Intensive Care Medicine

, Volume 40, Issue 3, pp 370–379

Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial

  • N. E. Brummel
  • T. D. Girard
  • E. W. Ely
  • P. P. Pandharipande
  • A. Morandi
  • C. G. Hughes
  • A. J. Graves
  • A. Shintani
  • E. Murphy
  • B. Work
  • B. T. Pun
  • L. Boehm
  • T. M. Gill
  • R. S. Dittus
  • J. C. Jackson
Original Article

DOI: 10.1007/s00134-013-3136-0

Cite this article as:
Brummel, N.E., Girard, T.D., Ely, E.W. et al. Intensive Care Med (2014) 40: 370. doi:10.1007/s00134-013-3136-0

Abstract

Purpose

Cognitive impairment after critical illness is common and debilitating. We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness.

Methods

We randomized 87 medical and surgical ICU patients with respiratory failure and/or shock in a 1:1:2 manner to three groups: usual care, early once-daily physical therapy, or early once-daily physical therapy plus a novel, progressive, twice-daily cognitive therapy protocol. Cognitive therapy included orientation, memory, attention, and problem-solving exercises, and other activities. We assessed feasibility outcomes of the early cognitive plus physical therapy intervention. At 3 months, we also assessed cognitive, functional, and health-related quality of life outcomes. Data are presented as median (interquartile range) or frequency (%).

Results

Early cognitive therapy was a delivered to 41/43 (95 %) of cognitive plus physical therapy patients on 100 % (92–100 %) of study days beginning 1.0 (1.0–1.0) day following enrollment. Physical therapy was received by 17/22 (77 %) of usual care patients, by 21/22 (95 %) of physical therapy only patients, and 42/43 (98 %) of cognitive plus physical therapy patients on 17 % (10–26 %), 67 % (46–87 %), and 75 % (59–88 %) of study days, respectively. Cognitive, functional, and health-related quality of life outcomes did not differ between groups at 3-month follow-up.

Conclusions

This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy. Future work to determine optimal patient selection, intensity of treatment, and benefits of cognitive therapy in the critically ill is needed.

Keywords

Delirium Cognitive impairment Brain injury Critical illness Rehabilitation Early mobility Barriers 

Supplementary material

134_2013_3136_MOESM1_ESM.docx (50 kb)
Supplementary material 1 (DOCX 50 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • N. E. Brummel
    • 1
    • 2
    • 3
  • T. D. Girard
    • 1
    • 2
    • 3
    • 4
  • E. W. Ely
    • 1
    • 2
    • 3
    • 4
  • P. P. Pandharipande
    • 5
    • 6
  • A. Morandi
    • 3
    • 7
    • 8
  • C. G. Hughes
    • 5
    • 6
  • A. J. Graves
    • 9
  • A. Shintani
    • 9
  • E. Murphy
    • 10
  • B. Work
    • 10
  • B. T. Pun
    • 2
  • L. Boehm
    • 11
  • T. M. Gill
    • 12
  • R. S. Dittus
    • 4
    • 13
  • J. C. Jackson
    • 1
    • 2
    • 14
    • 15
  1. 1.Division of Allergy, Pulmonary, and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleUSA
  2. 2.Department of Medicine, Center for Health Services ResearchVanderbilt University School of MedicineNashvilleUSA
  3. 3.Department of Medicine, Center for Quality of AgingVanderbilt University School of MedicineNashvilleUSA
  4. 4.Department of Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC) ServiceTennessee Valley Healthcare SystemNashvilleUSA
  5. 5.Division of Critical Care, Department of AnesthesiologyVanderbilt University School of MedicineNashvilleUSA
  6. 6.Anesthesia Service, Department of Veterans Affairs Medical CenterTennessee Valley Healthcare SystemNashvilleUSA
  7. 7.Department of Rehabilitation and Aged CareHospital AncelleCremonaItaly
  8. 8.Geriatric Research GroupBresicaItaly
  9. 9.Department of BiostatisticsVanderbilt University School of MedicineNashvilleUSA
  10. 10.Acute Rehabilitation ServicesVanderbilt University Medical CenterNashvilleUSA
  11. 11.School of NursingVanderbilt UniversityNashvilleUSA
  12. 12.Department of Internal Medicine, School of MedicineYale UniversityNew HavenUSA
  13. 13.Institute for Medicine and Public HealthVanderbilt University School of MedicineNashvilleUSA
  14. 14.Department of PsychiatryVanderbilt University Medical CenterNashvilleUSA
  15. 15.Department of Veterans Affairs Medical Center, Research ServiceTennessee Valley Healthcare SystemNashvilleUSA

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