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Feasibility Study of a Home Rehabilitative Network to Treat Prolonged Weaned Patients (UTIR)

4 juni 2014 uppdaterad av: Michele Vitacca, Fondazione Salvatore Maugeri

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.

Studieöversikt

Detaljerad beskrivning

Patients referred to the Fondazione Salvatore Maugeri for prolonged weaning are enrolled and trained in an individualised program of home care in order to recover their own autonomies. Home care compares 2 arms: usual care vs physiotherapist (PT)-assisted care. Usual care consists in supporting drug and oxygen therapy, mechanical ventilation, GP's assistance, periodical in-hospital visit. The PT-assisted home care is supported by PT at least 2 times/month, autonomous 50 min physical activity/working day by the help of a DVD. The physical activity consists in cyclette, calisthenic exercises, and training of the respiratory muscles. Few brief educational lessons by PT preceded the training activity. Every two weeks, PT calls the patient by phone for an educational reinforcement.

Studietyp

Interventionell

Inskrivning (Faktisk)

60

Fas

  • Inte tillämpbar

Kontakter och platser

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Studieorter

    • Brescia
      • Lumezzane, Brescia, Italien, 25065
        • Fondazione Salvatore Maugeri

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

  • 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.

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Stödjande vård
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Aktiv komparator: 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.
Experimentell: 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.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Critical Patients Autonomy Planning (CPAP)
Tidsram: 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

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP)
Tidsram: 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
Tidsram: 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
Tidsram: 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
Tidsram: 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
Tidsram: 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
Tidsram: 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
Tidsram: 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
Tidsram: 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
Tidsram: 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)
Tidsram: 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

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Utredare

  • Huvudutredare: Piero Ceriana, MD, Fondazione Salvatore Maugeri
  • Studierektor: Michele Vitacca, MD, Fondazione Salvatore Maugeri

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 juli 2011

Primärt slutförande (Faktisk)

1 januari 2013

Avslutad studie (Faktisk)

1 juli 2013

Studieregistreringsdatum

Först inskickad

10 april 2012

Först inskickad som uppfyllde QC-kriterierna

13 april 2012

Första postat (Uppskatta)

16 april 2012

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

5 juni 2014

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

4 juni 2014

Senast verifierad

1 juni 2014

Mer information

Termer relaterade till denna studie

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • UTIR
  • Dlg. 5685 on 28 May 2010 (Annat bidrag/finansieringsnummer: Lombardy Region)

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