Remote Exercise Program for Pediatric ICU Survivors
Feasibility Study of a Remote Exercise Intervention Program for Preventing Post-Intensive Care Syndrome in Pediatric Critical Illness Survivors
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Pediatric survivors of critical illness are at risk of developing pediatric post-intensive care syndrome (PICS-p), which includes physical, cognitive, emotional, and social impairments that may persist after discharge from the pediatric intensive care unit (PICU). Although early rehabilitation is recognized as an important strategy for improving recovery, sustained rehabilitation after hospital discharge remains challenging because of barriers such as repeated hospital visits and limited accessibility.
The purpose of this single-arm pilot clinical trial is to evaluate the feasibility and safety of a remote exercise intervention program for children at risk of PICS-p after PICU discharge and to generate preliminary data for a future confirmatory clinical trial.
Eligible participants are children aged 3 to 18 years who received treatment in the PICU for at least 48 hours and have not recovered to their pre-admission functional status. Participants will receive an individualized home-based exercise program consisting of remotely supervised exercise sessions, prescribed self-exercise using instructional video content, and weekly monitoring and feedback through videoconferencing.
The intervention will be delivered over 12 weeks. Outcome assessments will be conducted after PICU discharge (baseline), immediately before intervention initiation, monthly during the intervention, and 1 month after completion of the intervention to evaluate maintenance of treatment effects.
The primary outcomes include feasibility and safety, including adherence, completion rate, user satisfaction, adverse events, and reasons for discontinuation. Secondary outcomes include exploratory changes in physical function, respiratory function, balance, gait speed, muscle strength, motor performance, physical activity, activities of daily living, disability, quality of life, anxiety, and depressive symptoms. The findings will be used to optimize the intervention protocol and support the design of a future confirmatory clinical trial.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Seung Ha Lee, M.S.
- Phone Number: +82-2-2072-3608
- Email: pedshlee@gmail.com
Study Locations
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Seoul, South Korea, 03080
- Seoul National University Hospital
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Contact:
- Seung Ha Lee, M.S.
- Phone Number: +82-2-2072-3608
- Email: pedshlee@gmail.com
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 3 to 18 years.
- Discharged from the pediatric intensive care unit (PICU) after at least 48 hours of treatment.
- Has not recovered to the pre-PICU level of physical function (walking and mobility), confirmed using the Pediatric Overall Performance Category Scale (POPC) and the Gross Motor Function Classification System Family Report Questionnaire (GMFCS Family Report).
- Has sufficient cognitive and physical ability to understand and participate in the home-based exercise intervention.
- Able to maintain adequate attention for exercise training, assessed using the Richmond Agitation-Sedation Scale (RASS) and age-appropriate delirium assessment (psCAM-ICU or pCAM-ICU), when applicable.
- Written informed consent provided by the parent or legal guardian.
Exclusion Criteria:
- Newly developed neuromuscular disease after PICU admission that prevents participation in the video-based exercise program without therapist assistance.
- Medical conditions, indwelling catheters, or implanted medical devices requiring restriction of limb movement.
- Language or cognitive impairment that prevents understanding of the video-based exercise program.
- Uncontrolled hypertension, arrhythmia, persistent fever due to infection, or any condition making exercise unsafe.
- Declines to participate in the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Experimental: Remote Exercise Intervention
Participants will receive an individualized home-based remote exercise intervention program for 12 weeks following discharge from the pediatric intensive care unit.
The intervention includes individualized exercise prescription, instructional exercise videos, prescribed self-exercise, and weekly monitoring and feedback through videoconferencing.
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Participants will receive an individualized home-based remote exercise intervention program for 12 weeks.
The intervention consists of individualized exercise prescription, instructional exercise videos, prescribed self-exercise, and weekly monitoring and feedback through videoconferencing.
The exercise program will be tailored and progressively adjusted according to each participant's functional status and clinical progress.
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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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Exercise Adherence Rate
Time Frame: Baseline through Week 12
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Exercise adherence rate will be calculated as the percentage of prescribed exercise sessions completed by each participant during the 12-week remote exercise intervention.
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Baseline through Week 12
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Exercise Completion Rate
Time Frame: At Week 12
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Exercise completion rate will be calculated as the percentage of participants who complete the 12-week remote exercise intervention as specified in the study protocol.
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At Week 12
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Participant Satisfaction Score
Time Frame: Pre-intervention and at Months 1, 2, 3, and 4
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Participant satisfaction with the remote exercise intervention will be assessed using a study-specific satisfaction questionnaire at pre-intervention and at Months 1, 2, 3, and 4. Total scores range from 6 to 30, with higher scores indicating greater satisfaction.
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Pre-intervention and at Months 1, 2, 3, and 4
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Intervention-Related Adverse Events
Time Frame: Baseline through Month 4
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The number of intervention-related adverse events occurring during the study period will be recorded.
