Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program
Open accessAbstract
Introduction: Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery. Methods: A multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge. Results: Of the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects ( P = 0.84) or group by time interactions ( P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores. Conclusions: This individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of follow-up. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention. Trial registration: Australia and New Zealand Clinical Trials Register ACTRN12605000166673
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Meta-analyses report a higher incidence of hypoglycemia (glucose < 40 mg/dL) in critically ill patients when blood glucose was targeted to 80-110 mg/dL.
“Meta-analyses also report a higher incidence of hypoglycemia (glucose < 40 mg/dL) in critically patients where blood glucose was targeted to 80-110 mg/dL (516, 517).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [516]
The Materials and methods section describes eligibility for a home-based rehabilitation trial, and the Results report physical-recovery and quality-of-life outcomes; no page numbers are available in our copy. Searches for hypoglycemia, glucose targets, intensive insulin therapy, and glycemic control found no passage addressing the claimed meta-analysis finding. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSeveral randomised studies have assessed physical rehabilitation programmes for survivors of critical illness.
“Several randomised studies have assessed physical rehabilitation programmes for survivors of critical illness [581, 606, 644–651].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [606]
Several studies, mostly before-and-after design, have examined critical care transition programmes on reducing ICU readmission or death among patients transferred from ICU to ward.
“Several studies, mostly before-and-after design, have examined the impact of critical care transition programmes on reducing ICU readmission or death among patients transferred from ICU to the ward [597, 601, 603–611].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [606]
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- Authors
- Elliott, D., McKinley, S., Alison, J., Aitken, L. M., King, M., Leslie, G. D., Kenny, P., Taylor, P., Foley, R., & Burmeister, E.
- Affiliations
- University of Technology Sydney (AU)
- The University of Sydney (AU)
- Griffith University (AU)
- Curtin University (AU)
- Princess Alexandra Hospital (AU)
- Corresponding author
- Elliott, Doug
- ORCID
- Venue
- Critical Care
- Published
- 2011-06-09
- Volume
- 15
- Issue
- 3
- Pages
- R142-R142
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC3219014
- OpenAlex
- W2111597613
- Cited by
- 250
- References
- 54
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 11 · 2023: 11 · 2022: 8 · 2021: 17 · 2020: 9 · 2019: 20 · 2018: 19 · 2017: 18 · 2016: 34 · 2015: 20 · 2014: 16 · 2013: 17 · 2012: 19
- FWCI
- 15.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Griffith Research Online (submittedVersion, cc-by)
- eSpace (Curtin University) (submittedVersion, cc-by)
- eSpace (Curtin University) (submittedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council (352407)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- critical illness, health-related quality of life, physical function recovery, intensive care unit survivors, endurance training, resistance training, 6-minute walk test, SF-36, post-discharge recovery, mechanical ventilation
- MeSH terms
- Adult, Aged, Female, Home Care Services, Humans, Male, Middle Aged, Quality of Life, Critical Illness, Recovery of Function, Physical Therapy Modalities
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