Exercise rehabilitation for recovery from critical illness (Protocol)

Queen Margaret University, Edinburgh, UK. As part of an ongoing research education programme.This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this systematic review is to assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, on improving functional exercise capacity and quality of life in adult ICU survivors who have been mechanically ventilated for more than 24 hours. We will compare an exercise intervention to any other intervention or a control or 'usual care' programme. Exercise includes any structured or taught programmes. Respiratory or inspiratory muscle training is excluded due to it being initiated within the ICU environment, for example with weaning from a ventilator, and not as post-discharge rehabilitation as required for this review.sch_phyAngus 1997 Angus, DC. Understanding the incidence and long-term outcomes of ARDS. In: Gullo, A editor(s). Anaesthesia, pain, intensive care and emergency medicine: a scientific report. Berlin Heidelberg New York: Springer, 1997:289-98. Angus 2003 Angus DC, Carlet J, Brussels Roundtable 2002 Participants. Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Medicine 2003;29(3):368-77. [PUBMED: 12536269 ] Baumgartner 1999 Baumgartner WA,Walinsky PL, Salazar JD, Tseng EE, Brock MV, Doty JR, et al.Assessing the impact of cerebral injury after cardiac surgery: will determining the mechanism reduce the injury?. The Annals of Thoracic Surgery 1999;67(6):1871-3. [PUBMED: 10391329] Brown 1990 Brown AB, McCartney N, Sale DG. Positive adaptation to weightlifting in the elderly. Journal of Applied Physiology 1990;69(5): 1725-33. [PUBMED: 2272965] Burtin 2009 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: 19623052] Chaboyer 2003 Chaboyer W, Grace J. Following the path of ICU survivors: a quality improvement activity. Nursing in Critical Care 2003;8(4): 149-55. [PUBMED: 12940690] Eddleston 2000 Eddleston J, White P, Guthrie E. Survival, morbidity, and quality of life after discharge from intensive care. Critical Care Medicine 2000; 28(7):2293-9. [PUBMED: 10921555] Elliott 2006 Elliott D, McKinley S, Alison J, Aitken L, King M. Study protocol: Home-based rehabilitation for survivors of a critical illness. Critical Care 2006;10(3):R90. [PUBMED: 16792792 ] Fiatarone 1994 Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al.Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 1994;330(25):1769-75. [PUBMED: 8190152] Fletcher 2003 Fletcher S, Kennedy D, Ghosh I, Misra V, Kiff K, et al.Persistant neuromuscular and neurophysiological abnormalities in long-term survivors of prolonged critical illness. Critical Care Medicine 2003; 31(4):1012-6. [PUBMED: 12682465] Frank 2000 Frank M, Schlapfer H, Otte B, Yasikoff N, Conzelmann M. Results of neurorehabilitation. An outcome study 20 months after stroke. Praxis 2000;89(44):1799-808. [PUBMED: 11109917] Gill 2002 Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. New England Journal of Medicine 2002; 347(14):1068-74. [PUBMED: 12362007] Grimby 1986 Grimby G. Physical activity and muscle training in the elderly. Acta Medica Scandinavica. Supplementum. 1986;711:233-7. [PUBMED: 3535411] Guyatt 2008 Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, et al.What is quality of evidence- and why is it important to clinicians?. BMJ 2008;336:995-8. [PUBMED: 18456631] Higgins 2008 Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. Available from www.cochrane-handbook.org: The Cochrane Collaboration, 2008. Iversen 2003 Iversen MD, Fossel AH, Katz JN. Enhancing function in older adults with chronic low back pain: a pilot study of endurance training. Archives of Physical Medicine and Rehabilitation 2003;84 (9):1324-31. [PUBMED: 13680569] Jolliffe 2001 Jolliffe J, Rees K, Taylor RRS, Thompson DR, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD001800.] King 1998 King J, Crowe J. Mobilisation practices in Canadian critical care units. Physiotherapy Canada 1998;50(3):206-11. [MEDLINE: 0346574] Kouidi 2002 Kouidi E. Exercise training in dialysis patients: why, when, and how?. Artificial Organs 2002;26(12):1009-13. [PUBMED: 12460377] Krishnan 2002 Krishnan KR, Delong M, Kraemer H, Carney R, Spiegel D, Gordon C, et al.Comorbidity of depression with other medical diseases in the elderly. Biological Psychiatry 2002;52(6):559-88. [PUBMED: 12361669] Lavie 2009 Lavie CJ, Thomas RJ, Squires RW, Allison TG, Milani RV. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clinic Proceedings 2009; 84(4):373-83. [PUBMED: 19339657] Lewis 2003 Lewis M. Intensive care unit rehabilitation within the United Kingdom: a review. Physiotherapy 2003;89(9):531-8. [DOI: 10.1016/S0031-9406(05)60179-4] Martin 2005 Martin M, Salim A, Murray J, Demetriades D, Belzberg H, Rhee P. The decreasing incidence and mortality of acute respiratory distress syndrome after injury: a 5-year observational study. Journal of Trauma 2005;50(5):1107-13. [PUBMED: 16385287] Mazzeo 2001 Mazzeo RS, Tanaka H. Exercise prescription for the elderly: current recommendations. Sports Medicine 2001;31(11):809-18. [PUBMED: 11583105] Miller 2002 Miller MD, Crotty M, Giles LC, Bannerman E, Whitehead C, Cobiac L, et al.Corrected arm muscle area: an independent predictor of long-term mortality in community dwelling older adults?. Journal of the America Geriatrics Society 2002;50(7): 1272-7. [PUBMED: 12133024] Paffenbarger 1986 Paffenbarger RS, Hyde RT, Wing AL, Hseih CC. Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine 1986;314(10):605-13. [PUBMED: 3945246] Puhan 2006 Puhan MA, Busching G, Schunemann HJ, VanOort E, Zaugg C, Frey M. Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: a randomized trial. Annals of Internal Medicine 2006;145(11):816-25. [PUBMED: 17146066] Rantanen 2000 Rantanen T, Harris T, Leveille SG, Visser M, Foley D, et al.Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. Journal of Gerontology. Series A: Biological Sciences and Medical Sciences 2000;55(3):M168-73. [PUBMED: 10795731] RevMan 5.0 The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008. Schweickert 2009 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(epub):1874-82. [PUBMED: 19446324] Smith 2006 Smith TP, Kennedy SL, Smith M, Orent S, Fleshner M. Physiological improvements and health benefits during an exercisebased comprehensive rehabilitation program in medically complex patients. Exercise Immunology Review 2006;12:86-96. [PUBMED: 17201074] Stiller 2000 Stiller K. Physiotherapy in intensive care: toward an evidence-based practice. Chest 2000;118(6):1801-13. [PUBMED: 11115476] Storch 2008 Storch EK, Kruszynski DM. From rehabilitation to optimal function: role of clinical exercise therapy. Current Opinion in Critcal Care 2008;14(4):451-5. [PUBMED: 18614911] Wiles 2009 Wiles L, Stiller K. Passive limb movements for patients in an intensive care unit: A survey of physiotherapy practice in Australia. Journal of Critical Care 2009;epub:ahead of print. [PUBMED: 19819105] Yoshida 1999 Yoshida T, Kohzuki M, Yoshida K, Hiwatari M, Kamimoto M, Yamamoto C, et al.Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction. Nursing & Health Sciences 1999;1(3):163-70. [PUBMED: 10894639] Indicates the major publication for the study8pub1756pubArt.

