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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 |
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| Authors: | N. E. Brummel T. D. Girard E. W. Ely P. P. Pandharipande A. Morandi C. G. Hughes A. J. Graves A. Shintani E. Murphy B. Work B. T. Pun L. Boehm T. M. Gill R. S. Dittus J. C. Jackson |
| Affiliation: | 1. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 350, Nashville, TN, 37203-1425, USA 2. Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN, USA 3. Department of Medicine, Center for Quality of Aging, Vanderbilt University School of Medicine, Nashville, TN, USA 4. Department of Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC) Service, Tennessee Valley Healthcare System, Nashville, TN, USA 5. Division of Critical Care, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA 6. Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA 7. Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy 8. Geriatric Research Group, Bresica, Italy 9. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA 10. Acute Rehabilitation Services, Vanderbilt University Medical Center, Nashville, TN, USA 11. School of Nursing, Vanderbilt University, Nashville, TN, USA 12. Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA 13. Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA 14. Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA 15. Department of Veterans Affairs Medical Center, Research Service, Tennessee Valley Healthcare System, Nashville, TN, USA |
| Abstract: | PurposeCognitive impairment after critical illness is common and debilitating. We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness.MethodsWe randomized 87 medical and surgical ICU patients with respiratory failure and/or shock in a 1:1:2 manner to three groups: usual care, early once-daily physical therapy, or early once-daily physical therapy plus a novel, progressive, twice-daily cognitive therapy protocol. Cognitive therapy included orientation, memory, attention, and problem-solving exercises, and other activities. We assessed feasibility outcomes of the early cognitive plus physical therapy intervention. At 3 months, we also assessed cognitive, functional, and health-related quality of life outcomes. Data are presented as median (interquartile range) or frequency (%).ResultsEarly cognitive therapy was a delivered to 41/43 (95 %) of cognitive plus physical therapy patients on 100 % (92–100 %) of study days beginning 1.0 (1.0–1.0) day following enrollment. Physical therapy was received by 17/22 (77 %) of usual care patients, by 21/22 (95 %) of physical therapy only patients, and 42/43 (98 %) of cognitive plus physical therapy patients on 17 % (10–26 %), 67 % (46–87 %), and 75 % (59–88 %) of study days, respectively. Cognitive, functional, and health-related quality of life outcomes did not differ between groups at 3-month follow-up.ConclusionsThis pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy. Future work to determine optimal patient selection, intensity of treatment, and benefits of cognitive therapy in the critically ill is needed. |
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