The student was evaluated using the same process as a traditional student placement. Over 6 weeks, the student gained clinical experience in an acute care setting; accumulated more than 100 cardiorespiratory hours; participated in research activities for a randomized controlled trial, which led to a submission to Physiotherapy Practice; and applied for the Canadian Institutes of Health Research Health Professional Student Research Award. Implications: The CS is a developing role for Canadian physiotherapists. A CS placement gave the physiotherapy student the opportunity to apply traditional skills and knowledge as well as to develop advanced research skills. The success of this placement has established a foundation for future placements.
Collapse
Affiliation(s)
| | - Janelle Unger
- School of Rehabilitation Science, McMaster University.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ont
| | | | - Beverley Cole
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University.,Physiotherapy Department, St. Joseph's Healthcare, Hamilton
| |
Collapse
|
12
|
Rochwerg B, Millen T, Austin P, Zeller M, D’Aragon F, Jaeschke R, Masse MH, Mehta S, Lamontagne F, Meade M, Guyatt G, Cook DJ. Fluids in Sepsis and Septic Shock (FISSH): protocol for a pilot randomised controlled trial. BMJ Open 2017; 7:e017602. [PMID: 28729329 PMCID: PMC5642672 DOI: 10.1136/bmjopen-2017-017602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock. METHODS AND ANALYSIS This is a randomised, concealed, blinded parallel-group multicentre pilot trial. We will include adult critically ill patients with septic shock, defined as ongoing hypotension despite 1 L of fluid, or a serum lactate >4 mmol/L, who are within 6 hours of hospital presentation or rapid response team activation. We will exclude patients if they have an aetiology of shock other than sepsis, if they have acute burn injury, elevated intracranial pressure, intent to withdraw life support or previous enrolment in this or a competing trial. Following informed consent, patients will be randomised to a low chloride fluid strategy or a high chloride fluid strategy for the duration of their ICU stay or until 30 days postrandomisation. Clinicians, patients, families and research staff will be blinded. The primary outcome for this trial will be feasibility, assessed by consent rate, recruitment success and protocol adherence. Patient-important clinical outcomes include mortality, receipt of renal replacement therapy, intensive care unit and hospital lengths of stay and surrogate outcomes of incidence of acidosis, hyperkalaemia and acute kidney injury. ETHICS AND DISSEMINATION This pilot trial will test the feasibility of conducting the main trial, which will examine the effect of high versus low chloride fluids in patients with septic shock on patient-important outcomes. TRIAL REGISTRATION NUMBER NCT02748382, registered 8 April 2016. PROTOCOL DATE 1 July 2016.
Collapse
Affiliation(s)
- Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tina Millen
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Peggy Austin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Zeller
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Frédérick D’Aragon
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke et Faculté de Médecine et des Sciences dela Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Roman Jaeschke
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Sangeeta Mehta
- Mount Sinai Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Francois Lamontagne
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke et Faculté de Médecine et des Sciences dela Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maureen Meade
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
13
|
Kimawi I, Lamberjack B, Nelliot A, Toonstra AL, Zanni J, Huang M, Mantheiy E, Kho ME, Needham DM. Safety and Feasibility of a Protocolized Approach to In-Bed Cycling Exercise in the Intensive Care Unit: Quality Improvement Project. Phys Ther 2017; 97:593-602. [PMID: 28379571 DOI: 10.1093/ptj/pzx034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/16/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND In-bed, supine cycle ergometry as a part of early rehabilitation in the intensive care unit (ICU) appears to be safe, feasible, and beneficial, but no standardized protocol exists. A standardized protocol may help guide use of cycle ergometry in the ICU. OBJECTIVE This study investigated whether a standardized protocol for in-bed cycling is safe and feasible, results in cycling for a longer duration, and achieves a higher resistance. DESIGN A quality improvement (QI) project was conducted. METHODS A 35-minute in-bed cycling protocol was implemented in a single medical intensive care unit (MICU) over a 7-month quality improvement (QI) period compared to pre-existing, prospectively collected data from an 18-month pre-QI period. RESULTS One hundred and six MICU patients received 260 cycling sessions in the QI period vs. 178 MICU patients receiving 498 sessions in the pre-QI period. The protocol was used in 249 (96%) of cycling sessions. The QI group cycled for longer median (IQR) duration (35 [25-35] vs. 25 [18-30] minutes, P < .001) and more frequently achieved a resistance level greater than gear 0 (47% vs. 17% of sessions, P < .001). There were 4 (1.5%) transient physiologic abnormalities during the QI period, and 1 (0.2%) during the pre-QI period ( P = .031). LIMITATIONS Patient outcomes were not evaluated to understand if the protocol has clinical benefits. CONCLUSIONS Use of a protocolized approach for in-bed cycling appears safe and feasible, results in cycling for longer duration, and achieved higher resistance.
