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. 2015 Mar 4;2015(3):CD010942.
doi: 10.1002/14651858.CD010942.pub2.

Physical rehabilitation for critical illness myopathy and neuropathy

Jan Mehrholz  1 , Marcus Pohl, Joachim Kugler, Jane Burridge, Simone Mückel, Bernhard Elsner
Affiliations

Physical rehabilitation for critical illness myopathy and neuropathy

Jan Mehrholz et al. Cochrane Database Syst Rev. .

Abstract

Background: Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living.

Objectives: Our primary objective was to assess the effects of physical rehabilitation therapies and interventions for people with CIP and CIM in improving activities of daily living such as walking, bathing, dressing and eating. Secondary objectives were to assess effects on muscle strength and quality of life, and to assess adverse effects of physical rehabilitation.

Search methods: On 16 July 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register and on 14 July 2014 we searched CENTRAL, MEDLINE, EMBASE and CINAHL Plus. In July 2014, we searched the Physiotherapy Evidence Database (PEDro, http://www.pedro.org.au/) and three trials registries for ongoing trials and further data about included studies. There were no language restrictions. We also handsearched relevant conference proceedings and screened reference lists to identify further trials.

Selection criteria: We planned to include randomised controlled trials (RCTs), quasi-RCTs and randomised controlled cross-over trials of any rehabilitation intervention in people with acquired weakness syndrome due to CIP/CIM.

Data collection and analysis: We would have extracted data, assessed the risk of bias and classified the quality of evidence for outcomes in duplicate, according to the standard procedures of The Cochrane Collaboration. Outcome data collection would have been for activities of daily living (for example, mobility, walking, transfers and self care). Secondary outcomes included muscle strength, quality of life and adverse events.

Main results: The search strategy retrieved 3587 references. After examination of titles and abstracts, we retrieved the full text of 24 potentially relevant studies. None of these studies met the inclusion criteria of our review. No data were suitable to be included in a meta-analysis.

Authors' conclusions: There are no published RCTs or quasi-RCTs that examine whether physical rehabilitation interventions improve activities of daily living for people with CIP and CIM. Large RCTs, which are feasible, need to be conducted to explore the role of physical rehabilitation interventions for people with CIP and CIM.

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Conflict of interest statement

Jan Mehrholz: none known.

Marcus Pohl: none known.

Joachim Kugler: none known.

Jane Burridge: none known.

Simone Mückel: none known.

Bernhard Elsner: none known.

