Effects of Cardiopulmonary Rehabilitation in Participants With Post-Intensive Care Syndrome.
Clinical and Functional Effects of Supervised and Unsupervised Cardiopulmonary Rehabilitation in Post-Intensive Care Syndrome: Clinical and Randomized Trial
Survivors of prolonged critical illness may develop post-intensive care syndrome, with reduced respiratory and peripheral muscle function and exercise capacity. This trial compared a home-based rehabilitation programme delivered through a self-explanatory workbook with weekly telephone monitoring against centre-based supervised rehabilitation.
The secondary objectives will be: To compare the effects of a supervised program of 12 weeks of supervised exercises and a program of self-performed home exercises, guided by an exercise booklet, of the same duration on muscle strength and peripheral resistance; Compare the effects of a 12-week supervised exercise program and a self-performed home exercise program, guided by an exercise booklet, of the same duration on health-related quality of life and functional status.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
This is a randomized, controlled, assessor-blind treatment trial with a 1:1 allocation ratio.
Participants: Patients will be recruited at the Central Hospital of the Military Police and in the specialized multidisciplinary follow-up outpatient rehabilitation center. The participants will be adults (≥18 years and ≤ 65 years), who required hospitalization and need for invasive mechanical ventilation for at least 7 days and who were discharged after, between three and six months from hospital discharge between 2023 to 2025.
Intervention and comparison:
This study will be divided into three groups: control group(standard rehabilitation), face-to-face home intervention group. Both groups will be evaluated before and after the study period. Physical functions and functional capacity will be evaluated.
After ensuring that patients meet the inclusion criteria, they will be divided into groups that will receive supervised care in a supervised Pulmonary Rehabilitation Center, with protocoled exercises, the other group will receive a booklet of self-explanatory exercises for performing the exercises in home.
The intervention groups should perform the exercises in the period of 12 weeks, 3 times a week, totaling 36 intervention sessions.
Blinding The allocation sequence was generated before the start of enrolment. The assessor who performed the baseline clinical and functional evaluation was unaware of the arm to which the participant had been allocated, because allocation was disclosed only after that evaluation had been completed and recorded. Participants then followed the allocation already generated. The physiotherapists who delivered the rehabilitation sessions applied the assigned protocol and were not informed of the outcomes under investigation or of the hypothesis of the trial, so that their conduct of the sessions could not be oriented towards any particular outcome; they could not be blinded to the modality itself, since the two programmes are delivered in different settings. The assessor who performed the 12-week evaluation was unaware of the arm to which the participant had been allocated. Participants could not be blinded to the modality they received. State whether the baseline and 12-week assessments were performed by different assessors, what measures prevented participants from revealing their allocation during the 12-week assessment, and whether the statistician was unaware of allocation during the analysis.
Data monitoring
The trial is overseen by a data monitoring committee constituted at the institution to oversee its randomized clinical trials. The committee comprises five members, none of whom is a member of the study team or takes part in recruitment, delivery of the interventions, outcome assessment or data analysis. One member is the chair of the institutional Research Ethics Committee.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Ana Carolina Sebastião da Silva
- Phone Number: +5521970084169
- Email: carol.marques_125@hotmail.com
Study Locations
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Rio de Janeiro
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Rio de Janeiro, Rio de Janeiro, Brazil, 21073-460
- Centro de Fisiatria e Reabilitação da Polícia Militar- RJ
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients who required hospitalization and required invasive mechanical ventilation for at least 7 days and who were discharged after more than seven days of intensive care, between three and six months from hospital discharge;
- Both sexes;
- Over 18 years old and under 65 years old.
Exclusion Criteria:
- Need for supplemental home oxygen;
- Motor or neurological or cognitive alteration that contraindicates the participation in the cardiopulmonary rehabilitation program.
- Persistence of clinical signs of deep vein thrombosis
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Active Comparator: Center-based rehabilitation(Control)
The face-to-face intervention group will perform pulmonary rehabilitation at the Center-based rehabilitation.
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Both programmes lasted 12 weeks, with three sessions per week and a total of 36 sessions, and both were designed to address muscle strength, muscular fatigue and functional capacity.
The centre-based protocol was developed from previously published clinical trial protocols with those objectives.
It was delivered in a dedicated outpatient clinic by a physiotherapist specialized in the programme, in groups of up to three participants, always in the morning.
Each session lasted approximately 80 to 90 minutes and comprised: warm-up on a treadmill or cycle ergometer (5 min); aerobic training on a treadmill or cycle ergometer (30 to 45 min); loaded strength and muscular-endurance training of the upper and lower limbs (30 min), addressing the muscle groups used in daily activities through frontal and lateral raises, flexion and extension, functional diagonal movements, squats, and dorsiflexion and plantar flexion, performed as three sets of each exercise with a 1-minute interval between sets:
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Active Comparator: Home-based rehabilitation (Experimental)
The home-based intervention group will carry out home intervention through a self-explanatory exercise booklet.
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The home-based protocol comprised breathing exercises, stretching, muscle strengthening, balance and aerobic training, illustrated in a booklet.
The booklet was delivered after the baseline evaluation and its execution was explained by a physiotherapist specialized in rehabilitation sciences in a face-to-face session.
Every week the same professional made telephone contact to answer questions about the training, verify the regularity of the exercises and, where necessary, give advice.
The intervention evaluated is therefore this combined package of booklet, initial instruction and weekly telephone monitoring.
All exercises were designed to be simple and of low risk, at no cost to participants, and no equipment was provided; participants were advised to exercise preferably in the morning and in comfortable clothing.
Each session lasted approximately 80 to 90 minutes and comprised: pursed-lip breathing, consisting of nasal inspiration with the mouth closed followed by expiration through
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Functional Capacity
Time Frame: 12 weeks
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By 6MWD following the ERS/ATS field walking test
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12 weeks
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Respiratory muscle function (MIP)
Time Frame: 12 weeks
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MIP will be measure according to the ATS/ERS statement on respiratory muscle testing
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12 weeks
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Peripheral muscle function
Time Frame: 12 weeks
|
Quadriceps strength will be assessed by a one-repetition-maximum (1-RM) test on an extension chair and quadriceps endurance will be assessed after 30 minutes of rest as the time for which a load corresponding to 40% of the 1-RM could be sustained isometrically until task failure (isometric endurance, in seconds)
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12 weeks
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Daily living activity
Time Frame: 12 weeks
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It will be evaluated by the Post-COVID Function Scale(PCFS)
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12 weeks
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Quality of life improvement
Time Frame: 12 weeks
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The assessment of quality of life will be carried out using a generic instrument of 36 items, validated in Brazil and called the SF-36 (Short Form Health Survey).
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12 weeks
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Ana Carolina Sebastião da Silva, Centro Universitário Augusto Motta
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- NTC20457
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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