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Patsaki E1, Sidiras G1, Gerovasili V1, Karatzanos E1, Mitsiou G1, Kouvarakos A1, Routsi C1, Kotanidou A1, Nanas S1
1National and Kapodistrian University of Athens, Evangelismos Hospital, 1st Critical Care Department, Athens, Greece
Background: Survival following critical illness has been associated with physical disability and reduced quality of life especially in patients that have ICU acquired weakness (ICUaW). The detrimental effects of ICUaW rise the need for examining the therapeutic approaches as rehabilitation strategies for ICUaW have not been extensively studied.
Purpose: Aim of this randomized controlled single-blinded study was to investigate the long term effects of neuromuscular electrical stimulation (NMES) and a structured in-hospital rehabilitation program on muscle strength, functional ability and quality of life in patients with ICUaW at 3 and 6 months post hospital discharge.
Methods: 878 consecutive patients, who had been discharged from a general multidisciplinary ICU were evaluated and 128 of them, 36 with ICUaW, were eligible (inclusion criteria: in mechanical ventilation> 72hours and a cognitive status that allowed assessment) for the study and were randomly assigned after stratification to the intervention (NMES group, n=17) or the control group (n=21). NMES group received daily NMES sessions and a physical rehabilitation program whereas the control group received sham NMES and usual care. The Medical Research Council (MRC) score for muscle strength and handgrip dynamometry were used for the evaluation of muscle strength. Functional ability was assessed with FIM scale and Quality of Life (QoL) with ΝHP, and SF 36 questionnaires.
Results: Three months after hospital discharge the NMES group (n=5) presented significant improvement in absolute difference of MRC (mean±SD: 32±13 vs. 18±6, p=0.01) and in ΔMRC% compared to the control (n=10) [median(25th-75th percentile): 103(55-400) vs. 47(32-59), p=0.03, respectively)]. This beneficial effect was noted and in the sum score of lower limbs in absolute values (17±7 vs. 8±3, p=0.003) and in ΔMRC%(161(59-417) vs. 35(25-52), p=0.01). At 6 months, the NMES group (n=4) tended to improve more than the control (n=8) in ΔMRC% of lower limbs (14±6 vs. 9±3, p=0.06). Hand-grip strength didn't differ between groups at all points of assessment. Functional ability and QoL didn't differ between groups 3 and 6 months post hospital discharge.
Conclusion(s): NMES and a structured rehabilitation program in patients with ICUaW had beneficial effect in muscle strength at 3 months post hospital discharge. It should be noted as limitation the small number of participants at 3 and 6 months. Future research is necessary on rehabilitation of ICU survivors as their deficiencies persist several months after ICU discharge as well as the optimal parameters of NMES.
Implications: NMES is noted to be a significant tool in rehabilitation of patients who can't follow an active form of exercise such as patients with Choric Obstructive Pulmonary Disease and Chronic Heart Failure. This study presented the beneficial effect of NMES and a structured rehabilitation program in patients with ICUaW, which is a common complication of critical illness.
Keywords: critical illness, ICUaW, rehabilitation
Funding acknowledgements: Special Account for research Grants of the National and Kapodistrian University of Athens
Purpose: Aim of this randomized controlled single-blinded study was to investigate the long term effects of neuromuscular electrical stimulation (NMES) and a structured in-hospital rehabilitation program on muscle strength, functional ability and quality of life in patients with ICUaW at 3 and 6 months post hospital discharge.
Methods: 878 consecutive patients, who had been discharged from a general multidisciplinary ICU were evaluated and 128 of them, 36 with ICUaW, were eligible (inclusion criteria: in mechanical ventilation> 72hours and a cognitive status that allowed assessment) for the study and were randomly assigned after stratification to the intervention (NMES group, n=17) or the control group (n=21). NMES group received daily NMES sessions and a physical rehabilitation program whereas the control group received sham NMES and usual care. The Medical Research Council (MRC) score for muscle strength and handgrip dynamometry were used for the evaluation of muscle strength. Functional ability was assessed with FIM scale and Quality of Life (QoL) with ΝHP, and SF 36 questionnaires.
Results: Three months after hospital discharge the NMES group (n=5) presented significant improvement in absolute difference of MRC (mean±SD: 32±13 vs. 18±6, p=0.01) and in ΔMRC% compared to the control (n=10) [median(25th-75th percentile): 103(55-400) vs. 47(32-59), p=0.03, respectively)]. This beneficial effect was noted and in the sum score of lower limbs in absolute values (17±7 vs. 8±3, p=0.003) and in ΔMRC%(161(59-417) vs. 35(25-52), p=0.01). At 6 months, the NMES group (n=4) tended to improve more than the control (n=8) in ΔMRC% of lower limbs (14±6 vs. 9±3, p=0.06). Hand-grip strength didn't differ between groups at all points of assessment. Functional ability and QoL didn't differ between groups 3 and 6 months post hospital discharge.
Conclusion(s): NMES and a structured rehabilitation program in patients with ICUaW had beneficial effect in muscle strength at 3 months post hospital discharge. It should be noted as limitation the small number of participants at 3 and 6 months. Future research is necessary on rehabilitation of ICU survivors as their deficiencies persist several months after ICU discharge as well as the optimal parameters of NMES.
Implications: NMES is noted to be a significant tool in rehabilitation of patients who can't follow an active form of exercise such as patients with Choric Obstructive Pulmonary Disease and Chronic Heart Failure. This study presented the beneficial effect of NMES and a structured rehabilitation program in patients with ICUaW, which is a common complication of critical illness.
Keywords: critical illness, ICUaW, rehabilitation
Funding acknowledgements: Special Account for research Grants of the National and Kapodistrian University of Athens
Topic: Critical care
Ethics approval required: Yes
Institution: Evangelismos Hospital
Ethics committee: Evangelismos Hospital
Ethics number: 499
All authors, affiliations and abstracts have been published as submitted.
