ACT-ICU Study: Activity and Cognitive Therapy in the Intensive Care Unit
概览
- 阶段
- 不适用
- 干预措施
- 未指定
- 疾病 / 适应症
- Brain Injuries
- 发起方
- Vanderbilt University
- 入组人数
- 87
- 试验地点
- 1
- 主要终点
- Tower Test
- 状态
- 已完成
- 最后更新
- 9年前
概览
简要总结
Intensive care unit (ICU) hospitalization saves lives but often does so at a high personal cost to ICU survivors who frequently experience significant cognitive impairment and an array of physical and functional disabilities that limit their recovery and quality of life. While the problems experienced by these patients are likely amenable to rehabilitation, few ICU survivors receive focused rehabilitation. Recently, early physical rehabilitation in ICU patients has shown to improve the chances a patient will regain their pre-hospital functional status. Early cognitive rehabilitation for these patients has not yet been explored. This pilot study will determine the feasibility of early cognitive rehabilitation in ICU patients. The investigators will perform cognitive and physical rehabilitation, beginning in the earliest phases of critical illness, to determine the effect of these therapies on cognitive and functional outcomes in ICU survivors. The investigators hypothesize that combined cognitive and physical rehabilitation, started in the ICU, will improve recovery of cognitive and physical function as well as improve quality of life of ICU survivors.
详细描述
The long-term consequences of critical illness and intensive care unit (ICU) hospitalization in ICU survivors are profound and include cognitive, physical, and functional impairments. The purpose of this study is to pilot test a multi-component, cognitive and physical rehabilitation program beginning in the ICU, combined with a 12-week home-based cognitive rehabilitation program following hospital discharge to determine whether participation in a rehabilitation program will result in improved outcomes among ICU survivors. The study will rely on a randomized controlled clinical trial design, with patients assigned to one of three groups: a "usual care" control group, an early physical activity group (without cognitive therapy), or an early cognitive therapy and physical activity group. All individuals in the intervention groups will receive protocolized physical therapy while hospitalized. In addition, individuals in the early cognitive therapy and physical activity group will receive cognitive therapy starting in the ICU and continuing for 12 weeks once a patient leaves the hospital. In-home visits will occur every other week during the 12-week intervention period. The study's primary outcome is executive functioning (e.g. ability to plan, organize, multi-task) at 3-months following hospital discharge as measured by the Tower Test, a psychometric tool evaluating executive abilities. This has been chosen due to the fact that available research points to the presence of significant deficits in executive functioning among ICU survivors. Secondary outcomes include global cognitive function, physical function and Health Related Quality of Life by assessing scores on the following measures: Katz's ADL, Functional Activities Questionnaire, AD8, Short-Informant Questionnaire of Cognitive Decline in the Elderly, Clinical Dementia Rating Scale (if performed), Timed Up \& Go test, Mini-Mental State Exam, Dysexecutive Questionnaire, Activities-Specific Balance Confidence Scale, Behavior Rating Inventory of Executive Function, Behavior Pain Inventory, Trails A \& B test, Repeatable Battery for Assessment of Neuropsychological Status, General Employment Questionnaire, Beck Depression Inventory II, Post-traumatic stress checklist, Short Form 36, Canadian Study of Health and Aging and patient weight, and Tower Test score at 12 month follow-up. We will also track readmission to the hospital and admission to a nursing home or skilled rehabilitation facility as secondary outcomes during the 12-month follow-up period. The study duration will include 1 year of enrollment and 1 year for study completion following enrollment of the final patient.
研究者
Nathan Brummel
Assistant Professor of Medicine
Vanderbilt University
入排标准
入选标准
- •Adult patients admitted to the medical or surgical ICU who are receiving treatment for respiratory failure, cardiogenic shock, hemorrhagic shock, and/or septic shock.
排除标准
- •Moderate to severe dementia on ICU admission based on a standardized surrogate assessment (as this would prohibit patients from functioning independently at home);
- •Moderate or severe physical dysfunction that precludes performance of independent activities of daily living based on a standardized surrogate assessment;
- •Live greater than 120 miles from Nashville;
- •Blind, deaf, or unable to speak English;
- •Prisoners;
- •Homelessness and no secondary contact person available
结局指标
主要结局
Tower Test
时间窗: 3 months post hospital discharge
A psychometric measure of executive functioning.
次要结局
- Timed Up and Go (TUG)(12 months post hospital discharge)
- Functional Activities Questionnaire(12 months post-hospital discharge)
- EQ-5 Global Scores(12 months post hospital discharge)
- Activities-Specific Balance Confidence Scale (ABC)(12 months post hospital discharge)
- AD8(12 months post hospital discharge)
- Canadian Study of Health and Aging (CHSA) Frailty Scale(12 months post hospital discharge)
- Tower Test(12 months post hospital discharge)
- Mortality(2 months post hospital discharge)
- Katz Activities of Daily Living (ADL) scale(12 months post hospital discharge)
- Short-Informant Questionnaire of Cognitive Decline in the Elderly (Short IQCODE)(12 months post hospital discharge)
- TRAILS A & B Test(12 months post hospital discharge)
- Mini Mental State Exam (MMSE)(12 months post hospital discharge)
- Dysexecutive Questionnaire (Dys Exec)(12 months post hospital discharge)
- General and Employment Questionnaire(12 months post hospital discharge)
- Rehospitalization rate and number of hospital days(12 months post hospital discharge)