The Effect of Proprioceptive Neuromuscular Facilitation on Haemodynamic Responses in a Neurological Intensive Care

The Effect of Proprioceptive Neuromuscular Facilitation on the Ankle-Brachial Index and Haemodynamic Responses in Patients in a Neurological Intensive Care Unit: A Randomised Controlled Trial

Although there are studies examining the effect of actively performed PNF exercises on haemodynamic responses in intensive care patients and healthy individuals, there are no studies investigating their effect on circulation and haemodynamic responses in unconscious patients. Therefore, this study was designed to investigate the acute effects of proprioceptive neuromuscular facilitation (PNF) exercises on peripheral circulation and haemodynamic responses in patients admitted to a neurological intensive care unit.

Hypotheses:

H1-1: Passively administered PNF exercises have beneficial effects on peripheral circulation.

H2-1: Passively administered PNF exercises have beneficial effects on haemodynamic responses.

Study Overview

• Status: Not yet recruiting
• Conditions: Neurologic Disorder
• Intervention / Treatment: Other: Proprioceptive Neuromuscular Facilitation Exercises; Other: Passive Range of Motion Exercises

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients being monitored in the neurology intensive care unit
• Aged 18 years or over
• Haemodynamically stable
• No orthopaedic condition preventing the performance of passive joint movements in the upper and lower limbs
• A signed informed consent form from a patient's next of relative for participation in the study

Exclusion Criteria:

• Presence of haemodynamic instability
• Fractures, contractures or serious orthopaedic conditions in the upper or lower limbs that restrict movement
• Diagnosis or suspicion of deep vein thrombosis
• Severe peripheral arterial disease
• Serious cardiac arrhythmia that may prevent exercise

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PNF Group; Patients in the PNF group will undergo proprioceptive neuromuscular facilitation (PNF) exercises. The exercises will be performed with patients in the supine position and the head elevated by 30°.	Other: Proprioceptive Neuromuscular Facilitation Exercises; The following PNF patterns will be applied to the upper extremity: flexion - abduction - external rotation → extension - adduction - internal rotation; extension - abduction - internal rotation → flexion - adduction - external rotation The following PNF patterns will be applied to the lower extremities: flexion - adduction - external rotation (with the knee extended) → extension - abduction - internal rotation; extension - adduction - external rotation (with the knee extended) → flexion - abduction - internal rotation All exercises will be performed passively by the physiotherapist. Each movement will be performed in sets of 10-12 repetitions, with a 30-second rest period between sets.; Other Names: PNF
Sham Comparator: Control Group; Patients in the control group will undergo passive range of motion (PROM) exercises in the same position.	Other: Passive Range of Motion Exercises; Exercises for the upper extremities: shoulder flexion - extension; shoulder abduction - adduction; shoulder internal - external rotation; elbow flexion - extension; wrist flexion - extension; finger flexion - extension Exercises for the lower extremities: hip flexion - extension; hip abduction - adduction; hip internal - external rotation; knee flexion - extension; ankle dorsiflexion - plantar flexion All exercises will be performed passively by the physiotherapist. Each movement will be performed in sets of 10-12 repetitions, with a 30-second rest period between sets.; Other Names: PROM

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Ankle-Brachial İndex	Systolic blood pressure will be measured at the brachial artery (upper limb) and the posterior tibial or dorsalis pedis artery (lower limb) using a Hadesco ES-101EX Doppler device, with patients in a supine resting position. The cuff will be placed at mid-arm and above the malleolus. It will be inflated until the pulse disappears and deflated slowly; the first reappearance of the pulse will be recorded as systolic pressure. Measurements will be taken in order: same-side arm, same-side leg, opposite leg, and opposite arm. The ankle-brachial index will be calculated as the ratio of the highest lower limb systolic pressure to the highest upper limb systolic pressure.	Baseline and five or ten minutes after exercise
Heart Rate	Heart rate will be recorded as beats per minute and breaths per minute, respectively, based on data obtained from the patient monitor. Measurement will be taken whilst patients are in the supine position and at rest.	Baseline and five or ten minutes after exercise
Systolic blood pressure and diastolic blood pressure	Systolic and diastolic blood pressure measurements will be taken from the patient's upper extremity using an appropriately sized cuff and recorded in millimetres of mercury (mmHg). Measurement will be taken whilst patients are in the supine position and at rest.	Baseline and five or ten minutes after exercise
Respiratory rate	respiratory rate will be recorded as beats per minute and breaths per minute, respectively, based on data obtained from the patient monitor. Measurement will be taken whilst patients are in the supine position and at rest.	Baseline and five or ten minutes after exercise
Peripheral oxygen saturation (SpO₂)	Peripheral oxygen saturation (SpO₂) will be measured using a pulse oximeter. Measurement will be taken whilst patients are in the supine position and at rest.	Baseline and five or ten minutes after exercise

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate Pressure Product	Rate Pressure Product is calculated by dividing the product of heart rate and systolic blood pressure by 1,000	Baseline and five or ten minutes after exercise
Quadriceps circumference measurement	Measurements will be taken whilst patients are in the supine position or, where appropriate, in a seated position. During the measurement, a non-elastic tape measure will be used to measure the circumference at the widest part of the thigh. The tape measure will be placed parallel to the thigh circumference, and the measurement result will be recorded in centimetres (cm). To enhance the reliability of the measurement, two separate measurements will be taken for each patient, and the average of the obtained values will be used in the analyses.	Baseline and five or ten minutes after exercise
Oxford Acute Severity of Illness Score	Oxford Acute Severity of Illness Score comprises a total of 10 parameters: age, heart rate, mean arterial pressure, respiratory rate, body temperature, Glasgow Coma Scale, urine output, mechanical ventilation status, length of stay in intensive care, and the presence of elective surgery. Each parameter is assessed according to specific score ranges, and the total score indicates the severity of the illness. Higher scores indicate a higher risk of mortality.	Baseline and five or ten minutes after exercise

Collaborators and Investigators

• Sponsor: Abant Izzet Baysal University

Study record dates

Study Major Dates

• Study Start (Estimated): May 15, 2026
• Primary Completion (Estimated): January 15, 2027
• Study Completion (Estimated): May 15, 2027

Study Registration Dates

• First Submitted: April 3, 2026
• First Submitted That Met QC Criteria: April 9, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 9, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Neurological Intensive Care; Proprioceptive Neuromusculer Facilitation; Haemodynamic Responses
• Additional Relevant MeSH Terms: Nervous System Diseases
• Other Study ID Numbers: AIBU-FTR-BS-002

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No