- ICH GCP
- Registre américain des essais cliniques
- Essai clinique NCT01577927
Feasibility Study of a Home Rehabilitative Network to Treat Prolonged Weaned Patients (UTIR)
Feasibility and Efficacy of a Home Rehabilitative Network for Prolonged Weaned Patients Discharged From a Weaning Unit
Patients at high complexity with severe chronic diseases can require several admission in intensive care units (ICU) to overcome acute exacerbations by the use of assisted ventilation. In the last 10 years, new technologies and beds in ICU evidenced a new group of patients often needing weaning procedures due to a long-lasting period of mechanical ventilation. These patients are often under chronic conditions with recurrent symptoms, reduced effort tolerance and depression.
Weaning process is a frail step in the medical history of a patient who has survived an acute episode of respiratory failure and has spent a period of time under mechanical ventilation. Patients are followed for the duration of in-hospital stay, an expected average period of 4 weeks.
When discharged fron an Intensive Care Unit (ICU) or a weaning center, the patient is usually managed by GPs and by the hospital where he has been admitted to following re-exacerbations. The conventional approach is for sure inadequate for this type of patient whose clinical complexity, disability and frailty need for a continuity of care through a higher complex approach of management.
A structured program of Home Rehabilitation could be a possible solution to this problem. Thus, the hypothesis of the study is to evaluate feasibility and sustainability and efficacy of a home rehabilitative network for prolonged weaned patients discharged from a weaning unit.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Type d'étude
Inscription (Réel)
Phase
- N'est pas applicable
Contacts et emplacements
Lieux d'étude
-
-
Brescia
-
Lumezzane, Brescia, Italie, 25065
- Fondazione Salvatore Maugeri
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
- General Inclusion criteria: 1. Signature of the informed 2. Good expectation of life
- Specific Inclusion Criteria : Score of general dependences < 19 according to the Critical Patients Autonomy Planning (CPAP) Scale
Exclusion Criteria:
- Patient with neuromuscular, highly progressive neurological diseases (i.e. amyotrophic lateral sclerosis), patient requiring surgical interventions, sedation, and hemodialysis.
- Unstable patient conditions as daily variability of the blood arterial pressure >20%, arrhythmias, PaO2/FiO2 < 300, unsatisfactory respiratory pattern, haemoglobin < 7 g /dL, temperature > 38°C, presence of neurological or orthopaedic side effects, and recent embolisms from TVP. Refusal.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Soins de soutien
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Comparateur actif: Usual home care
No assistance or care by PT.
|
Usual home care consists in supporting drug and oxygen therapy, mechanical ventilation, GP's assistance,and periodical in-hospital visit.
|
|
Expérimental: PT-assisted home rehabilitation
Assisted home care is supported by a PT at least 2 times/month.
Few brief educational lessons preceeded the training activity that the patient performs by himself at home.
|
Patient performs 50 min physical activity/working day autonomously by the help of a DVD. The physical activity consists in cyclette, calisthenic exercises, and training of the respiratory muscles. Every two weeks, PT phones the patient for an educational reinforcement. |
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Critical Patients Autonomy Planning (CPAP)
Délai: Changes from baseline and 4 weeks, and 6 months after home activity
|
CPAP is a measure of dependency.
CPAP was evaluated at three different time-points: at in-hospital admission (baseline), at discharge (patients are followed for the duration of their in-hospital stay, an expected average time of 4 weeks), and after 6 months of physical activity at home.
|
Changes from baseline and 4 weeks, and 6 months after home activity
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP)
Délai: Changes from baseline and 4 weeks (average time), and 6 months after home activity
|
Respiratory Functionality
|
Changes from baseline and 4 weeks (average time), and 6 months after home activity
|
|
MRF 26
Délai: Changes between discharge at 4 weeks (average time) and 6 months after home activity
|
Quality of life evaluation.
|
Changes between discharge at 4 weeks (average time) and 6 months after home activity
|
|
Likert Scale
Délai: Changes between discharge at 4 weeks (average time) and 6 months after home activity
|
Satisfaction for patient/caregiver
|
Changes between discharge at 4 weeks (average time) and 6 months after home activity
|
|
Mortality
Délai: Changes between 3, 6 and 12 months post-discharge
|
Clinical measure
|
Changes between 3, 6 and 12 months post-discharge
|
|
MRC Scale and/or dynamometer
Délai: Changes between baseline, discharge at 4 weeks, and 6 months after home activity
|
Rehabilitative measure referring to muscles force
|
Changes between baseline, discharge at 4 weeks, and 6 months after home activity
|
|
6-min walking test
Délai: Changes from baseline and discharge at 4 weeks, and 6 months after home activity
|
Rehabilitative measure evaluating the effort tolerance.
|
Changes from baseline and discharge at 4 weeks, and 6 months after home activity
|
|
EuroQol
Délai: Changes between discharge at 4 weeks (average time) and 6 months after home activity
|
Quality of life evaluation
|
Changes between discharge at 4 weeks (average time) and 6 months after home activity
|
|
Gussago Nursing Scale
Délai: Changes from baseline and 4 weeks, and 6 months after home activity
|
Measure of dependency.
|
Changes from baseline and 4 weeks, and 6 months after home activity
|
|
Barthel Index
Délai: Changes from baseline and 4 weeks, and 6 months after home activity
|
Measure of dependency.
|
Changes from baseline and 4 weeks, and 6 months after home activity
|
|
Pre-morbidity life-style (PLS)
Délai: Changes from baseline and 4 weeks, and 6 months after home activity
|
Measure of dependency.
|
Changes from baseline and 4 weeks, and 6 months after home activity
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Piero Ceriana, MD, Fondazione Salvatore Maugeri
- Directeur d'études: Michele Vitacca, MD, Fondazione Salvatore Maugeri
Publications et liens utiles
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- UTIR
- Dlg. 5685 on 28 May 2010 (Autre subvention/numéro de financement: Lombardy Region)
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