Elwadhi Aman, Panda Prateek Kumar, Tyagi Amit Kumar, Neyaz Osama, Kaur Amanjot, Tiwari Lokesh Kumar, Sharawat Indar Kumar
Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Neurocrit Care. 2025 Sep 4. doi: 10.1007/s12028-025-02357-3.
An early protocolized rehabilitation (EPR) program has the potential to improve functional outcomes in pediatric neurocritical care patients in the pediatric intensive care unit over standard care alone. However, this requires validation through a randomized controlled trial (RCT).
This single-blind, parallel-design, two-arm RCT evaluated the efficacy of EPR in improving functional outcomes at 24 weeks in pediatric neurocritical patients aged 1-18 years compared to usual care. The study also aimed to compare adaptive function, gross motor function, language skills, cognition, behavioral issues, sleep patterns, quality of life, and family functional outcomes between the two groups. EPR was initiated within 72 h of mechanical ventilation and was customized for each patient by a team of specialists in pediatric neurology, physical medicine and rehabilitation, and speech and language pathology. Rehabilitation sessions were conducted daily for one week, then three times a week for one month, and monthly after discharge, supplemented with weekly teleconsultations.
A total of 196 patients were enrolled (98 in each arm). At 24 weeks, the Pediatric Cerebral Performance Category score was significantly better in the intervention arm (mean difference 0.133 [95% confidence interval 0.055-0.205], p < 0.001). Additionally, improvements were noted in the EPR arm across Child Behavior Checklist, Vineland Adaptive Behavior Scale, Children's Sleep Habits Questionnaire, Pediatric Quality of Life Inventory, and Family Assessment Device scores (p < 0.001 for all).
EPR in pediatric neurocritical patients significantly improves functional outcomes and quality of life at 24 weeks compared to usual care.
早期标准化康复（EPR）方案有可能比单纯的标准护理更能改善儿科重症监护病房中儿科神经重症监护患者的功能结局。然而，这需要通过随机对照试验（RCT）进行验证。
这项单盲、平行设计、双臂RCT评估了EPR与常规护理相比，在改善1至18岁儿科神经重症患者24周时功能结局方面的疗效。该研究还旨在比较两组之间的适应性功能、粗大运动功能、语言技能、认知、行为问题、睡眠模式、生活质量和家庭功能结局。EPR在机械通气72小时内启动，由儿科神经学、物理医学与康复以及言语和语言病理学专家团队为每位患者量身定制。康复治疗每周进行7天，持续1周，然后每周进行3次，持续1个月，出院后每月进行1次，并辅以每周的远程会诊。
共纳入196例患者（每组98例）。在24周时，干预组的儿科脑功能表现类别评分显著更好（平均差异0.133 [95%置信区间0.055 - 0.205]，p < 0.001）。此外，EPR组在儿童行为检查表、文兰适应行为量表、儿童睡眠习惯问卷、儿科生活质量量表和家庭评估量表评分方面均有改善（所有p < 0.001）。
与常规护理相比，儿科神经重症患者的EPR在24周时显著改善了功能结局和生活质量。
