An investigation of exercise dosage during critical illness on functional recovery

Michelle Paton's research focuses on the investigation of exercise dosage during critical illness on functional recovery.

Michelle Paton

Systematic Review and IPDMA

Critical illness can lead to prolonged muscle weakness and an accelerated neurocognitive decline that can cause long-term disabilities Intensive Care Unit (ICU) survivors may never fully recover from. Active rehabilitation during the early stages of critical illness has been linked to improved outcomes for this cohort. Although early rehabilitation in the ICU is seen as safe and feasible, there is no evidence describing the effect of exercise dosage and therefore how to prescribe this treatment. This research, comprised of a systematic review (SR) and individual patient data meta-analysis (IPDMA), retrospective observational studies and a nested cohort trial, will start to answer some of these questions.

The SR and one-stage IPDMA will source records from suitable previous research trials and analyse the data not only according to the intervention they received, but by the amount and intensity of exercise they performed. The primary outcome will be the effect of exercise dosage on hospital length of stay (LOS) with secondary outcomes of exercise dosage on ICU LOS, ventilator free days, ICU and hospital mortality, strength at ICU discharge (via the MRC-SS), discharge destination and QoL 6 months following ICU admission (via the SF-36). Subgroup analysis will be performed as able to review correlations between other variables reported (such as admission diagnosis, illness severity, presence of delirium or previous functional level) to determine if there are individual characteristics that respond better to exercise therapy.

Observational Studies

The retrospective observational studies will review exercise dosage performed in ICU (obtained through medical note audits) against functional recovery at six months following ICU admission (obtained through patient reported outcome measures (PROMs)). It is hoped that trends will be identified to assist healthcare professionals in prescription of exercise in ICU to improve outcomes for patients.

Nested Cohort Trial - PREDICTABLE

In the nested cohort trial, PREDICTABLE, 40 ICU survivors will be visited at home to have in-person functional assessments performed. These outcomes will be reviewed against the PROMs to ensure that a correlation exists. This will allow researchers to feel more confident applying PROMs in this cohort. The survivors will also be interviewed to gain their perspective of the main issues that affect recovery from critical illness. This will allow themes to be established to improve healthcare provision for this cohort.

Contact: For further information, please contact Michelle Paton by email.