Physical function after ICU did not improve with cycling plus usual physiotherapy

Key takeaways:

• On the third day following ICU discharge, researchers collected the Physical Function Test for ICU-scored measure.
• No patients had unplanned extubation, cardiac arrest or fall to the knees.

Mechanically ventilated adults receiving in-bed cycling plus usual physiotherapy had similar physical function after ICU discharge to those receiving only usual physiotherapy, according to results published in NEJM Evidence.

“We studied cycling because it is an intervention that can overcome two commonly reported patient-level barriers to starting early rehabilitation activities in the ICU at the time of trial design: invasive mechanical ventilation and sedation,” Michelle E. Kho, PT, PhD, associate professor in the School of Rehabilitation Science at McMaster University, and colleagues wrote.

In the international, open-label, multicenter, randomized controlled CYCLE trial, Kho and colleagues analyzed 360 mechanically ventilated adults (mean age, 61.5 years; 43.1% women) in the ICU to find out how the Physical Function ICU Test-scored (PFIT-s) measure differs among those receiving 30 minutes of early in-bed cycling plus usual physiotherapy (n = 178; mean age, 61.8 years; 42.1% women) vs. those receiving only usual physiotherapy (n = 182; mean age, 61.2 years; 44% women).

This outcome was collected on the third day following ICU discharge, and high scores on the PFIT-s scale (0-10) signaled better physical function, according to researchers.

A high proportion of patients received at least one session in the cycling plus usual physiotherapy group (88.8%), and this was also the case when switching to the usual physiotherapy only group (94%).

Shortly after the start of invasive mechanical ventilation (median, 2 days), patients began cycling (if applicable) and usual physiotherapy.

The average amount of time spent cycling across three sessions was 27.2 minutes, and the average amount of time spent doing usual physiotherapy per day across four sessions differed based on the group. Those receiving only usual physiotherapy had longer daily usual physiotherapy sessions vs. those receiving cycling plus usual physiotherapy (29.1 minutes vs. 23.7 minutes).

Both survivors from the cycling plus usual physiotherapy group and the usual physiotherapy group (total n = 294) had similar PFIT-s when evaluated 3 days after ICU discharge (7.7 vs. 7.5), according to researchers.

Other comparable outcomes between those receiving cycling plus usual physiotherapy and those receiving only usual physiotherapy included median length of mechanical ventilation (5 days vs. 5.5 days), ICU stay (11 days vs. 11 days) and hospitalization (21.5 days vs. 21 days).

Those receiving both cycling plus usual physiotherapy faced a slightly lower risk for ICU death (HR = 0.84; 95% CI, 0.51-1.39) and hospital death (HR = 0.92; 95% CI, 0.59-1.44) than those only receiving usual physiotherapy.

Researchers also observed slightly better measures in the cycling plus usual physiotherapy group vs. the usual physiotherapy group in several outcomes at hospital discharge: median number of 30-second sit-to-stand repetitions (8 vs. 7), median 2-minute walk distance (73.2 m vs. 67 m), ICU Patient-Reported Functional Score (8.2 vs. 7.5) and Clinical Frailty Scale Score (4.5 vs. 4.9).

In terms of safety, no patients had unplanned extubation, cardiac arrest or fall to the knees, which were classified as serious adverse events, but slightly more patients receiving cycling plus usual physiotherapy vs. only usual physiotherapy reported an adverse event (9.2%; n = 16 vs. 5.8%; n = 10).

“No adverse events occurred in over 90% of patients and during over 98% of sessions (cycling or routine physiotherapy),” Kho and colleagues wrote.