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review

Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society of Sarcopenia, Cachexia and Wasting DisordersSkeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related quality of life. We sought randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials comparing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or ‘usual care’ programme in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were performed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies evaluated health-related quality of life and neither reported differences between intervention and control groups. Meta-analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of outcome measurements. We were unable to determine an overall effect on functional exercise capacity or health-related quality of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited. Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis

Differences in long-term physical activity trajectories among individuals with chronic widespread pain : A secondary analysis of a randomized controlled trial

Funding Sources: The MUSICIAN trial was funded by Arthritis Research UK, Chesterfield, UK (Grant award number 17292) and the MELODIC study was funded by NHS Grampian Endowment Grant, Project No: 14/40.Peer reviewedPostprin

The difference in potential harms between whole blood and component blood transfusion in major bleeding: A rapid systematic review and meta-analysis of RCTs

Our aim was to assess whether there is a difference in outcomes of potential &ldquo;all-cause&rdquo; harm in the transfusion of whole blood (WB) compared to blood components (BC) for any bleeding patient regardless of age or clinical condition. We searched multiple electronic databases using a pre-defined search strategy from inception to 2nd&nbsp;March 2021. 1 reviewer screened, extracted, and analysed data, with verification by a second reviewer of all decisions. We used Cochrane ROB1 and GRADE to assess the quality of the evidence. We used predefined subgroups of trauma and non-trauma studies in the analysis. We included six RCTs (618 participants) which compared WB and BC&nbsp;transfusion therapy&nbsp;in major bleeding, one trauma trial (n&nbsp;=&nbsp;107), and 5 surgical trials (non-trauma) (n&nbsp;=&nbsp;511). We GRADED evidence as very-low for all outcomes (downgraded for high and unclear risk of bias, small sample size, and wide confidence intervals around the estimate). Our primary outcome (all-cause mortality at 24-hours and 30-days) was reported in 3 out of 6 included trials. There was no evidence of a difference in mortality of WB compared to BC therapy (very-low certainty evidence). There may be a benefit of WB therapy compared to BC therapy in the non-trauma subgroup, with a reduction in the duration of oxygen dependence (1 study;&nbsp;n&nbsp;=&nbsp;60; mean difference 5.9 fewer hours [95% Confidence Interval [CI] -10.83, &ndash;0.99] in WB group), and a reduction in hospital stay (1 study,&nbsp;n&nbsp;=&nbsp;64, median difference 6 fewer days in WB group) (very-low certainty evidence). For the remaining outcomes (organ injury,&nbsp;mechanical ventilation&nbsp;and intensive care unit requirement, infection, arterial/venous thrombotic events, and haemolytic transfusion reaction) there was no difference between WB and BC therapy (wide CI, crossing line of no effect), though many of these outcomes were based on small single studies (very-low certainty evidence). In conclusion, there appears to be little to no difference in harms between WB and BC therapy, based on small studies with very low certainty of the evidence. Further large trials are required to establish the overall safety of WB compared to BC, and to assess differences between trauma and non-trauma patients.</p

