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
{"title":"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。","authors":"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","doi":"10.1007/s12630-024-02838-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT02377830 ); first posted 4 March 2015.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1406-1416"},"PeriodicalIF":3.4000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"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\",\"doi\":\"10.1007/s12630-024-02838-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT02377830 ); first posted 4 March 2015.</p>\",\"PeriodicalId\":56145,\"journal\":{\"name\":\"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie\",\"volume\":\" \",\"pages\":\"1406-1416\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12630-024-02838-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12630-024-02838-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/24 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
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.
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.
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.
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