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Baseline through Month 4
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Exercise Intervention Discontinuation
Time Frame: Baseline through Week 12
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The number of participants who discontinue the remote exercise intervention will be recorded.
Reasons for discontinuation will also be documented.
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Baseline through Week 12
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Muscle Thickness by Ultrasound
Time Frame: Baseline through 12 weeks
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Muscle thickness and muscle quality will be assessed using ultrasound to evaluate changes in skeletal muscle following the intervention.
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Baseline through 12 weeks
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Medical Research Council Sum Score (MRC-SS)
Time Frame: Baseline through Week 12
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Muscle strength will be assessed using the Medical Research Council Sum Score (MRC-SS).
Total scores range from 0 to 60, with higher scores indicating greater muscle strength.
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Baseline through Week 12
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Hand Grip Strength
Time Frame: Baseline through 12 weeks
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Hand grip strength will be measured using a hand dynamometer and recorded in kilograms (kg).
Higher values indicate greater hand grip strength.
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Baseline through 12 weeks
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Body Weight
Time Frame: Baseline through 12 weeks
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Body weight will be measured using a digital scale and recorded in kilograms (kg) to monitor physical changes during the intervention.
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Baseline through 12 weeks
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Sit and Reach Test
Time Frame: Baseline through 12 weeks
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Flexibility will be assessed using the Sit and Reach Test.
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Baseline through 12 weeks
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Maximal Inspiratory Pressure (MIP)
Time Frame: Baseline through Week 12
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Inspiratory muscle strength will be assessed using maximal inspiratory pressure (MIP), measured in centimeters of water pressure (cmH₂O).
Higher values indicate greater inspiratory muscle strength.
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Baseline through Week 12
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Maximal Expiratory Pressure (MEP)
Time Frame: Baseline through Week 12
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Expiratory muscle strength will be assessed using maximal expiratory pressure (MEP), measured in centimeters of water pressure (cmH₂O).
Higher values indicate greater expiratory muscle strength.
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Baseline through Week 12
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Peak Cough Flow (PCF)
Time Frame: Baseline through Week 12
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Cough effectiveness will be assessed using peak cough flow (PCF), measured in liters per minute (L/min).
Higher values indicate better cough function.
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Baseline through Week 12
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Pediatric Balance Scale
Time Frame: Baseline through Week 12
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Balance function will be assessed using the Pediatric Balance Scale.
Total scores range from 0 to 56, with higher scores indicating better balance function.
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Baseline through Week 12
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10 Meter Walk Test
Time Frame: Baseline through 12 weeks
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Walking ability will be assessed using the 10 Meter Walk Test.
Walking speed will be recorded in meters per second (m/s).
Higher values indicate faster walking speed.
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Baseline through 12 weeks
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Movement Assessment Battery for Children-3 (MABC-3)
Time Frame: Baseline through Week 12
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Motor performance will be assessed using the Movement Assessment Battery for Children-3 (MABC-3).
Total standard scores range from 1 to 19, with higher scores indicating better motor performance.
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Baseline through Week 12
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Physical Activity
Time Frame: Baseline through Week 16
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Physical activity will be continuously monitored using a smartwatch and quantified as metabolic equivalents (METs).
Higher MET values indicate greater physical activity levels.
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Baseline through Week 16
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Modified Barthel Index
Time Frame: Baseline through 16 weeks
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Functional independence in activities of daily living will be assessed using the Modified Barthel Index.
Total scores range from 0 to 100, with higher scores indicating greater functional independence in activities of daily living.
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Baseline through 16 weeks
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Modified Rankin Scale
Time Frame: Baseline through 16 weeks
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Overall functional disability will be assessed using the Modified Rankin Scale.
Total scores range from 0 to 6, with higher scores indicating greater functional disability.
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Baseline through 16 weeks
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Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) Generic Core Scales
Time Frame: Baseline through 16 weeks
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Health-related quality of life will be assessed using the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) Generic Core Scales.
Total scores range from 0 to 100, with higher scores indicating better health-related quality of life.
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Baseline through 16 weeks
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PROMIS Parent Proxy Anxiety
Time Frame: Baseline through 16 weeks
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Anxiety symptoms will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Parent Proxy Anxiety (Short Form 8a v2.0).
Raw summed scores range from 8 to 40 and are converted to standardized T-scores for analysis.
Higher T-scores indicate greater anxiety symptoms.
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Baseline through 16 weeks
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PROMIS Parent Proxy Depressive Symptoms
Time Frame: Baseline through 16 weeks
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Depressive symptoms will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Parent Proxy Depressive Symptoms (Short Form 6a v2.0).
Raw summed scores range from 6 to 30 and are converted to standardized T-scores for analysis.
Higher T-scores indicate greater depressive symptoms.
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Baseline through 16 weeks
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Sung Eun Hyun, M.D., Ph.D., Seoul National University Hospital
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
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
- H-2606-206-1764
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
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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