Journal of Rehabilitation Medicine 51-10 | Page 83

Effect of physiotherapy for ICU-acquired muscle weakness
an electrophysiological examination. Furthermore,
future studies should investigate different rehabilitation
strategies (e.g. electrostimulation) to improve function.
Conclusion
This is one of the first studies of physiotherapy interven-
tions in the rehabilitation of chronic critically ill patients
with ICUAW. This study therefore provides a more
detailed understanding of the rehabilitation and might
provide implications for the rehabilitation of people
with chronic ICUAW. Future RCTs should investigate
the effects of early mobilization combined with early
walking training on the recovery of people with ICUAW.
This study indicates that chronic critically ill patients
with ICUAW in the post-acute phase receiving passive
treatment are less likely to regain walking ability than
patients who receive early mobilization, task-oriented
walking, muscle training of lower extremity (such as
sit-to-stand training), and balance activities in standing.
ACNOWLEDGEMENTS
This work was supported by Klinik Bavaria Kreischa.
The authors have no conflicts of interests to declare.
REFERENCES
1. Kress J, Hall J. ICU-acquired weakness and recovery from
critical illness. N Engl J Med 2014; 370: 1626–1635.
2. Elliott D, Davidson JE, Harvey MA, Bemis-Dougherty A,
Hopkins RO, Iwashyna TJ, et al. Exploring the scope of
post-intensive care syndrome therapy and care: enga-
gement of non-critical care providers and survivors in a
second stakeholders meeting. Crit Care Med 2014; 42:
2518–2526.
3. Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe
G. Clinical review: critical illness polyneuropathy and
myopathy. Crit Care 2008; 12: 238.
4. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert
C, Wunsch H, et al. Improving long-term outcomes after
discharge from intensive care unit: report from a stake-
holders’ conference. Crit Care Med 2012; 40: 502–509.
5. Wieske L, Dettling-Ihnenfeldt DS, Verhamme C, Nollet F,
van Schaik IN, Schultz MJ, et al. Impact of ICU-acquired
weakness on post-ICU physical functioning: a follow-up
study. Crit Care 2015; 19: 196.
6. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A,
Diaz-Granados N, Al-Saidi F, et al. One-year outcomes in
survivors of the acute respiratory distress syndrome. N
Engl J Med 2003; 348: 683–693.
7. Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch
T, Mesotten D, Wilmer Aea. Acute outcomes and 1-year
mortality of intensive care unit-acquired weakness. A co-
hort study and propensity-matched analysis. Am J Respir
Crit Care Med 2014; 190: 410–420.
8. Hermans G, Van Mechelen H, Bruyninckx F, Vanhullebusch
T, Clerckx B, Meersseman P, et al. Predictive value for
weakness and 1-year mortality of screening electrophy-
siology tests in the ICU. Intensive Care Med 2015; 41:
2138–2148.
9. Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevran-
sky JE, Shanholtz C, et al. Physical complications in acute
803
lung injury survivors: a two-year longitudinal prospective
study. Crit Care Med 2014; 42: 849–859.
10. Needham DM, Wozniak AW, Hough CL, Morris PE, Dinglas
VD, Jackson JC, et al. Risk factors for physical impairment
after acute lung injury in a national, multicenter study. Am
J Respir Crit Care Med 2014; 189: 1214–1224.
11. Semmler A, Okulla T, Kaiser M, Seifert B, Heneka MT.
Long-term neuromuscular sequelae of critical illness. J
Neurol 2013; 260: 151–157.
12. Mehrholz J, Thomas S, Burridge JH, Schmidt A, Scheffler
B, Schellin R, et al. Fitness and mobility training in pa-
tients with intensive care unit-acquired muscle weakness
(FITonICU): study protocol for a randomised controlled
trial. Trials 2016; 17: 559.
13. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical
illness. Am J Respir Crit Care Med 2010; 182: 446–454.
14. Mehrholz J, Mückel S, Oehmichen F, Pohl M. The General
Weakness Syndrome Therapy (GymNAST) study: protocol
for a cohort study on recovery on walking function. BMJ
Open 2014; 4: e006168.
15. Outermans JC, van Peppen RP, Wittink H, Takken T, Kwak-
kel G. Effects of a high-intensity task-oriented training
on gait performance early after stroke: a pilot study. Clin
Rehabil 2010; 24: 979–987.
16. Scrivener K, Sherrington C, Schurr K. Amount of exercise
in the first week after stroke predicts walking speed and
unassisted walking. Neurorehabil Neural Repair 2012;
26: 932–938.
17. Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Bur-
ridge J. Time spent in rehabilitation and effect on measures
of activity after stroke [protocol]. Cochrane Database of
Systematic Reviews 2017; Art. No.: CD012596. DOI:
012510.011002/14651858.CD14012596.
18. Berney S, Haines K, Denehy L. Physiotherapy in critical
care in Australia. Cardiopulm Phys Ther J 2012; 23: 19–25.
19. Berney SC, Rose JW, Denehy L, Granger CL, Ntoumeno-
poulos G, Crothers E, et al. Commencing out-of-bed reha-
bilitation in critical care-what influences clinical decision-
making? Arch Phys Med Rehabil 2019; 100: 261–269 e262.
20. Koo KK, Choong K, Cook DJ, Herridge M, Newman A, Lo
V, et al. Early mobilization of critically ill adults: a survey
of knowledge, perceptions and practices of Canadian
physicians and physiotherapists. CMAJ Open 2016; 4:
E448–E454.
21. Schreiber AF, Ceriana P, Ambrosino N, Malovini A, Nava
S. Physiotherapy and weaning from prolonged mechanical
ventilation. Respir Care 2019; 64: 17–25.
22. Nordon-Craft A, Moss M, Quan D, Schenkman M. Intensive
care unit-acquired weakness: implications for physical
therapist management. Phys Ther 2012; 92: 1494–1506.
23. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV,
Keane KA, et al. The Richmond Agitation-Sedation Scale:
validity and reliability in adult intensive care unit patients.
Am J Respir Crit Care Med 2002; 166: 1338–1344.
24. Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L.
Clinical gait assessment in the neurologically impaired. Re-
liability and meaningfulness. Phys Ther 1984; 64: 35–40.
25. Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M.
Predictive validity and responsiveness of the Functional
Ambulation Category in hemiparetic patients after stroke.
Arch Phys Med Rehabil 2007; 88: 1314–1319.
26. Pohl M, Bertram M, Hoffmann B, Jöbges M, Ketter G, Krusch
C, et al. Der Frühreha-Index: Ein Manual zur Operationa-
lisierung. Rehabilitation 2010; 49: 22–29.
27. Hermans G, Van den Berghe G. Clinical review: intensive
care unit acquired weakness. Crit Care 2015; 19: 274.
28. Zanni JM, Korupolu R, Fan E, Pradhan P, Janjua K, Palmer
JB, et al. Rehabilitation therapy and outcomes in acute
respiratory failure: an observational pilot project. J Crit
Care 2010; 25: 254–262.
29. Thomas S, Burridge JH, Pohl M, Oehmichen F, Mehrholz J.
Recovery of sit-to-stand function in patients with intensive-
J Rehabil Med 51, 2019