Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program

Elliott Doug, Mckinley Sharon, Alison Jennifer, Aitken, King Madeleine, Leslie, Kenny Patricia, Taylor Penny, Foley Rachel, Burmeister, Burmeister Elizabeth

Description

Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery. Methods A multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge. Results Of the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects ( P = 0.84) or group by time interactions ( P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores. Conclusions This individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of follow-up. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention. Trial registration Australia and New Zealand Clinical Trials Register ACTRN12605000166673

Informations

• Publié par: biomed
• Publié le: 01 janvier 2011
• Nombre de lectures: 71
• Langue: English

Extrait

Elliottet al.Critical Care2011,15:R142 http://ccforum.com/content/15/3/R142

R E S E A R C H

Open Access

Healthrelated quality of life and physical recovery after a critical illness: a multicentre randomised controlled trial of a homebased physical rehabilitation program 1* 2 3 4 5 6 Doug Elliott , Sharon McKinley , Jennifer Alison , Leanne M Aitken , Madeleine King , Gavin D Leslie , 7 1 8 9 Patricia Kenny , Penny Taylor , Rachel Foley and Elizabeth Burmeister

Abstract Introduction:Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a homebased physical rehabilitation program incorporating trainer visits to participants’homes. This study was designed to test the effect of an individualised eightweek homebased physical rehabilitation program on recovery. Methods:A multicentre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four followup phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF36 physical function (PF) scale and sixminute walk test (6MWT), and healthrelated quality of life (SF36) conducted at 1, 8 and 26 weeks after hospital discharge. Results:Of the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 posthospital; for the intervention and control groups respectively, mean normbased PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects (P= 0.84) or group by time interactions (P= 0.68) for PF. Similar results were found for 6MWT and the SF36 summary scores. Conclusions:This individualised eightweek homebased physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of followup. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention. Trial registration:Australia and New Zealand Clinical Trials Register ACTRN12605000166673

* Correspondence: [e-mail] 1 Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia Full list of author information is available at the end of the article

© 2011 Elliott et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.