Fossat G, et al. - A single-center, randomized clinical trial was performed to examine whether early in-bed leg cycling plus electrical stimulation of the quadriceps muscles in addition to standardized early rehabilitation would result in greater muscle strength at discharge from the intensive care unit (ICU). Researchers reported that it did not improve global muscle strength at discharge from the ICU.

Methods

• This trial enlisting critically ill adult subjects at one ICU within an 1,100-bed hospital in France.
• Enlistment was from July 2014 to June 2016, and there was a 6-month follow-up, which finished on November 24, 2016.
• After that, patients were randomized to early in-bed leg cycling plus electrical stimulation of the quadriceps muscles added to standardized early rehabilitation (n=159) or standardized early rehabilitation alone (usual care) (n=155).
• Muscle strength at discharge from the ICU evaluated by physiotherapists blinded to treatment group using the Medical Research Council grading system (score range, 0-60 points; a higher score reflects better muscle strength; minimal clinically important difference of 4 points) was the primary outcome.
• The number of ventilator-free days and ICU Mobility Scale score (range, 0-10; a higher score reflects better walking capability) were the included secondary outcomes at ICU discharge.
• At 6 months, functional autonomy and health-related quality of life were evaluated.

Results

• Out of 314 randomized patients, 312 (mean age, 66 years; women, 36%; receiving mechanical ventilation at study inclusion, 78%) completed the study and were involved into the analysis.
• It was observed that the median global Medical Research Council score at ICU discharge was 48 (interquartile range [IQR], 29 to 58) in the intervention group, and 51 (IQR, 37 to 58) in the usual care group (median difference, -3.0 [95% CI, -7.0 to 2.8]; P=.28).
• It was noted that the ICU Mobility Scale score at ICU discharge was 6 (IQR, 3 to 9) in both groups (median difference, 0 [95% CI, -1 to 2]; P=.52).
• Findings revealed that the median number of ventilator-free days at day 28 was 21 (IQR, 6 to 25) in the intervention group, and 22 (IQR, 10 to 25) in the usual care group (median difference, 1 [95% CI, -2 to 3]; P=.24).
• Data revealed that clinically significant events occurred during mobilization sessions in 7 patients (4.4%) in the intervention group, and in 9 patients (5.8%) in the usual care group.
• No significant between-group differences were found in the outcomes assessed at 6 months.