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Newman ANL, Gravesande J, Rotella S, Wu SS, Topp-Nguyen N, Kho ME, Harris JE, Fox-Robichaud A, Solomon P. Physiotherapy in the neurotrauma intensive care unit: A scoping review. J Crit Care 2018; 48:390-406. [PMID: 30316038 DOI: 10.1016/j.jcrc.2018.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/20/2018] [Accepted: 09/30/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE This scoping review summarizes the literature on the safety and effectiveness of physiotherapy interventions in patients with neurological and/or traumatic injuries in the intensive care unit (ICU), identifies literature gaps and provides recommendations for future research. MATERIALS AND METHODS We searched five databases from inception to June 2, 2018. We included published retrospective studies, case studies, observation and randomized controlled trials describing physiotherapy interventions in ICU patients with neurotrauma injuries. Two reviewers reviewed the databases and independently screened English articles for eligibility. Data extracted included purpose, study design, population (s), outcome measures, interventions and results. Thematic analysis and descriptive numerical summaries are presented by intervention type. RESULTS 12,846 titles were screened and 72 met the inclusion criteria. Most of the studies were observational studies (44 (61.1%)) and RCTs (14 (19.4%)). Early mobilization, electrical stimulation, range of motion, and chest physiotherapy techniques were the most common interventions in the literature. Physiotherapy interventions were found to be safe with few adverse events. CONCLUSIONS Gaps in the literature suggest that future studies require assessment of long term functional outcomes and quality of life, examination of homogenous populations and more robust methodologies including clinical trials and larger samples.
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Affiliation(s)
- Anastasia N L Newman
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada; Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
| | - Janelle Gravesande
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
| | - Stephanie Rotella
- Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada
| | - Stephen S Wu
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada
| | - Nam Topp-Nguyen
- Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada.
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada; Physiotherapy Department, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
| | - Alison Fox-Robichaud
- Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada; Department of Medicine, Division of Critical Care, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
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Yelnik AP, Quintaine V, Andriantsifanetra C, Wannepain M, Reiner P, Marnef H, Evrard M, Meseguer E, Devailly JP, Lozano M, Lamy C, Colle F, Vicaut E. AMOBES (Active Mobility Very Early After Stroke): A Randomized Controlled Trial. Stroke 2016; 48:400-405. [PMID: 28008092 DOI: 10.1161/strokeaha.116.014803] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/08/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Intensive physical therapy (PT) facilitates motor recovery when provided during a subacute stage after stroke. The efficiency of very early intensive PT has been less investigated. We aimed to investigate whether intensive PT conducted within the first 2 weeks could aid recovery of motor control. METHODS This multicentre randomized controlled trial compared soft PT (20-min/d apart from respiratory needs) and intensive PT (idem+45 minutes of intensive exercises/day) initiated within the first 72 hours after a first hemispheric stroke. The primary outcome was change in motor control between day (D) 90 and D0 assessed by the Fugl-Meyer score. Main secondary outcomes were number of days to walking 10 m unassisted, balance, autonomy, quality of life, and unexpected medical events. All analyses were by intent to treat. RESULTS We could analyze data for 103 of the 104 included patients (51 control and 52 experimental group; 64 males; median age overall 67 [interquartile range 59-77], 67 right hemispheric lesions, 80 ischemic lesions, National Institutes of Health Stroke Scale score ≥8 for 82%). Fugl-Meyer score increased over time (P<0.0001), with no significant effect of treatment (P=0.29) or interaction between treatment and time (P=0.40). The median change in score between D90 and D0 was 27.5 (12-40) and 22.0 (12-56) for control and experimental groups (P=0.69). Similar results were found for the secondary criteria. CONCLUSIONS Very early after stroke, intensive exercises may not be efficient in improving motor control. This conclusion may apply to mainly severe stroke. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01520636.
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Affiliation(s)
- Alain P Yelnik
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.).
| | - Victorine Quintaine
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Cedric Andriantsifanetra
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Marie Wannepain
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Peggy Reiner
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Hélène Marnef
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Mathilde Evrard
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Elena Meseguer
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Jean Pascal Devailly
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Monica Lozano
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Catherine Lamy
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Florence Colle
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
| | - Eric Vicaut
- From the PRM Department, GH Lariboisière F. Widal, AP-HP, Paris Diderot University, UMR8257, Paris, France (A.P.Y., V.Q., C.A., M.W., H.M., M.E.); Neurological Department GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (P.R.); Department of Neurology and Stroke Centre (E.M.) and PRM Department (J.P.D., M.L.), GH Paris Nord Val de Seine, AP-HP, Paris Diderot University, Paris, France; Neurological Department (C.L.) and PRM Department (F.C.), Sainte Anne Hospital, Paris Descartes University, Paris, France; and Clinical Research Unit GH Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France (E.V.)
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