Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients

Abstract Introduction Early rehabilitation of mechanically ventilated patients is safe, feasible and beneficial to prevent ICU-AW and its consequences. However, there are no guidelines or evidence-based studies about the optimal protocol of early rehabilitation. There is traditional meta-analysis about the effect of simple protocol, such as active mobilization, neuromuscular electrical stimulation, in-bed cycling exercise, interactive video games and so on, but no studies to explore the effects of multiple protocols together. For the extensive clinical implementation, it is important to conduct a network meta-analysis to compare the effect of different protocols of early rehabilitation.Methods and analysis PubMed, Cochrane library, Web of Science, EMbase, grey literature and referent literature will be searched from inception to August 2019. Study selection, data extraction and quality assessment will be performed independently by two reviewers. The primary outcome is ICU acquired weakness (ICU-AW), secondary outcomes include the duration of mechanical ventilation and length of stay in ICU and hospital. Statistical analysis and graphical presentations will be conducted by R software (V.3.6.0). Cochrane Handbook for Systematic Reviews (V5.1.0) will be used to conduct the quality assessment. The rank possibility will be performed by the histogram. Statistical inconsistency assessment, sensitivity analysis and publication bias will be performed.Discussion This protocol is prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The protocol gives an insight into the scope and parameters for the systematic review to be carried out.Registration number PROSPERO CRD42020141901

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Construct validity of the Functional Status Score for the Intensive Care Unit: a prospective observational study using actigraphy in mechanically-ventilated patients

10.21203/rs.3.rs-17257/v1 ◽

2020 ◽

Author(s):

Agustín Camus-Molina ◽

Felipe González-Seguel ◽

Ana Cristina Castro-Ávila ◽

Jaime Leppe

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Prospective Observational Study ◽

Activity Time ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Icu Discharge ◽

Inactivity Time ◽

Ventilated Patients

Abstract Background The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a widely used instrument, designed to measure the mobility of critically ill patients that is available in English, Portuguese, Turkish and Spanish. The lack of a gold standard for measuring mobility limits the validation of outcome measures. However, actigraphy, from which measures movement intensity can be derived, is a potential alternative in the intensive care unit (ICU). Thus, this study aimed to assess the construct validity (hypotheses testing) of the FSS-ICU using continuous actigraphy from ICU admission to ICU discharge. Methods This prospective observational study included mechanically-ventilated patients selected from a 12-bed academic medical-surgical ICU. The Chilean-Spanish version of the FSS-ICU was used to evaluate its correlation with activity counts, activity time (>99 counts per minute) and inactivity time (0-99 counts per minute) measured by actigraphy ( GT9X Link ActiGraph). The FSS-ICU was assessed on awakening and at ICU discharge, while actigraphy variables were recorded from ICU admission to ICU discharge. Results Of 92 patients screened, 30 were analysed. The median FSS-ICU was 19 (IQR 10–26) points on awakening and 28.5 (IQR 22–32) at ICU discharge. There was no floor/ceiling effect of the FSS-ICU at awakening (0%/0%) and only a ceiling effect at ICU discharge that was acceptable (0%/10%). Less activity time was associated with better mobility on the FSS-ICU at both awakening (rho = -0.62, P<0.001) and ICU discharge (rho = -0.79, P<0.001). Activity counts and activity time were not correlated as expected with the FSS-ICU. Conclusions The FSS-ICU had a strong correlation with inactivity time during the ICU stay. These findings enhance the available clinimetric properties of the FSS-ICU.

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