Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. (2023)

PICO

Patient/Population

Adult patients (aged >= 18 years) who were functionally independent and mechanically ventilated at baseline and within the first 96 h of mechanical ventilation, and expected to continue for at least 24 h (n=200)

Intervention

  • Early physical and occupational therapy (early mobilisation).

Comparison

  • Usual care

Outcomes

  • Cognitive impairment at 1 year (MoCA).

  • Cognitive impairment at
    hospital discharge.

  • ICU-acquired weakness at hospital discharge and 1 year.

  • Functional independence at hospital discharge and 1 year.

  • Quality of life at hospital discharge and 1 year (SF-36).

  • Institution-free days at 1 year.

Translatability:   (3/3) Easy                                    

Comments: “Early mobilisation might be the first known intervention to improve long-term cognitive impairment in ICU survivors after mechanical ventilation. These findings clearly emphasise the importance of avoiding delays in initiating mobilisation. However, the increased adverse events in the intervention group warrants further investigation to replicate these findings.”
Limitations: “its large effect size and modest sample size, it warrants replication in future work…..low rate of mobilisation in the control group. Despite our experience with early mobilisation in the ICU,10 shifting therapy to routinely occur in the early days of mechanical ventilation remained challenging in the usual care group….The screening tool for cognitive function might overestimate the prevalence of impairment; however, the high sensitivity of the MoCA test28 correspondingly indicates that the false negative rate is also comparatively low….the missing data due to loss to follow-up could bias these findings. Additionally, post-randomisation treatments, such as continued rehabilitation services, cognitive therapy, or receipt of psychoactive medications, were not measured and could alter these findings. There was also no adjustment for multiple testing. Finally, the small proportion of patients
in the intervention group who did not receive early mobilisation, coupled with the loss to follow-up, could introduce measurement bias and random despite the intention-to-treat analysis.”

Appraisals:

Trustworthiness – The study contains no serious weaknesses. Based on this result you should conclude that the trustworthiness of the study is high (90%). This means there is a 10% chance that alternative explanations for the effect found are possible. The effect size was large and 95% CI was OK. (by CAT)

Metrics and
Journal Details:

scite_ report – 

 SCOPUS CiteScore View       Resurchify Impact Score View   scite Journals View

McMaster REHAB+ View

BTB

Intervention

  • Early physical and occupational therapy (early mobilization).

Dose

  • Sessions ranged from 25 min to 30 min.  Progression of activities was dependent on patient tolerance and stability.

Periodicity

  • Daily until hospital discharge or return to the baseline level of function

Local/Technic:

Physical and occupational therapy after interruption of sedation. “Progressive mobilisation starting with range of motion and advancing to bed mobility activities, transferring to an upright position, sitting, standing, marching in place, and walking, as tolerated. Exercise and cueing (eg, being upright when sitting or handing an object to grasp) were used to stimulate command following, increase patient interaction, and increase strength and range of motion for extremities used for functional activities. While sitting, patients participated in activities of daily living and practiced functional tasks.” (complete details description).

NOTE: Must read “Prespecified criteria that precluded the initiation or continuation of the therapy session ” in the article Procedures section.

    Citation: Patel, B. K., Wolfe, K. S., Patel, S. B., Dugan, K. C., Esbrook, C. L., Pawlik, A. J., Stulberg, M., Kemple, C., Teele, M., Zeleny, E., Hedeker, D., Pohlman, A. S., Arora, V. M., Hall, J. B., & Kress, J. P. (2023). Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. The Lancet. Respiratory medicine, S2213-2600(22)00489-1. Advance online publication. https://doi.org/10.1016/S2213-2600(22)00489-1 

    Add a Comment

    Your email address will not be published. Required fields are marked *