Timing of induction of labour in the prevention of prolonged pregnancy: Systematic review with meta‐analysis

Objective To update the systematic review which informed the National Institute for Health and Care Excellence guideline “Inducing Labour” (NG207), including additional data and analyses, and comparison with a recent individual patient data analysis of 41- versus 42-week induction. Search Strategy Multiple database search (including Cochrane Central Register of Controlled Trials, MEDLINE, and Embase) from inception to 10th September 2021 for randomised controlled trials (RCTs) comparing different induction timing in uncomplicated singleton pregnancies. Data Collection and Analysis One reviewer screened, extracted, analysed, and assessed the quality/certainty of the evidence (using ROB1 and GRADE), with second reviewer verification. Main Results Five week-to-week comparisons, and one overall comparison (induction vs. delayed induction, 20 RCTs, n = 15 725 pregnant women) for assessment of predefined subgroups. Most data were for 41 versus 42 weeks and 39 versus 41 weeks: 10 times as many participants as the other week-to-week comparisons. There was evidence of an effect at 41 versus 42 weeks (five RCTs, n = 5819) in favour of 41-week induction: fewer perinatal deaths and neonatal intensive care unit admissions (low-to-moderate certainty of the evidence); there was no evidence of an effect in either direction for the remaining outcomes (very-low to moderate certainty). There was no evidence of an effect for outcomes reported for: 40 versus 42 weeks (three RCTs, n = 668, very-low to low certainty); 39 versus 42 weeks (three RCTs, n = 1103, very-low to moderate certainty); 39 versus 41 weeks (four RCTs, n = 7101, very-low to low certainty); and 41/42 versus 43/44 weeks (four RCTs, n = 954, very-low to low certainty). Conclusion The evidence supports offering induction at 41 + 0 weeks compared to 42 + 0 weeks to reduce adverse perinatal and obstetric outcomes. Practioners points 1. Evidence supports offering induction at 41 + 0 weeks compared to 42 + 0 weeks to reduce adverse perinatal outcomes in uncomplicated singleton pregnancies. 2. Other week-to-week comparisons require more data for all outcomes. 3. More data is needed for all week-to-week comparisons for women at potentially higher risk for adverse outcomes: black, Asian, and minority ethnic groups, higher body mass index (30+), older (35+ years), and women who conceived using artificial reproductive technology

Assessing efficacy and safety of replacement fluids in therapeutic plasma exchange: A systematic scoping review of outcome measures used

Objective The aim of this systematic scoping review is to identify and categorize the outcome measures that have been reported in clinical studies, where therapeutic plasma exchange (TPE) has been used as an intervention in any clinical settings, excluding thrombotic thrombocytopenic purpura (TTP). Methods We searched electronic databases using a predefined search strategy from inception to October 9, 2020. Two reviewers independently screened and extracted data. Results We included 42 studies (37 RCTs and 5 prospective cohort studies) grouped into six main categories (neurology, immunology, renal, rheumatology, hematology, and dermatology). Primary outcomes were defined in eight studies (19%, 8/42) and were categorized as efficacy (five studies) or patient reported outcomes (three studies). A power calculation was reported in six studies (75%, 6/8): five neurology studies (mainly patient reported outcomes) and a single immunological study (efficacy outcome). Disease-specific efficacy outcomes were dependent on the clinical setting of the population receiving TPE. Most of the trials (43%, 18/42) were undertaken in patients with neurology conditions where clear, disease-specific, clinical outcome measures were used, including neurological disability scales (11/18, 61%), change in neurological examination (9/18, 50%), and functional improvement scores (7/18, 39%). For other conditions, the reporting of disease-specific outcomes was poorly reported. Safety outcomes were mainly related to replacement fluid type rather than being disease-specific. The most common outcome reported was hypotension (19%, 8/42), and this was primarily in patients exchanged with albumin. Conclusion Future clinical studies to determine which fluid replacement option is most efficacious and safe should use disease-specific outcomes, as a trial in one therapeutic area may not necessarily translate to another therapeutic area. Patient reported outcomes are not universally reported for all disease areas. Safety measures focused primarily on fluid safety