J Pediatr Intensive Care
DOI: 10.1055/s-0044-1787261
Megan Kupferschmid
1
Department of Nursing, OSF HealthCare, Peoria, Illinois, United States
,
Samantha Monk
2
OSF HealthCare, Peoria, Illinois, United States
,
Jamie Poorman
3
Department of Pediatric Intensive Care, Children's Hospital of Illinois at OSF HealthCare, Peoria, Illinois, United States
,
Jonathan Gehlbach
3
Department of Pediatric Intensive Care, Children's Hospital of Illinois at OSF HealthCare, Peoria, Illinois, United States
,
Kimberly Burkiewicz
3
Department of Pediatric Intensive Care, Children's Hospital of Illinois at OSF HealthCare, Peoria, Illinois, United States
,
LaMonica Henrekin
3
Department of Pediatric Intensive Care, Children's Hospital of Illinois at OSF HealthCare, Peoria, Illinois, United States
,
Cara Ledford
3
Department of Pediatric Intensive Care, Children's Hospital of Illinois at OSF HealthCare, Peoria, Illinois, United States
,
Maureen Welty
3
Department of Pediatric Intensive Care, Children's Hospital of Illinois at OSF HealthCare, Peoria, Illinois, United States
,
3
Department of Pediatric Intensive Care, Children's Hospital of Illinois at OSF HealthCare, Peoria, Illinois, United States
› Author Affiliations
Funding This work was supported by the Children's Hospital of Illinois Foundation Grant of $75,000 to purchase two RT Supine 300 ergometers. The device manufacturer (Restorative Technologies, Inc.) had no involvement in the study design, conduct, or analysis.
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Abstract
The primary aim of this study is to determine whether a standardized in-bed mobility protocol involving an in-bed cycle ergometer in critically ill children increases functional outcomes as measured by the Functional Status Scale (FSS) and dynamometer measurements compared with patients participating in standard rehabilitation care. The secondary aim was to compare hospital length of stay (HLOS) between the two groups. This pilot randomized controlled trial (RCT) was conducted between April 2021 and December 2022. Eligible patients were randomized to the intervention group (up to 30 minutes of daily in-bed cycle ergometer use) or the control group (standardized rehabilitation care). During the study duration, 30 patients were randomized (13 in the control group and 17 in the intervention group). The difference in whole-body muscle strength measurements (enrollment vs. completion of study) was higher in the experimental group (3.68 lbs.) compared with the control group (1.5 lbs.). However, the difference between groups was not statistically significant (p = 0.18). Both the intervention group and the control group showed similar significant improvements in the FSS scores throughout the therapy, with no difference between the two groups. There was a significant positive correlation between exercise time and change in muscle strength (r = 0.75, p = 0.002). No difference in HLOS was detected in the study. Results from this pilot RCT suggest a trend toward benefits from using in-bed cycle ergometers. These devices may be an additional modality for preserving muscle function in critically ill children. Larger multicentric studies are needed for more conclusive evidence.
Keywords
intensive care unit -
pediatric -
early mobility -
cycle ergometer -
functional outcomes
Authors' Contributions
M.K. conceived and designed the project; she obtained regulatory approval and funding. M.K. also performed patient enrollment, randomization, and measurements. She assisted in drafting the protocol and final manuscript. J.G., S.M., J.P., K.B., L.H., C.L., and M.W. assisted in study design, patient recruitment, enrollment, and measurements. S.T. supervised the design and conduct of the study. He performed statistical analysis and interpretation and drafted the initial manuscript and all revisions. All authors have reviewed the final manuscript and approved it as submitted.
Publication History
Received: 11 January 2024
Accepted: 23 April 2024
Article published online:
30 May 2024
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References
1
Stollings JL,
Balas MC,
Chanques G.
Evolution of sedation management in the intensive care unit (ICU). Intensive Care Med 2022; 48 (11) 1625-1628
2
Choong K,
Awladthani S,
Khawaji A.
et al;
Canadian Critical Care Trials Group.
Early exercise in critically ill youth and children, a preliminary evaluation: the wEECYCLE pilot trial. Pediatr Crit Care Med 2017; 18 (11) e546-e554
3
Wieczorek B,
Ascenzi J,
Kim Y.
et al.
PICU Up!: impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatr Crit Care Med 2016; 17 (12) e559-e566
4
Schweickert WD,
Pohlman MC,
Pohlman AS.
et al.
Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373 (9678) 1874-1882
5
Taito S,
Shime N,
Ota K,
Yasuda H.
Early mobilization of mechanically ventilated patients in the intensive care unit. J Intensive Care 2016; 4 (01) 50
6
Wieczorek B,
Burke C,
Al-Harbi A,
Kudchadkar SR.
Early mobilization in the pediatric intensive care unit: a systematic review. J Pediatr Intensive Care 2015; 2015 (04) 129-170
7
Kudchadkar SR,
Nelliot A,
Awojoodu R.
et al;
Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.
