Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up

Abstract

Introduction: The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors.

Methods: We conducted a single-center, assessor-blinded, randomized controlled trial. One hundred and fifty participants were stratified and randomized to receive usual care or intervention if they were in the ICU for 5 days or more and had no permanent neurological insult. The intervention group received intensive exercises in the ICU and the ward and as outpatients. Participants were assessed at recruitment, ICU admission, hospital discharge and at 3-, 6- and 12-month follow-up. Physical function was evaluated using the Six-Minute Walk Test (6MWT) (primary outcome), the Timed Up and Go Test and the Physical Function in ICU Test. Patient-reported outcomes were measured using the Short Form 36 Health Survey, version 2 (SF-36v2) and Assessment of Quality of Life (AQoL) Instrument. Data were analyzed using mixed models.

Results: The a priori enrollment goal was not reached. There were no between-group differences in demographic and hospital data, including acuity and length of acute hospital stay (LOS) (Acute Physiology and Chronic Health Evaluation II score: 21 vs 19; hospital LOS: 20 vs 24 days). No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12 months after ICU discharge. However, exploratory analyses showed the rate of change over time and mean between-group differences in 6MWT from first assessment were greater in the intervention group.

Conclusions: Further research examining the trajectory of improvement with rehabilitation is warranted in this population.

Trial registration: The trial was registered with the Australian New Zealand Clinical Trials Registry ACTRN12605000776606.

Figure 1

Participant flow through the trial.

Figure 2

Mean Six-Minute Walk Test (standard error) by study group calculated from model estimates. Note that the calculated population mean for this sample (ages 60 to 69 years) is 539 m. The steeper incline of the intervention group line, particularly between discharge to home and 3-month post–ICU discharge study visit, indicates a greater rate of improvement in Six-Minute Walk Test (6MWT) distance.