Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial
Critical illness polyneuropathy (CIP) and myopathy (CIM) is a common syndrome in critically ill ICU patients. Causing agents are multifold: a systemic inflammatory response, immobility, corticosteroids and neuromuscular blocking agents, and hyperglycaemia. Between 5 en 10% of patients who require mechanical ventilation for acute conditions develop chronic critical illness.
These patients suffer from long-lasting physical impairments, including muscle weakness and decreased functional ability, and neuropsychiatric dysfunction, with a significantly decreased QOL. Early physical rehabilitation (in ICU) has been shown to decrease ventilation time, LOS, and improve functional outcomes in people who are critically ill.
This study focuses on the safety and effect of added cognitive therapy during early ICU rehab. Progressive cognitive therapy included orientation, memory, attention, and problem-solving exercises, and other activities. Outcome measures were cognitive, functional, and health-related quality of life assessments. Patients were divided in 3 groups: usual care, physiotherapy only and cognitive-plus-physiotherapy.
At 3 months, no differences were found in this pilot study between the 3 groups, but cognitive therapy was feasible, safe and well received by patients. Long term follow-up might show different figures. > From: Brummel et al., Intensive Care Med (2013) (Epub ahead of print). All rights reserved to Springer Verlag.
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