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Randomized Controlled Trial
. 2018 Mar;73(3):213-221.
doi: 10.1136/thoraxjnl-2016-209858. Epub 2017 Aug 5.

Intensive Versus Standard Physical Rehabilitation Therapy in the Critically Ill (EPICC): A Multicentre, Parallel-Group, Randomised Controlled Trial

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Free PMC article
Randomized Controlled Trial

Intensive Versus Standard Physical Rehabilitation Therapy in the Critically Ill (EPICC): A Multicentre, Parallel-Group, Randomised Controlled Trial

Stephen E Wright et al. Thorax. .
Free PMC article

Abstract

Background: Early physical rehabilitation in the intensive care unit (ICU) has been shown to improve short-term clinical outcomes but long-term benefit has not been proven and the optimum intensity of rehabilitation is not known.

Methods: We conducted a randomised, parallel-group, allocation-concealed, assessor-blinded, controlled trial in patients who had received at least 48 hours of invasive or non-invasive ventilation. Participants were randomised in a 1:1 ratio, stratified by admitting ICU, admission type and level of independence. The intervention group had a target of 90 min physical rehabilitation per day, the control group a target of 30 min per day (both Monday to Friday). The primary outcome was the Physical Component Summary (PCS) measure of SF-36 at 6 months.

Results: We recruited 308 participants over 34 months: 150 assigned to the intervention and 158 to the control group. The intervention group received a median (IQR) of 161 (67-273) min of physical rehabilitation on ICU compared with 86 (31-139) min in the control group. At 6 months, 62 participants in the intervention group and 54 participants in the control group contributed primary outcome data. In the intervention group, 43 had died, 11 had withdrawn and 34 were lost to follow-up, while in the control group, 56 had died, 5 had withdrawn and 43 were lost to follow-up. There was no difference in the primary outcome at 6 months, mean (SD) PCS 37 (12.2) in the intervention group and 37 (11.3) in the control group.

Conclusions: In this study, ICU-based physical rehabilitation did not appear to improve physical outcomes at 6 months compared with standard physical rehabilitation.

Trial registration number: ISRCTN 20436833.

Keywords: critical care; early mobilisation; mechanical ventilation; physiotherapy; rehabilitation.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
Physical rehabilitation time delivered per treatment day. Treatment days are defined as the number of days when the participant received physical rehabilitation on intensive care unit.
Figure 3
Figure 3
Content of physical rehabilitation sessions.
Figure 4
Figure 4
Upper and lower limb strength achieved during physical rehabilitation sessions. Oxford Scale: 0/5 no contraction; 1/5 visible/palpable muscle contraction but no movement; 2/5 movement with gravity eliminated; 3/5 movement against gravity only; 4/5 movement against gravity with some resistance; 5/5 movement against gravity with full resistance.
Figure 5
Figure 5
Mobility level achieved during physical rehabilitation sessions.
Figure 6
Figure 6
Participant survival to 6 months postrandomisation.

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