A comparison of earlier and enhanced rehabilitation of mechanically ventilated patients in critical care compared to standard care (REHAB): study protocol for a single-site randomised controlled feasibility trial

doi:10.1186/s40814-017-0131-1

. 2017 Apr 17:3:19.

doi: 10.1186/s40814-017-0131-1. eCollection 2017.

A comparison of earlier and enhanced rehabilitation of mechanically ventilated patients in critical care compared to standard care (REHAB): study protocol for a single-site randomised controlled feasibility trial

Affiliations

¹ Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
² Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
³ Department of Statistics, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
⁴ Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Centre for Translational Inflammation Research, University of Birmingham Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
⁵ National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK.

PMID: 28428892
PMCID: PMC5393007
DOI: 10.1186/s40814-017-0131-1

A comparison of earlier and enhanced rehabilitation of mechanically ventilated patients in critical care compared to standard care (REHAB): study protocol for a single-site randomised controlled feasibility trial

Catherine Snelson et al. Pilot Feasibility Stud. 2017.

. 2017 Apr 17:3:19.

doi: 10.1186/s40814-017-0131-1. eCollection 2017.

Authors

Affiliations

¹ Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
² Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
³ Department of Statistics, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
⁴ Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Centre for Translational Inflammation Research, University of Birmingham Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
⁵ National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK.

PMID: 28428892
PMCID: PMC5393007
DOI: 10.1186/s40814-017-0131-1

Abstract

Background: Mortality from critical illness is improving, but survivors suffer from prolonged weakness and psychological and cognitive impairments. Maximising the recovery after critical illness has been highlighted as a research priority, especially in relation to an ageing population who present with higher rates of pre-morbid disability. Small studies have shown that starting rehabilitation early within the intensive care unit (ICU) improves short-term outcomes. Systematic reviews have highlighted the need for robust multicentre randomised controlled trials with longer term follow-up.

Methods: The study design is a randomised controlled study to explore the feasibility of providing earlier and enhanced rehabilitation to mechanically ventilated patients at high risk of ICU-acquired weakness within the ICU. The rehabilitation intervention involves a structured programme, with progression along a functionally based mobility protocol according to set safety criteria. The overall aim of the intervention is to commence mobilisation at an earlier time point in the patient's illness and increase mobility of the patient through their recovery trajectory. Participants will be randomised to enhanced rehabilitation or standard care, with the aim of recruiting at least 100 patients over 16 months. The trial design will assess recruitment and consent rates from eligible patients, compliance with the intervention, and assess a range of possible outcome measures for use in a definitive trial, with follow-up continuing for 12 months post hospital discharge.

Discussion: This study will evaluate the feasibility of providing an earlier and enhanced rehabilitation intervention to mechanically ventilated patients in critical care. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from this study will inform the design of a phase III multicentre trial of enhanced rehabilitation for critically ill adults.

Trial registration: ISRCTN90103222, 13/08/2015; retrospectively registered.

Keywords: Critical care; Mechanical ventilation; Physiotherapy; Rehabilitation.

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Figures

**Fig. 2**
Flow chart for earlier and enhanced rehabilitation

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References

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[1] Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502–509. doi: 10.1097/CCM.0b013e318232da75. - DOI - PubMed

[2] Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502–509. doi: 10.1097/CCM.0b013e318232da75. - DOI - PubMed

[3] Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Eng J Med. 2011;364(14):1293–1304. doi: 10.1056/NEJMoa1011802. - DOI - PubMed

[4] Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Eng J Med. 2011;364(14):1293–1304. doi: 10.1056/NEJMoa1011802. - DOI - PubMed

[5] Griffiths J, Hatch RA, Bishop J, Morgan K, Jenkinson C, Cuthbertson BH, Brett SJ. An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. Crit Care. 2013;17(3):R100. doi: 10.1186/cc12745. - DOI - PMC - PubMed

[6] Griffiths J, Hatch RA, Bishop J, Morgan K, Jenkinson C, Cuthbertson BH, Brett SJ. An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. Crit Care. 2013;17(3):R100. doi: 10.1186/cc12745. - DOI - PMC - PubMed

[7] Yende S, Austin S, Rhodes A, Finfer S, Opal S, Thompson T, et al. Long-term quality of life among survivors of severe sepsis. Crit Care Med. 2016;44(8):1461–1467. doi: 10.1097/CCM.0000000000001658. - DOI - PMC - PubMed

[8] Yende S, Austin S, Rhodes A, Finfer S, Opal S, Thompson T, et al. Long-term quality of life among survivors of severe sepsis. Crit Care Med. 2016;44(8):1461–1467. doi: 10.1097/CCM.0000000000001658. - DOI - PMC - PubMed

[9] Baldwin M. Measuring and predicting long term outcomes in older survivors of critical illness. Minerva Anaesthesiol. 2015;81:650–661. - PMC - PubMed

[10] Baldwin M. Measuring and predicting long term outcomes in older survivors of critical illness. Minerva Anaesthesiol. 2015;81:650–661. - PMC - PubMed

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A comparison of earlier and enhanced rehabilitation of mechanically ventilated patients in critical care compared to standard care (REHAB): study protocol for a single-site randomised controlled feasibility trial

Affiliations

A comparison of earlier and enhanced rehabilitation of mechanically ventilated patients in critical care compared to standard care (REHAB): study protocol for a single-site randomised controlled feasibility trial

Authors

Affiliations

Abstract

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References

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