Figures

1
1
Study flow diagram.
See this image and copyright information in PMC

Update of

References

References to studies excluded from this review

Ali 2008 {published data only}
    1. Ali NA, O'Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, et al. Acquired weakness, handgrip strength, and mortality in critically ill patients. American Journal of Respiratory and Critical Care Medicine 2008;178(3):261‐8. - PubMed
Angelopoulos 2013 {published data only}
    1. Angelopoulos E, Karatzanos E, Dimopoulos S, Mitsiou G, Stefanou C, Patsaki I, et al. Acute microcirculatory effects of medium frequency versus high frequency neuromuscular electrical stimulation in critically ill patients ‐ a pilot study. Annals of Intensive Care 2013;3(1):39. [PUBMED: 24355422] - PMC - PubMed
Berney 2003 {published data only}
    1. Berney S, Denehy L. The effect of physiotherapy treatment on oxygen consumption and haemodynamics in patients who are critically ill. Australian Journal of Physiotherapy 2003;49(2):99‐105. - PubMed
Brummel 2014 {published data only}
    1. Brummel NE, Girard TD, Ely EW, Pandharipande PP, Morandi A, Hughes CG, et al. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT‐ICU) trial. Intensive Care Medicine 2014;40(3):370‐9. [PUBMED: 24257969] - PMC - PubMed
Burtin 2009 {published data only}
    1. Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, et al. Early exercise in critically ill patients enhances short‐term functional recovery. Critical Care Medicine 2009;37(9):2499‐505. - PubMed
Caruso 2005 {published data only}
    1. Caruso P, Denari SD, Ruiz SA, Bernal KG, Manfrin GM, Friedrich C. Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients. Clinics (Sao Paulo) 2005;60(6):479‐84. - PubMed
Delany 2003 {published data only}
    1. Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Diseases of the Colon and Rectum 2003;46(7):851‐9. - PubMed
Denehy 2013 {published data only}
    1. Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow‐up. Critical Care 2013;17(4):R156. - PMC - PubMed
Derde 2012 {published data only}
    1. Derde S, Hermans G, Derese I, Güiza F, Hedström Y, Wouters PJ. Muscle atrophy and preferential loss of myosin in prolonged critically ill patients. Critical Care Medicine 2012;40(1):79‐89. - PubMed
Gerovasili 2009 {published data only}
    1. Gerovasili V, Stefanidis K, Vitzilaios K, Karatzanos E, Politis P, Koroneos A, et al. Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study. Critical Care (London, England) 2009;13(5):R161. [PUBMED: 19814793] - PMC - PubMed
    1. Karatzanos E, Gerovasili V, Zervakis D, Tripodaki E‐S, Apostolou K, Vasileiadis I, et al. Electrical muscle stimulation: an effective form of exercise and early mobilization to preserve muscle strength in critically ill patients. Critical Care Research & Practice 2012; Vol. 2012:432752. [PUBMED: 22545212] - PMC - PubMed
Gruther 2010 {published data only}
    1. Gruther W, Kainberger F, Fialka‐Moser V, Paternostro‐Sluga T, Quittan M, Spiss C, et al. Effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients: a pilot study. Journal of Rehabilitation Medicine 2010;42(6):593‐7. [1650‐1977] - PubMed
Guerin 2004 {published data only}
    1. Guerin C, Gaillard S, Lemasson S, Ayzac L, Girard R, Beuret P, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA 2004;292(19):2379‐87. - PubMed
