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"Sit-to-stand" is key to independent living. For intensive care unit (ICU) survivors, failure to perform sit-to-stand results in bed-bound status, unable participating in important activities of daily living (ADLs) or instrumental ADLs. Recent studies indicated that 31% of ICU survivors remained bed-bound and unable to "sit-to-stand" after returning home. Our preliminary findings further indicated that 70% of ICU survivors who had the ICU-acquired weakness (ICU-AW) were unable to "sit-to-stand" one-month after ICU discharge.
The aim of this 3-year research project was to develop a feasible and effective "sit-to-stand" intervention (STS intervention) and to examine effects of the STS Care in improving ICU survivors' "sit-to-stand" ability, walking independently, physical function, and rates of bed-bound and mortality one year following ICU discharge.
The trial was approved by the Human Research Ethics Committee at the study site before enrollment. Adult ICU patients (≥ 20 years) admitted consecutively to six medical ICUs of a university affiliated medical center was eligible for the study if they were unable to "sit-to-stand" independently at ICU discharge. Upon signing informed consent, participants will be first stratified by "able to stable sitting" or "unable to stable sitting" and then randomized separately into the intervention or usual care groups, according to computer-generated randomization tables. Participants in the intervention group received both usual care and the STS intervention. The hospital-based (up to 14 days) STS Intervention was provided daily by a independent trained nurse. STS care includes anti-gravity and resistant exercise (intensity based on patients' tolerance), repetitive sit-to-stand practice, and advice on sit-to-stand strategies. A comprehensive functional evaluation (rate of sit-to-stand, rate of walking independently, FSS-ICU scores, numbers of sit-to-stand repetitions in 30 seconds, MRC scores, muscle strength at knee extensors, scores of the barthel index for activities of daily living (ADL), scores of instrumental activities of daily living scale (IADL), the walking distance by the 6-minute walk test, rate of bed-bound status, and rate of mortality) was assessed by a blinded research nurse after ICU discharge at 48hours, 14 day, 1, 3, and 12 months. ICU-AW diagnosis (yes or no) at ICU discharge and daily caloric intake were selected a priori as pre-defined covariates and will be included in the analysis.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | No Intervention | Participants in the control group received usual care. | |
| Sit-to-stand care group | Experimental | Intervention was provided once daily by trained nurses for a maximum of 2 workweeks or until hospital discharge or death. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sit-to-stand Intervention | Other |
|
| Measure | Description | Time Frame |
|---|---|---|
| Sit-to-stand independently | Participants are able to sit to stand independently, allowed armrest use | Baseline within 48 hours. 14 day, 1, and 3 months after ICU discharge. |
| FSS-ICU scores | The FSS-ICU use 7-points score to evaluated 5 functional tasks, which includes rolling, supine-to -sit transfer, unsupported sitting, sit-to-stand transfer, and ambulation. Score range from 0 to 35, higher score indicated better physical performance. Walking independently will be analyzed. | Baseline within 48 hours. 14 day, 1, and 3 months after ICU discharge. |
| Modified 30-second sit-to-stand test | Measured by recording the numbers of sit-to-stand a person can complete in 30 seconds, alowed armrest used. | 14day, 1, and 3 months after ICU discharge. |
| Muscle strength(kg) at knee extensors | Measured by Hoggan MicroFET®2 in kg | Baseline within 48 hours. 14 day, 1, 3, and 12 months after ICU discharge |
| MRC scores | Measured by medical research council scale (MRC) in score, range from 0 to 60 score, higher score indicated better muscle strength | Baseline within 48 hours. 1, 3, and 12 months after ICU discharge |
| Measure | Description | Time Frame |
|---|---|---|
| Barthel index for activities of daily living (ADL) | Measured by ADL in score, range from 0-100 score, higher score indicated health condition | Baseline within 48 hours. 1, 3, and 12 months after ICU discharge. |
| Instrumental activities of daily living scale (IADL) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cheryl, Chia-Hui Chen, PhD | Taipei | National Taiwan University Hospital | 10055 | Taiwan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
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Participants who are unable to perform sit-to-stand independently within 48 houre of ICU discharge were enrolled. In the assignment procedure, participants were stratified by "able to stable sitting" or "unable to stable sitting" and then 1:1 randomly assigned to the intervention or usual care groups. Participants in intervention group receive both usual care and an STS care once daily for two workweeks or discharged within two workweeks or death. In contrast, control group will accept usual care. All participants will be assessed at 48 hours,14day, 1, 3, and 12 months following ICU discharge. A comprehensive functional evaluation (rate of sit-to-stand, rate of walking independently, FSS-ICU scores, numbers of sit-to-stand repetitions in 30 seconds, MRC scores, muscle strength at knee extensors, ADL, and IADL) and rates of bed-bound status and mortality will be assessed by a outcome assessor.
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Measured by IADL in score, range from 0 to 8 score, higher score indicated better health condition |
| Baseline within 48 hours. 1, 3, and 12 months after ICU discharge. |
| Rate of bed-bound status | Obtained by family interview and medical record | 1, 3, and 12 months after ICU discharge. |
| Rate of mortality | Obtained by family interview and medical record | 1, 3, and 12 months after ICU discharge. |
| The 6 minute walk test | Measured by walked distance in 6 minutes(6MWT) in meter, range from 400 to 700 meters, higher value indicated better global health condition | 3 and 12 months after ICU discharge. |
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