Arm cycle ergometry in critically ill patients: A systematic review.

Cycle ergometry Intensive care unit Physical function Physiotherapy Rehabilitation

Journal

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
ISSN: 1036-7314
Titre abrégé: Aust Crit Care
Pays: Australia
ID NLM: 9207852

Informations de publication

Date de publication:
04 Apr 2024
Historique:
received: 30 09 2023
revised: 14 12 2023
accepted: 21 01 2024
medline: 6 4 2024
pubmed: 6 4 2024
entrez: 5 4 2024
Statut: aheadofprint

Résumé

Intensive care unit (ICU) survivors face functional limitations due to ICU-acquired weakness. Arm cycle ergometry (ACE) introduced in the ICU may improve physical function. To our knowledge, there is limited evidence on the effectiveness of ACE and physical function outcomes in critically ill patients. The objective of this systematic review was to examine the impact of ICU-based ACE on physical function, safety, and other clinical outcomes. Systematic Review. A search of seven databases was conducted from the inception to January 1, 2023: Medline Ahead of Print, Ovid MEDLINE(R), Allied and Complementary Medicine Database (AMED), Embase, Cochrane Central, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We included two arm studies of critically ill adults admitted to the ICU who received ACE and any comparator for our primary outcome, physical function. Our secondary outcomes included severe events. We included safety studies with or without a comparator group. Screening, data abstraction, and risk-of-bias assessments were completed independently, in duplicate. We used the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the overall certainty of evidence. We screened 651 citations and included eight studies that enrolled 183 patients. Due to heterogeneity, meta-analysis was not performed. For our primary outcome, one randomised controlled trial found significant improvements in physical function, measured by the Barthel Index with ACE, whereas a nonrandomised study showed no difference. Out of the six studies reporting safety, none reported any severe safety events. The overall certainty of evidence was very low. ACE initiated in the ICU is a likely safe intervention. Based on the limited ACE studies and heterogeneity between studies, further research with more rigorous studies evaluating important outcomes for patients is needed.

Sections du résumé

BACKGROUND BACKGROUND
Intensive care unit (ICU) survivors face functional limitations due to ICU-acquired weakness. Arm cycle ergometry (ACE) introduced in the ICU may improve physical function. To our knowledge, there is limited evidence on the effectiveness of ACE and physical function outcomes in critically ill patients.
OBJECTIVE OBJECTIVE
The objective of this systematic review was to examine the impact of ICU-based ACE on physical function, safety, and other clinical outcomes.
REVIEW METHOD USED METHODS
Systematic Review.
DATA SOURCES METHODS
A search of seven databases was conducted from the inception to January 1, 2023: Medline Ahead of Print, Ovid MEDLINE(R), Allied and Complementary Medicine Database (AMED), Embase, Cochrane Central, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature (CINAHL).
REVIEW METHODS METHODS
We included two arm studies of critically ill adults admitted to the ICU who received ACE and any comparator for our primary outcome, physical function. Our secondary outcomes included severe events. We included safety studies with or without a comparator group. Screening, data abstraction, and risk-of-bias assessments were completed independently, in duplicate. We used the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the overall certainty of evidence.
RESULTS RESULTS
We screened 651 citations and included eight studies that enrolled 183 patients. Due to heterogeneity, meta-analysis was not performed. For our primary outcome, one randomised controlled trial found significant improvements in physical function, measured by the Barthel Index with ACE, whereas a nonrandomised study showed no difference. Out of the six studies reporting safety, none reported any severe safety events. The overall certainty of evidence was very low.
CONCLUSION CONCLUSIONS
ACE initiated in the ICU is a likely safe intervention. Based on the limited ACE studies and heterogeneity between studies, further research with more rigorous studies evaluating important outcomes for patients is needed.

Identifiants

DOI: 10.1016/j.aucc.2024.01.008 PMID: 38580486
pubmed: 38580486
pii: S1036-7314(24)00024-9
doi: 10.1016/j.aucc.2024.01.008
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Informations de copyright

Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Auteurs

Lauren Vanderlelie (L)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada. Electronic address: laurenjaynev@outlook.com.

Sandra Bosich (S)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.

Heather O'Grady (H)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.

Karim Azizi (K)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.

Jasdeep Lally (J)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.

Sarah Micks (S)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.

Saheb Sandhu (S)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.

Bailey Whyte (B)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.

Michelle E Kho (ME)

School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada; St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. Electronic address: khome@mcmaster.ca.

Classifications MeSH