Physical rehabilitation in critically ill children: a multicenter point prevalence study in the United States. Crit Care Med 2020; 48 (05) 634-644
8
Ista E,
Scholefield BR,
Manning JC.
et al;
EU PARK-PICU Collaborators.
Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU). Crit Care 2020; 24 (01) 368
9
Needham DM,
Korupolu R,
Zanni JM.
et al.
Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 2010; 91 (04) 536-542
10
Fossat G,
Baudin F,
Courtes L.
et al.
Effect of in-bed leg cycling and electrical stimulation of the quadriceps on global muscle strength in critically ill adults: a randomized clinical trial. JAMA 2018; 320 (04) 368-378
11
Takaoka A,
Utgikar R,
Rochwerg B,
Cook DJ,
Kho ME.
The efficacy and safety of in-intensive care unit leg-cycle ergometry in critically ill adults. A systematic review and meta-analysis. Ann Am Thorac Soc 2020; 17 (10) 1289-1307
12
Choong K,
Chacon MDP,
Walker RG.
et al.
In-bed mobilization in critically ill children: a safety and feasibility trial. J Pediatr Intensive Care 2015; 4 (04) 225-234
13 APTA. American Physical Therapy Association. Accessed May 3, 2024 at:
https://www.apta.org/
14 AOTA. American Occupational Therapy Association. Updated March 1, 2024 . Accessed May 3, 2024 at:
https://www.aota.org/
15
Pollack MM,
Holubkov R,
Glass P.
et al;
Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.
Functional Status Scale: new pediatric outcome measure. Pediatrics 2009; 124 (01) e18-e28
16
Le-Ngoc L,
Janssen J.
Validity and reliability of a hand-held dynamometer for dynamic muscle strength assessment. Rehabil Med 2012; 4: 53-66
17 Shirley Ryan AbilityLab. Hand Held Myometry / Dynamometry | RehabMeasures Database. Updated April 28, 2016 . Accessed May 3, 2024 at:
https://www.sralab.org/rehabilitation-measures/hand-held-myometry-dynamometryhttps://www.sralab.org/rehabilitation-measures/hand-held-myometry-dynamometry#pediatric-disorders
18
Zurca AD,
Suttle ML,
October TW.
An antiracism approach to conducting, reporting, and evaluating pediatric critical care research. Pediatr Crit Care Med 2022; 23 (02) 129-132
19
Altman DG,
Schulz KF,
Moher D.
et al;
CONSORT GROUP (Consolidated Standards of Reporting Trials).
The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001; 134 (08) 663-694
20
Dumas HM,
Fragala-Pinkham MA,
Rosen EL,
Lombard KA,
Farrell C.
Pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT) and Alberta infant motor scale (AIMS): validity and responsiveness. Phys Ther 2015; 95 (11) 1559-1568
21
Burtin C,
Clerckx B,
Robbeets C.
et al.
Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009; 37 (09) 2499-2505
22
Mentiplay BF,
Perraton LG,
Bower KJ.
et al.
Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study. PLoS One 2015; 10 (10) e0140822
23
Samosawala NR,
Vaishali K,
Kalyana BC.
Measurement of muscle strength with handheld dynamometer in intensive care unit. Indian J Crit Care Med 2016; 20 (01) 21-26
24
Benfica PDA,
Aguiar LT,
Brito SAF,
Bernardino LHN,
Teixeira-Salmela LF,
Faria CDCM.
Reference values for muscle strength: a systematic review with a descriptive meta-analysis. Braz J Phys Ther 2018; 22 (05) 355-369
25
Hébert LJ,
Maltais DB,
Lepage C,
Saulnier J,
Crête M.
Hand-held dynamometry isometric torque reference values for children and adolescents. Pediatr Phys Ther 2015; 27 (04) 414-423
26
Eek MN,
Kroksmark A-K,
Beckung E.
Isometric muscle torque in children 5 to 15 years of age: normative data. Arch Phys Med Rehabil 2006; 87 (08) 1091-1099
27
Harrison PL,
Oakland T.
Adaptive Behavior Assessment System. Psychological Corporation San Antonio, TX; 2000
28
Fragala-Pinkham MA,
Dumas HM,
Lombard KA,
O'Brien JE.
Responsiveness of the pediatric evaluation of disability inventory-computer adaptive test in measuring functional outcomes for inpatient pediatric rehabilitation. J Pediatr Rehabil Med 2016; 9 (03) 215-222
29
Brewster R,
Wong M,
Magnani CJ.
et al.
Early discontinuation, results reporting, and publication of pediatric clinical trials. Pediatrics 2022; 149 (04) e2021052557
30
Pica N,
Bourgeois F.
Discontinuation and nonpublication of randomized clinical trials conducted in children. Pediatrics 2016; 138 (03) e20160223
31
Duffett M,
Choong K,
Hartling L,
Menon K,
Thabane L,
Cook DJ.
Randomized controlled trials in pediatric critical care: a scoping review. Crit Care 2013; 17 (05) R256
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