Progressive mobility program and technology to increase the level of physical activity and its benefits in respiratory, muscular system, and functionality of ICU patients: study protocol for a randomized controlled trial

Abstract

BackgroundEnhanced mobility in the Intensive Care Unit (ICU) could minimize the negative effects of critical illness, such as declines in cognitive, muscular, respiratory, and functional capacity. We aim to compare the functional status at ICU discharge of patients who underwent a progressive mobilization protocol versus patients who received conventional physiotherapy. We also examine the level of physical activity in the ICU, the degree of pulmonary and muscle function, and the length of stay to analyze correlations between these variables.MethodsThis is a protocol for a randomized controlled trial with blind evaluation. Ninety-six ICU patients will be recruited from a single center and randomly assigned to a control group or an intervention group. To determine the level of protocol activity the patient will receive, the patients’ ability to participate actively and their muscle strength will be considered. The protocol consists of five phases, ranging from passive therapies to walking and climbing stairs. The primary outcome will be the functional status at ICU discharge, measured with the Barthel Index and the ICU Mobility Scale (IMS). Measured secondary outcomes will include the level of physical activity, maximal inspiratory and expiratory pressures, forced expiratory volume in 1 second, maximum voluntary ventilation, handgrip strength, surface electromyography of the lower limb muscles, and results of the Timed Up and Go and 2-Minute Walk tests. Evaluations will be made within 2 days of ICU discharge except for the level of activity, which will be evaluated daily. Physiological variables and activity level will be analyzed by chi-square and t tests, according to the intention-to-treat paradigm.DiscussionMobility and exercise in the ICU should be undertaken with intensity, quantity, duration, and frequency adjusted according to the patients’ status. The results of this study may contribute to new knowledge of early mobility in the ICU, activity level, and varying benefits in critical patients, directing new approaches to physiotherapeutic interventions in these patients.Trial registrationRecruitment will begin in February 2017, and the expected completion date is August 2018. Patients are already being recruited.ClinicalTrials.gov, ID: NCT02889146. Registered on 3 March 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2641-4) contains supplementary material, which is available to authorized users.

Skeletal Muscle Wasting and Function Impairment in Intensive Care Patients With Severe COVID-19

“…This improvement can be explained by the clinical course of the COVID-19 and increased mobility of these patients. Corroborating our results, Schujmann et al (2018) , showed that mobility and exercise improve respiratory function in critically ill patients, besides the favorable clinical course. It is important to note that the ICU where the data were collected in the current study presents a structured early mobilization guideline ( Murakami et al, 2015 ).…”

Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings – Results of an expert consensus and feasibility field test

“…Higher scores indicate worse PTSD symptoms. the physical function domain are also supported by feasibility of TUG, 110,111 handgrip strength, [111][112][113] 6-MWT, 110 and SPPB 114 in patients of acute ICU settings, as well as currently running clinical trials in critical care patients with TUG, 115 handgrip strength 115,116 and 2-MWT 105 as outcomes.…”

“…Lower scores indicate higher impairment EQ-5D-5L 47,48 a PICS domain: Health-related quality of life (HRQoL) Outcomes/subdomains: Mobility, self-care, usual activities, pain/discomfort, anxiety/depression, general subjective health Instrument: Brief self-report questionnaire of generic HRQoL; six items; time frame: today. EQ-5D-5L descriptive system has 5 items (1 item per subdomain), with 5-point scales from 1 to 5; generic subjective health rating with 1 additional single item, in form of a thermometer scale from 0 to 100; single index value for general health state can be calculated Cut-off score not available EQ-5D descriptive system: Higher scores indicate higher impairment EQ-5D subjective health rating: Lower scores indicate higher impairment the physical function domain are also supported by feasibility of TUG, 110,111 handgrip strength, [111][112][113] 6-MWT, 110 and SPPB 114 in patients of acute ICU settings, as well as currently running clinical trials in critical care patients with TUG, 115 handgrip strength 115,116 and 2-MWT 105 as outcomes.…”

Percieved barriers to early progressive mobilization in the ICU: Multidisciplinary perspectives in an underserved population

“…EPM has demonstrated many benefits across the literature including reduction in healthcare costs, improved functional status at discharge and overall minimizing negative effects of critical illness. [24] One of the most well studied benefits is that of improved functional mobility at discharge. [8,25] Patients who are initiated with EPM in the first 72 hours of critical illness experience improved physical function on discharge.…”