Characterizing usual-care physical rehabilitation in Canadian intensive care unit patients: a secondary analysis of the Canadian multicentre Critical Care Cycling to Improve Lower Extremity Strength pilot randomized controlled trial.

IF 3.4 3区医学 Q1 ANESTHESIOLOGY Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2024-10-01 Epub Date: 2024-09-24 DOI:10.1007/s12630-024-02838-7

Heather K O'Grady, Ian Ball, Sue Berney, Karen E A Burns, Deborah J Cook, Alison Fox-Robichaud, Margaret S Herridge, Timothy Karachi, Sunita Mathur, Julie C Reid, Bram Rochwerg, Thomas Rollinson, Jill C Rudkowski, Jackie Bosch, Lyn S Turkstra, Michelle E Kho

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引用次数: 0

Abstract

Purpose: Physical rehabilitation (PR) in the intensive care unit (ICU) may improve outcomes for survivors but clinical trial results have been discordant. We hypothesized that discordant results may reflect treatment heterogeneity received by "usual care" comparator groups in PR studies. Usual-care PR is typically underspecified, which is a barrier to comparing results across treatment studies. The primary objective of the present study was to describe the usual-care PR received by critically ill patients enrolled in the Canadian multicentre Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) pilot randomized controlled trial (RCT) of PR. Other objectives were to help contextualize current research and provide data for international comparison.

Methods: In this secondary analysis of the CYCLE pilot RCT, patients were randomized to in-bed cycling and usual-care PR or usual-care PR alone. Physiotherapists documented usual-care PR including therapy received, type of activity, duration, adverse events and consequences, reasons for no PR, and concurrent relevant medical interventions. We characterized usual care using descriptive statistics at the cohort and patient levels.

Results: Across seven Canadian centres, 30 patients were randomized to usual-care PR. The median [interquartile range (IQR)] ICU stay was 10 [9-24] days and patients received PR on a median [IQR] of 5 [3-9] days for 23 [17-30] min per day. Eighteen patients (60%) stood, marched, or walked during usual care. Transient adverse events occurred in three patients on 1.5% (3/198) of days and none prompted session termination.

Conclusions: In the usual-care arm of the CYCLE pilot RCT, PR was delivered on half of ICU days and over half of patients stood, marched, or walked. Adverse events during usual-care PR were uncommon.

Study registration: ClinicalTrials.gov ( NCT02377830 ); first posted 4 March 2015.

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加拿大重症监护室患者常规护理物理康复的特点：加拿大多中心重症监护室骑自行车改善下肢力量试点随机对照试验的二次分析。

目的：重症监护病房（ICU）中的物理康复（PR）可改善幸存者的预后，但临床试验结果却不一致。我们假设，不一致的结果可能反映了 PR 研究中 "常规护理 "比较组所接受的治疗的异质性。通常情况下，"常规护理 "PR 并不明确，这是比较不同治疗研究结果的一个障碍。本研究的主要目的是描述参加加拿大多中心危重症骑自行车改善下肢力量（CYCLE）试验性随机对照试验（RCT）的危重症患者所接受的惯常护理 PR。其他目的是帮助了解当前研究的背景，并为国际比较提供数据：在这项 CYCLE 试点随机对照试验的二次分析中，患者被随机分配到床上骑车和常规护理 PR 或仅常规护理 PR。物理治疗师记录了常规护理 PR 的情况，包括接受的治疗、活动类型、持续时间、不良事件和后果、未进行 PR 的原因以及同时进行的相关医疗干预。我们使用队列和患者层面的描述性统计来描述常规护理的特点：在加拿大的七个中心中，有 30 名患者随机接受了常规治疗 PR。重症监护病房的中位数[四分位距 (IQR)] 为 10 [9-24] 天，患者接受 PR 的中位数[四分位距 (IQR)] 为 5 [3-9] 天，每天 23 [17-30] 分钟。18 名患者（60%）在常规护理期间站立、行进或行走。3名患者在1.5%（3/198）的天数中发生了短暂的不良反应，但无一例导致疗程终止：结论：在 CYCLE 试验性 RCT 的常规护理组中，有一半的 ICU 日进行了 PR，超过一半的患者进行了站立、行进或步行。在常规护理公关过程中，不良事件并不常见：研究注册：ClinicalTrials.gov（NCT02377830）；2015年3月4日首次发布。

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.