Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
Phys Ther. 2012 Dec;92(12):1580-92. doi: 10.2522/ptj.20110414. Epub 2012 May 10.
In the coming years, the number of survivors of critical illness is expected to increase. These survivors frequently develop newly acquired physical and cognitive impairments. Long-term cognitive impairment is common following critical illness and has dramatic effects on patients' abilities to function autonomously. Neuromuscular weakness affects similar proportions of patients and leads to equally profound life alterations. As knowledge of these short-term and long-term consequences of critical illness has come to light, interventions to prevent and rehabilitate these devastating consequences have been sought. Physical rehabilitation has been shown to improve functional outcomes in people who are critically ill, but subsequent studies of physical rehabilitation after hospital discharge have not. Post-hospital discharge cognitive rehabilitation is feasible in survivors of critical illness and is commonly used in people with other forms of acquired brain injury. The feasibility of early cognitive therapy in people who are critically ill remains unknown.
The purpose of this novel protocol trial will be to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units.
This is a randomized controlled trial.
The setting for this trial will be medical and surgical intensive care units of a large tertiary care referral center.
The participants will be patients who are critically ill with respiratory failure or shock.
Patients will be randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be performed with patients who are noncomatose and will consist of orientation, memory, and attention exercises (eg, forward and reverse digit spans, matrix puzzles, letter-number sequences, pattern recognition). Daily physical rehabilitation sessions will advance patients from passive range of motion exercises through ambulation. Patients with cognitive or physical impairment at discharge will undergo a 12-week, in-home cognitive rehabilitation program.
A battery of neurocognitive and functional outcomes will be measured 3 and 12 months after hospital discharge.
If feasible, these interventions will lay the groundwork for a larger, multicenter trial to determine their efficacy.
预计在未来几年，危重病幸存者的数量将会增加。这些幸存者经常出现新获得的身体和认知障碍。重症后长期认知障碍很常见，对患者的自主功能能力有重大影响。神经肌肉无力影响相似比例的患者，并导致同样深刻的生活改变。随着对这些重症短期和长期后果的认识不断提高，人们一直在寻求预防和康复这些破坏性后果的干预措施。身体康复已被证明可以改善重症患者的功能结局，但随后对出院后身体康复的研究并未显示出改善。在重症后幸存者中，认知康复是可行的，并且在其他形式的获得性脑损伤中也经常使用。在重症患者中早期认知治疗的可行性仍不清楚。
本新型方案试验的目的将是确定对来自内科和外科重症监护病房的重症患者进行早期和持续的认知康复与身体康复相结合的可行性。
这是一项随机对照试验。
该试验的地点将是一家大型三级转诊中心的内科和外科重症监护病房。
参与者将是患有呼吸衰竭或休克的重症患者。
患者将被随机分配到接受常规护理、身体康复或认知康复加身体康复的组。对于非昏迷患者，将每天进行两次认知康复治疗，包括定向、记忆和注意力练习（例如，顺背和倒背数字、矩阵拼图、字母数字序列、模式识别）。每天进行身体康复治疗，将患者从被动运动范围练习推进到步行。出院时存在认知或身体障碍的患者将接受为期 12 周的家庭认知康复计划。
将在出院后 3 个月和 12 个月测量一系列神经认知和功能结局。
如果可行，这些干预措施将为更大规模的多中心试验奠定基础，以确定其疗效。