Jackson 2012 {published data only}
    1. Jackson J, Ely EW, Morey MC, Anderson VM, Denne LB, Clune J, et al. Cognitive and physical rehabilitation of ICU survivors: results of the RETURN randomized, controlled pilot investigation. Critical Care Medicine 2012;40(4):1088–97. - PMC - PubMed
Kho 2012 {published data only}
    1. Kho ME, Truong AD, Brower RG, Palmer JB, Fan E, Needham DM. Neuromuscular electrical stimulation for intensive care unit‐acquired weakness: protocol and methodological implications for a randomized, sham‐controlled, phase II trial. Physical Therapy 2012;92(12):1564‐79. - PMC - PubMed
Meesen 2010 {published data only}
    1. Meesen RL, Dendale P, Cuypers K, Berger J, Hermans A, Thijs H, et al. Neuromuscular electrical stimulation as a possible means to prevent muscle tissue wasting in artificially ventilated and sedated patients in the intensive care unit: A pilot study. Neuromodulation 2010;13(4):315‐20. - PubMed
Muehling 2008 {published data only}
    1. Muehling BM, Halter G, Lang G, Schelzig H, Steffen P, Wagner F, et al. Prospective randomized controlled trial to evaluate "fast‐track" elective open infrarenal aneurysm repair. Langenbecks Archiv fur Chirurgie 2008;393(3):281‐7. [1435‐2451: (Electronic)] - PubMed
Muehling 2009 {published data only}
    1. Muehling B, Schelzig H, Steffen P, Meierhenrich R, Sunder‐Plassmann L, Orend KH. A prospective randomized trial comparing traditional and fast‐track patient care in elective open infrarenal aneurysm repair. World Journal of Surgery. 2009/01/13 2009; Vol. 33, issue 3:577‐85. [0364‐2313: (Print)] - PubMed
Nava 1998 {published data only}
    1. Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Archives of Physical Medicine Rehabilitation 1998;79(7):849‐54. - PubMed
Parry 2012 {published data only}
    1. Parry SM, Berney S, Koopman R, Bryant A, El‐Ansary D, Denehy L. Early rehabilitation in critical care (eRiCC): functional electrical stimulation with cycling protocol for a randomised controlled trial. BMJ Open 2012;2(5):e001891. - PMC - PubMed
Porta 2005 {published data only}
    1. Porta R, Vitacca M, Gilè LS, Clini E, Bianchi L, Zanotti E, et al. Supported arm training in patients recently weaned from mechanical ventilation. Chest 2005;128(4):2511‐20. [0012‐3692] - PubMed
Poulsen 2011 {published data only}
    1. Poulsen JB, Møller K, Jensen CV, Weisdorf S, Kehlet H, Perner A. Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock. Critical Care Medicine 2011;39(3):456‐61. - PubMed
Routsi 2010 {published data only}
    1. Routsi C, Gerovasili V, Vasileiadis I, Karatzanos E, Pitsolis T, Nanas S. Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial. Critical Care 2010;14(2):R74. - PMC - PubMed
Schweickert 2009 {published data only}
    1. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373(9678):1874‐82. [PUBMED: 19446324] - PMC - PubMed
Troosters 2010 {published data only}
    1. Troosters T, Probst VS, Crul T, Pitta F, Gayan‐Ramirez G, Decramer M. Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 2010;181(10):1072‐7. - PubMed
Zanotti 2003 {published data only}
    1. Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed‐bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest 2003;124(1):292‐6. - PubMed

