Aitken, L. M.

Barnett, A.

McPhail, S.

Nickels, M.

Walsham, J.

English

City Research Online

              City, University of London Institutional RepositoryCitation: Nickels, M., Aitken, L. M. ORCID: 0000-0001-5722-9090, Walsham, J., Barnett, A. and McPhail, S. (2019). Early in-bed cycling versus usual care in the ICU on muscle atrophy and mobility: A randomized trial. Critical Care Medicine, 47(1), p. 47. This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link:  https://openaccess.city.ac.uk/id/eprint/23421/Link to published version: Copyright and reuse: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to.City Research Online:            http://openaccess.city.ac.uk/            publications@city.ac.ukCity Research OnlineMarc Nickels1,2,3, Leanne Aitken4,5,6, James Walsham6,7, Adrian Barnett2, Steven McPhail2,3 1 Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia, 2 Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Brisbane, Australia,  3 Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia,  4 School of Health Sciences, City, University of London, London, United Kingdom,  5 Menzies Health Institute Queensland, Griffith University, Brisbane, Australia,  6 Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia,  7 School of Medicine, University of Queensland, Brisbane, Australia  Learning Objectives: Critically ill patients lose large amounts of skeletal muscle early during their ICU admission. This muscle loss is associated with the development of weakness and functional impairments. In-bed cycling initiated early in an ICU admission may reduce muscle atrophy, maintain muscle strength and promote recovery of mobility. Methods:  A two-arm (blinded assessment) randomized controlled trial (RCT) compared usual care versus early in-bed cycling (in addition to usual care). The setting was a tertiary mixed medical, surgical, trauma ICU. Participants included adult patients with expected duration of mechanical ventilation >48 hours. All participants received usual care while patients randomized to the intervention group received an additional daily intervention of 30 minutes of in-bed cycling. In-bed cycling participants were encouraged to cycle actively whenever possible whilst pre-specified safety parameters were observed. The in-bed cycling sessions could be passive, machine-assisted or active. The primary outcome was rectus femoris cross sectional area (RFCSA) measured by ultrasound (blinded ultrasonographers) at: Baseline, Days 3, 7, 10 (primary) post-study enrollment, as well as 7 days post-discharge from ICU. Other outcomes included manual muscle strength assessed by the Medical Research Council (MRC) Sum Score and distance in meters walked during the 6-minute walk test (6MWT) 7 days post-discharge from ICU. Results:  Seventy-four participants (mean (SD) age = 56 (17), 69% male) were recruited. There was a difference of 4% in median RFCSA atrophy at Day 10 (primary outcome) favoring the intervention group. Participants in the in-bed cycling group (n = 37) had a median (IQR) percent of RFCSA atrophy of -9.4% (-23.2%, 0.8%) in comparison to usual care participants (n = 37) -13.2% (-26.4%, -2.9%). During the 6MWT the in-bed cycling group walked median (IQR) 258 meters (30, 326) versus usual care participants median (IQR) 210 meters (25, 318). The median (IQR) MRC Sum Score 7-days post ICU discharge was similar in the intervention 58 (54, 60) and usual care 57 (53, 59) groups. Conclusions:  Outcomes following this pilot trial of daily in-bed cycling in addition to usual care were encouraging. In-bed cycling may reduce muscle atrophy and improve mobility post-critical illness. Further investigation in a larger multi-center RCT is warranted.  

Early in-bed cycling versus usual care in the ICU on muscle atrophy and mobility: A randomized trial

Nickels, Marc

Aitken, Leanne

Walsham, James

Barnett, Adrian

McPhail, Steven

University of Queensland eSpace

EARLY IN-BED CYCLING VERSUS USUAL CARE IN THE ICU ON MUSCLE ATROPHY AND MOBILITY: A RANDOMIZED TRIAL

https://openaccess.city.ac.uk/id/eprint/23421/1/SCCM%20abstract%20final_20180801_with%20authors.pdf

Early in-bed cycling versus usual care in the ICU on muscle atrophy and mobility: A randomized trial

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