Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit

Kho, Michelle E.; Martin, Robert A.; Toonstra, Amy; Zanni, Jennifer M.; Mantheiy, Earl; Nelliot, Archana; Needham, Dale M.

doi:10.1016/j.jcrc.2015.07.025

Cited by 51 publications

(56 citation statements)

References 23 publications

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“…The BEDCYC group will receive, in addition to standard treatment, 20 min of in-bed cycle ergometer sessions (the same number, frequency and treatment time as the MOBILITY group) [22]. We chose in-bed cycling as comparator to compare two true active and potentially effective interventions.…”

Section: Methodsmentioning

confidence: 99%

“…We chose in-bed cycling as comparator to compare two true active and potentially effective interventions. For instance Kho et al recently described the feasibility and safety of in-bed cycle ergometry as part of routine ICU practice [22]. They described 181 patients on ICU receiving a total of 541 cycling sessions and described a very low (0.2%) event rate and concluded that the use of in-bed cycling as part of routine physical therapy interventions in ICU patients is feasible and appears to be safe [22].…”

Section: Methodsmentioning

confidence: 99%

“…For instance Kho et al recently described the feasibility and safety of in-bed cycle ergometry as part of routine ICU practice [22]. They described 181 patients on ICU receiving a total of 541 cycling sessions and described a very low (0.2%) event rate and concluded that the use of in-bed cycling as part of routine physical therapy interventions in ICU patients is feasible and appears to be safe [22]. We will use the same in-bed cycle therapy approach as described earlier; however, contrary to the CYCLE pilot protocol of Kho et al [37] we will use 20-min in-bed cycle ergometer sessions instead of 30-min sessions.…”

Section: Methodsmentioning

confidence: 99%

“…Examples here include (additional) in-bed cycling often being used in critically ill patients on ICU [22] and also in the post-acute phase [18] and a physiotherapy programme with augmented levels of mobilisation is likely to be desirable as mobilisation is often used in the rehabilitation of chronically critically ill patients [3]. …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Fitness and mobility training in patients with Intensive Care Unit-acquired muscle weakness (FITonICU): study protocol for a randomised controlled trial

Mehrholz

Thomas

Burridge

et al. 2016

Trials

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BackgroundCritical 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/designWe 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.DiscussionThis 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 resul...

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fitness and mobility training in patients with Intensive Care Unit-acquired muscle weakness (FITonICU): study protocol for a randomised controlled trial

Mehrholz

Thomas

Burridge

et al. 2016

Trials

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“…Over an 18-month period, 181 subjects (80% mechanically ventilated) received a total of 541 cycling sessions with trained physical therapists, with only one safety event reported (0.2% rate). 65 Functional electrical stimulation uses neuromuscular electrical stimulation to stimulate multiple groups of muscles concurrently in a functional way that mimics voluntary contraction. Functional electrical stimulation can be conducted with cycle ergometry to achieve functional electrical stimulation-assisted cycling.…”

Section: Future Directions For the Fieldmentioning

confidence: 99%

Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future

2016

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Despite the historical precedent of mobilizing critically ill patients, bed rest is common practice in ICUs worldwide, especially for mechanically ventilated patients. ICU-acquired weakness is an increasingly recognized problem, with sequelae that may last for months and years following ICU discharge. The combination of critical illness and bed rest results in substantial muscle wasting during an ICU stay. When initiated shortly after the start of mechanical ventilation, mobilization and rehabilitation can play an important role in decreasing the duration of mechanical ventilation and hospital stay and improving patients' return to functional independence. This review summarizes recent evidence supporting the safety, feasibility, and benefits of early mobilization and rehabilitation of mechanically ventilated patients and presents a brief summary of future directions for this field.

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Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review

Connolly

Salisbury

O’Neill

et al. 2016

J cachexia sarcopenia muscle

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Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise‐based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health‐related quality of life. We sought randomized controlled trials, quasi‐randomized controlled trials, and controlled clinical trials comparing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or ‘usual care’ programme in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were performed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies evaluated health‐related quality of life and neither reported differences between intervention and control groups. Meta‐analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of outcome measurements. We were unable to determine an overall effect on functional exercise capacity or health‐related quality of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited. Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis.

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Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit

Cited by 51 publications

References 23 publications

Fitness and mobility training in patients with Intensive Care Unit-acquired muscle weakness (FITonICU): study protocol for a randomised controlled trial

Fitness and mobility training in patients with Intensive Care Unit-acquired muscle weakness (FITonICU): study protocol for a randomised controlled trial

Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review

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