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Intensive Care Medicine
Published in: Intensive Care Medicine 3/2014

01-03-2014 | Original Article

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

Authors: 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

Published in: Intensive Care Medicine | Issue 3/2014

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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.
Appendix
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Metadata
Title
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
Authors
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
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 3/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-013-3136-0

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