Teesside University, Health and Social Care Institute, Middlesbrough, UK.
Academic Department of Anaesthesia and Critical Care Medicine, James Cook University Hospital, Middlesbrough, UK.
Br J Anaesth. 2014 Jul;113(1):130-7. doi: 10.1093/bja/aeu051. Epub 2014 Mar 7.
Evidence is limited for the effectiveness of interventions for survivors of critical illness after hospital discharge. We explored the effect of an 8-week hospital-based exercise-training programme on physical fitness and quality-of-life.
In a parallel-group minimized controlled trial, patients were recruited before hospital discharge or in the intensive care follow-up clinic and enrolled 8-16 weeks after discharge. Each week, the intervention comprised two sessions of physiotherapist-led cycle ergometer exercise (30 min, moderate intensity) plus one equivalent unsupervised exercise session. The control group received usual care. The primary outcomes were the anaerobic threshold (in ml O2 kg(-1) min(-1)) and physical function and mental health (SF-36 questionnaire v.2), measured at Weeks 9 (primary time point) and 26. Outcome assessors were blinded to group assignment.
Thirty patients were allocated to the control and 29 to the intervention. For the anaerobic threshold outcome at Week 9, data were available for 17 control vs 13 intervention participants. There was a small benefit (vs control) for the anaerobic threshold of 1.8 (95% confidence interval, 0.4-3.2) ml O2 kg(-1) min(-1). This advantage was not sustained at Week 26. There was evidence for a possible beneficial effect of the intervention on self-reported physical function at Week 9 (3.4; -1.4 to 8.2 units) and on mental health at Week 26 (4.4; -2.4 to 11.2 units). These potential benefits should be examined robustly in any subsequent definitive trial.
The intervention appeared to accelerate the natural recovery process and seems feasible, but the fitness benefit was only short term.
Current Controlled Trials ISRCTN65176374 (http://www.controlled-trials.com/ISRCTN65176374).
目前有关危重病患者出院后干预措施有效性的证据有限。我们探讨了为期 8 周的基于医院的运动训练方案对身体适应性和生活质量的影响。
在一项平行组最小化对照试验中，在出院前或在重症监护随访诊所招募患者，并在出院后 8-16 周入组。每周，干预包括两次物理治疗师主导的踏车运动（30 分钟，中等强度），外加一次同等的非监督运动。对照组接受常规护理。主要结局是无氧阈（以 ml O2 kg(-1) min(-1)表示）和身体功能和心理健康（SF-36 问卷 v.2），在第 9 周（主要时间点）和第 26 周测量。结果评估者对分组分配不知情。
30 名患者被分配到对照组，29 名患者被分配到干预组。第 9 周的无氧阈结果，数据可用于 17 名对照组和 13 名干预组参与者。干预组的无氧阈有较小的改善（与对照组相比）为 1.8（95%置信区间，0.4-3.2）ml O2 kg(-1) min(-1)。这种优势在第 26 周时并未持续。干预组在第 9 周的自我报告身体功能（3.4；-1.4 至 8.2 单位）和第 26 周的心理健康（4.4；-2.4 至 11.2 单位）方面可能有有益的效果。这些潜在的益处应该在任何后续的确定性试验中进行稳健检验。
该干预似乎加速了自然恢复过程，且似乎可行，但适应性获益仅为短期。
当前对照试验 ISRCTN65176374（http://www.controlled-trials.com/ISRCTN65176374）。
