Dose of Early Therapeutic Mobility: Does Type or Frequency Matter?
| Status: | Archived |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 7/1/2011 |
| Start Date: | May 2009 |
| End Date: | May 2011 |
This study will examine the effects of once and twice daily activity performed with patients
who are breathing with the aid of a machine in an intensive care unit. Activity can occur
in bed. Activity can include transfer to a chair and even walking once the patient's
condition allows safe, out-of-bed activity. The investigators hypothesize that early,
progressive activity will reduce inflammatory molecules in the blood, promote muscle and
physical health and help patients to recover more quickly from critical illness.
Early therapeutic mobility (ETM) activity has been recommended to facilitate recovery and
improve outcomes for the survivors of critical illness who experience prolonged mechanical
ventilation. The effective dose (i.e., type, frequency and duration) of ETM activity is not
known and there are limited reports about the application and effects of ETM in mechanically
ventilated intensive care unit (ICU) patients. Three inflammatory biomarkers, interleukin
(IL)-6, IL-10 and C-reactive protein, are potentially altered by a single episode of ETM
activity. Systemic markers of physical health (i.e., vital signs, delirium, muscle strength,
ventilator associated pneumonia, and duration of mechanical ventilation) may also be
positively influenced by ETM. The primary aim of this interdisciplinary study is to compare
the immediate effects of frequency--single and twice daily episodes--of ETM activity and the
effects of type--low and moderate intensity--of ETM activity on molecular biomarkers of
inflammation and systemic markers of physical health in mechanically ventilated adults.
This is an experimental design, using repeated measures; subjects will be randomized to
receive either one or two episodes of ETM activity daily during week days while in the ICU.
Type of activity will be determined by patient condition. The research questions are:
1. a. What are the differences between the frequency (once versus twice daily) of ETM
activities on inflammatory biomarkers: interleukin (IL)-6, IL-10 and C-reactive protein
(CRP)? 1.b. What are the differences between the type (low or moderate) of ETM
activities on inflammatory biomarkers: IL-6, IL-10 and CRP?
2. a. What are the differences between frequency of ETM activities on systemic markers of
physical health: vital signs, delirium, muscle strength, ventilator-associated
pneumonia and duration of mechanical ventilation? 2.b. What are the differences between
type of ETM activities on systemic markers of physical health: vital signs, delirium,
muscle strength, ventilator-associated pneumonia and duration of mechanical
ventilation?
Data will be collected for a maximum of 3 contiguous days in ICU patients who are
mechanically ventilated for >48 hours, then weekly to examine short-term patient responses
to ETM activities in this preliminary study. Daily episodes of activity will be provided by
a study interventionist. Repeated measures MANCOVA and ANCOVA will be used to answer the
research questions. This collaborative study evaluates a biobehavioral methodology within an
interdisciplinary team consistent with the biobehavioral methods to improve outcome research
(PA-07-008) and the mission of the National Institute of Nursing Research to improve
treatments and health based on evidence.
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