Collapse
Affiliation(s)
- Ibtehal Kimawi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine
| | - Bryanna Lamberjack
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
| | - Archana Nelliot
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine
| | - Amy Lee Toonstra
- OACIS Group, Johns Hopkins University School of Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
| | - Jennifer Zanni
- OACIS Group, Johns Hopkins University School of Medicine; Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Minxuan Huang
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine
| | - Earl Mantheiy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine
| | - Michelle E Kho
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, and School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, 5th Floor, Baltimore, MD 21205 (USA); OACIS Group, Johns Hopkins University School of Medicine; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| |
Collapse
|
14
|
Hodgson CL, Tipping CJ. Physiotherapy management of intensive care unit-acquired weakness. J Physiother 2017; 63:4-10. [PMID: 27989729 DOI: 10.1016/j.jphys.2016.10.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022] Open
Abstract
[Hodgson CL, Tipping CJ (2016) Physiotherapy management of intensive care unit-acquired weakness.Journal of Physiotherapy63: 4-10].
Collapse
Affiliation(s)
- Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University; The Alfred Hospital, Melbourne, Australia
| | - Claire J Tipping
- Australian and New Zealand Intensive Care Research Centre, Monash University; The Alfred Hospital, Melbourne, Australia
| |
Collapse
|
15
|
Mehrholz J, Thomas S, Burridge JH, Schmidt A, Scheffler B, Schellin R, Rückriem S, Meißner D, Mehrholz K, Sauter W, Bodechtel U, Elsner B. Fitness and mobility training in patients with Intensive Care Unit-acquired muscle weakness (FITonICU): study protocol for a randomised controlled trial. Trials 2016; 17:559. [PMID: 27881152 PMCID: PMC5121933 DOI: 10.1186/s13063-016-1687-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/09/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Critical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of people with ICUAW is, therefore, of great importance at both an individual and a societal level. A recent systematic Cochrane review found no randomised controlled trials (RCT), and thus no supporting evidence, for physical rehabilitation interventions for people with defined CIP and CIM to improve activities of daily living. Therefore, the aim of our study is to compare the effects of an additional physiotherapy programme with systematically augmented levels of mobilisation with additional in-bed cycling (as the parallel group) on walking and other activities of daily living. METHODS/DESIGN We will conduct a prospective, rater-masked RCT of people with ICUAW with a defined diagnosis of CIM and/or CIP in our post-acute hospital. We will randomly assign patients to one of two parallel groups in a 1:1 ratio and will use a concealed allocation. One intervention group will receive, in addition to standard ICU treatment, physiotherapy with systematically augmented levels of mobilisation (five times per week, over 2 weeks; 20 min each session; with a total of 10 additional sessions). The other intervention group will receive, in addition to standard ICU treatment, in-bed cycle sessions (same number, frequency and treatment time as the intervention group). Standard ICU treatment includes sitting balance exercise, stretching, positioning, and sit-to-stand training, and transfer training to get out of bed, strengthening exercise (in and out of bed), and stepping and assistive standing exercises. Primary efficacy endpoints will be walking ability (defined as a Functional Ambulation Category (FAC) level of ≥3) and the sum score of the Functional Status Score for the Intensive Care Unit (FSS-ICU) (range 0-22 points) assessed by a blinded tester immediately after 2 weeks of additional therapy. Secondary outcomes will include assessment of sit-to-stand recovery, overall limb strength (Medical Research Council, MRC) and grip strength, the Physical Function for the Intensive Care Unit Test-Scored (PFIT-S), the EuroQol 5 Dimensions (EQ-5D) questionnaire and the Reintegration to Normal Living Index (RNL-Index) assessed by a blinded tester. We will measure primary and secondary outcomes with blinded assessors at baseline, immediately after 2 weeks of additional therapy, and at 3 weeks and 6 months and 12 months after the end of the additional therapy intervention. Based on our sample size calculation 108 patients will be recruited from our post-acute ICU in the next 3 to 4 years. DISCUSSION This will be the first RCT comparing the effects of two physical rehabilitation interventions for people with ICUAW due to defined CIP and/or CIM to improve walking and other activities of daily living. The results of this trial will provide robust evidence for physical rehabilitation of people with CIP and/or CIP who often require long-term care. TRIAL REGISTRATION We registered the study on 6 April 2016 before enrolling the first patient in the trial at the German Clinical Trials Register ( www.germanctr.de ) with the identifier DRKS00010269 . This is the first version of the protocol (FITonICU study protocol).
Collapse
Affiliation(s)
- Jan Mehrholz
- Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany. .,Department of Public Health, Medizinische Fakultät, Carl Gustav Carus, Technische Universität, Dresden, Germany.
| | - Simone Thomas
- Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Jane H Burridge
- Neurorehabilitation Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - André Schmidt
- Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Bettina Scheffler
- Fach und Privatkrankenhaus, Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Ralph Schellin
- Fach und Privatkrankenhaus, Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Stefan Rückriem
- Fach und Privatkrankenhaus, Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Daniel Meißner
- Fach und Privatkrankenhaus, Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Katja Mehrholz
- Fach und Privatkrankenhaus, Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Wolfgang Sauter
- Fach und Privatkrankenhaus, Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Ulf Bodechtel
- Fach und Privatkrankenhaus, Klinik Bavaria in Kreischa, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany
| | - Bernhard Elsner
- Department of Public Health, Medizinische Fakultät, Carl Gustav Carus, Technische Universität, Dresden, Germany
| |
Collapse
|