Additional references

Adler 2012
    1. Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary Physical Therapy Journal 2012;23(1):5‐13. - PMC - PubMed
Bemis‐Dougherty 2012
    1. Bemis‐Dougherty AR, Smith JM. What follows survival of critical illness? Physical therapists' management of patients with post‐intensive care syndrome. Physical Therapy 2013;93(2):179‐85. - PubMed
Bercker 2005
    1. Bercker S, Weber‐Carstens S, Deja M, Grimm C, Kaisers U. Critical illness polyneuropathy and myopathy in patients with acute respiratory distress syndrome. Critical Care Medicine 2005;33(4):711‐5. - PubMed
Berney 2012
    1. Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Physical Therapy 2012;92(12):1524‐35. - PubMed
Bolton 2005
    1. Bolton CF. Neuromuscular manifestations of critical illness. Muscle & Nerve 2005;32(2):140‐63. - PubMed
Connolly 2012
    1. Connolly B, Denehy L, Brett S, Elliott D, Hart N. Exercise rehabilitation following hospital discharge in survivors of critical illness: an integrative review. Critical Care 2012;16(3):226. - PMC - PubMed
Denehy 2008
    1. Denehy L, Berney S, Skinner E, Edbrooke L, Warrillow S, Hawthorne G, et al. Evaluation of exercise rehabilitation for survivors of intensive care: protocol for single blind randomised controlled trial. Open Critical Care Medicine Journal 2008;1:39‐47.
Dodds 1993
    1. Dodds TA, Martin DP, Stolov WC, Deyo RA. A validation of the functional independence measurement and its performance among rehabilitation inpatients. Archives of Physical Medicine and Rehabilitation 1993;74(5):531‐6. - PubMed
Doherty 2010
    1. Doherty N, Steen CD. Critical illness polyneuromyopathy (CIPNM); rehabilitation during critical illness. Therapeutic options in nursing to promote recovery: a review of the literature. Intensive and Critical Care Nursing 2010;26(6):353‐62. - PubMed
Fan 2012
    1. Fan E. Critical illness neuromyopathy and the role of physical therapy and rehabilitation in critically ill patients. Respiratory Care 2012;57(6):933‐44; discussion 944‐6. - PubMed
GRADEpro 2014 [Computer program]
    1. Jan Brozek, Andrew Oxman, Holger Schünemann. GRADEpro. Version 3.2 for Windows. Jan Brozek, Andrew Oxman, Holger Schünemann, 2008.
Hanekom 2011
    1. Hanekom S, Gosselink R, Dean E, Aswegen H, Roos R, Ambrosino N, et al. The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice. Clinical Rehabilitation 2011;25(9):771‐87. - PubMed
Hermans 2008
    1. Hermans G, Jonghe B, Bruyninckx F, Berghe G. Clinical review: critical illness polyneuropathy and myopathy. Critical Care 2008;12(6):238. - PMC - PubMed
Hermans 2014
    1. Hermans G, Jonghe B, Bruyninckx F, Berghe G. Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD006832.pub3] - DOI - PMC - PubMed
Herridge 2011
    1. Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz‐Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. New England Journal of Medicine 2011;364(14):1293‐304. - PubMed
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011a
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011b
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011c
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 16: Special topics in statistics. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Kaarlola 2006
    1. Kaarlola A, Tallgren M, Pettilä V. Long‐term survival, quality of life, and quality‐adjusted life‐years among critically ill elderly patients. Critical Care Medicine 2006;34(8):2120‐6. - PubMed
Kayambu 2013
    1. Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta‐analysis. Critical Care Medicine 2013;41(6):1543‐54. - PubMed
Koo 2013
    1. Koo KKY, Fan E. ICU‐acquired weakness and early rehabilitation in the critically ill. Journal of Clinical Outcomes Management 2013;20(5):223‐31.
Lacomis 2000
    1. Lacomis D, Zochodne DW, Bird SJ. Critical illness myopathy. Muscle & Nerve 2000;23(12):1785‐8. - PubMed
Latronico 2011
    1. Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurology 2011;10(10):931‐41. - PubMed
Mahoney 1965
    1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Maryland State Medical Journal 1965;14:61‐5. - PubMed
Mehlhorn 2014
    1. Mehlhorn J, Freytag A, Schmidt K, Brunkhorst FM, Graf J, Troitzsch U, et al. Rehabilitation interventions for postintensive care syndrome: a systematic review. Critical Care Medicine 2014;42(5):1263‐71. - PubMed
Mehrholz 2014b
    1. Mehrholz J, Mückel S, Oehmichen F, Pohl M. The General Weakness Syndrome Therapy (GymNAST) study: protocol for a cohort study on recovery on walking function. BMJ Open 2014;4(10):e006168. - PMC - PubMed
Nordon‐Craft 2012
    1. Nordon‐Craft A, Moss M, Quan D, Schenkman M. Intensive care unit‐acquired weakness: implications for physical therapist management. Physical Therapy 2012;92(12):1494‐506. - PMC - PubMed
Ohtake 2012
    1. Ohtake PJ, Strasser DC, Needham DM. Rehabilitation for people with critical illness: taking the next steps. Physical Therapy 2012;92(12):1484‐8. Erratum in Physical Therapy 2013;93(2):282. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Roach 1988
    1. Roach KE, Dillen LR. Development of an acute care index of functional status for patients with neurologic impairment. Physical Therapy 1988;68(7):1102‐8. - PubMed
Skinner 2009
    1. Skinner EH, Berney S, Warrillow S, Denehy L. Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Critical Care and Resuscitation 2009;11(2):110‐5. - PubMed
Skinner 2011
    1. Skinner EH, Warrillow S, Denehy L. Health‐related quality of life in Australian survivors of critical illness. Critical Care Medicine 2011;39(8):1896‐905. - PubMed
Stevens 2007
    1. Stevens RD, Dowdy DW, Michaels RK, Mendez‐Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Medicine 2007;33(11):1876‐91. - PubMed
Zanni 2010
    1. Zanni JM, Korupolu R, Fan E, Pradhan P, Janjua K, Palmer JB, et al. Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. Journal of Critical Care 2010;25(2):254‐62. - PubMed

References to other published versions of this review

Mehrholz 2014a
    1. Mehrholz J, Pohl M, Kugler J, Burridge J, Mückel S. Physical rehabilitation for critical illness myopathy and neuropathy. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD010942] - DOI - PMC - PubMed

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