First results about recovery of walking function in patients with intensive care unit-acquired muscle weakness from the General Weakness Syndrome Therapy (GymNAST) cohort study.

OBJECTIVES: To describe the time course of recovery of walking function and other activities of daily living in patients with intensive care unit (ICU)-acquired muscle weakness. DESIGN: This is a cohort study. PARTICIPANTS: We included critically ill patients with ICU-acquired muscle weakness. SETTING: Post-acute ICU and rehabilitation units in Germany. MEASURES: We measured walking function, muscle strength, activities in daily living, motor and cognitive function. RESULTS: We recruited 150 patients (30% female) who fulfilled our inclusion and exclusion criteria. The primary outcome recovery of walking function was achieved after a median of 28.5 days (IQR=45) after rehabilitation onset and after a median of 81.5 days (IQR=64) after onset of illness. Our final multivariate model for recovery of walking function included two clinical variables from baseline: the Functional Status Score ICU (adjusted HR=1.07 (95% CI 1.03 to 1.12) and the ability to reach forward in cm (adjusted HR=1.02 (95% CI 1.00 to 1.04). All secondary outcomes but not pain improved significantly in the first 8 weeks after study onset. CONCLUSIONS: We found good recovery of walking function for most patients and described the recovery of walking function of people with ICU-acquired muscle weakness. TRIALS REGISTRATIONS NUMBER: Sächsische Landesärztekammer EK-BR-32/13-1; DRKS00007181, German Register of Clinical Trials.

Physical rehabilitation for critical illness myopathy and neuropathy.

BACKGROUND: Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. OBJECTIVES: Our primary objective was to assess the effects of physical rehabilitation therapies and interventions for people with CIP and CIM in improving activities of daily living such as walking, bathing, dressing and eating. Secondary objectives were to assess effects on muscle strength and quality of life, and to assess adverse effects of physical rehabilitation. SEARCH METHODS: On 16 July 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register and on 14 July 2014 we searched CENTRAL, MEDLINE, EMBASE and CINAHL Plus. In July 2014, we searched the Physiotherapy Evidence Database (PEDro, http://www.pedro.org.au/) and three trials registries for ongoing trials and further data about included studies. There were no language restrictions. We also handsearched relevant conference proceedings and screened reference lists to identify further trials. SELECTION CRITERIA: We planned to include randomised controlled trials (RCTs), quasi-RCTs and randomised controlled cross-over trials of any rehabilitation intervention in people with acquired weakness syndrome due to CIP/CIM. DATA COLLECTION AND ANALYSIS: We would have extracted data, assessed the risk of bias and classified the quality of evidence for outcomes in duplicate, according to the standard procedures of The Cochrane Collaboration. Outcome data collection would have been for activities of daily living (for example, mobility, walking, transfers and self care). Secondary outcomes included muscle strength, quality of life and adverse events. MAIN RESULTS: The search strategy retrieved 3587 references. After examination of titles and abstracts, we retrieved the full text of 24 potentially relevant studies. None of these studies met the inclusion criteria of our review. No data were suitable to be included in a meta-analysis. AUTHORS' CONCLUSIONS: There are no published RCTs or quasi-RCTs that examine whether physical rehabilitation interventions improve activities of daily living for people with CIP and CIM. Large RCTs, which are feasible, need to be conducted to explore the role of physical rehabilitation interventions for people with CIP and CIM.

The General Weakness Syndrome Therapy (GymNAST) study: protocol for a cohort study on recovery on walking function.

INTRODUCTION: Critical illness myopathy (CIM) and polyneuropathy (CIP) are common complications of critical illness that frequently occur together. Both cause so called intensive care unit (ICU)-acquired muscle weakness. This weakness of limb muscles increases morbidity and delay rehabilitation and recovery of walking ability. Although full recovery has been reported people with severe weakness may take months to improve walking. Focused physical rehabilitation of people with ICU-acquired muscle weakness is therefore of great importance. However, although physical rehabilitation is common, detailed knowledge about the pattern and the time course of recovery of walking function are not well understood. Therefore, the aim of the General Weakness Syndrome Therapy (GymNAST) study is to describe the time course of recovery of walking function and other activities of daily living in these patients. METHODS AND ANALYSIS: We conduct a prospective cohort study of people with ICU-acquired muscle weakness with defined diagnosis of CIM or CIP. Based on our sample size calculation, approximately 150 patients will be recruited from the ICU of our hospital in Germany. Amount and content of physical rehabilitation, clinical tests for example, muscle strength and motor function and neuropsychological assessments will be used as independent variables. The primary outcomes will include recovery of walking function and mobility. Secondary outcomes will include global motor function, activities in daily life and participation. ETHICS AND DISSEMINATION: The study is being carried out in agreement with the Declaration of Helsinki and conducted with the approval of the local medical Ethics Committee (Landesärztekammer Sachsen, Germany, reference number EK-BR-32/13-1) and with the understanding and written consent of each patient's guardian. The results of this study will be published in peer-reviewed journals and disseminated to the medical society and general public.

Immediate effects of two attention strategies on trunk control on patients after stroke. A randomized controlled pilot trial.

OBJECTIVE: To compare the immediate effects of an external focus to enhance lateral body weight shift after stroke. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation hospital. SUBJECTS: Twenty patients after stroke (11 males; mean (SD) age 72.2 (7.4) years; duration of illness 56 (14) days; there were 9 (45%) left-sided strokes) with impaired sitting balance were randomly allocated into two groups either external focus (n = 10) or internal focus (n = 10). INTERVENTION: Patients in the external focus group, while sitting, were instructed to shift as much weight as they could sidewards to an external point next to their hip. Patients in the internal focus group were instructed to shift as much weight as they could sidewards to their hip. MAIN OUTCOME MEASURES: Immediate lateral body weight shift as well as anterior-posterior deviation was measured in centimetres with a sensor mat. RESULTS: Patients in the external focus group achieved greater lateral body weight shift than those in the internal focus group (mean shift (SD) 8.7 (2.6) cm vs. 4.5 (3.3) cm, respectively; P = 0.006). However, there were no significant differences in anterior-posterior deviation (mean shift (SD) 2.3 (1.3) cm vs. 1.2 (1.2) cm, respectively; P = 0.08). CONCLUSION: Using an external focus may lead immediately to an enhanced lateral body weight shift while sitting, without increasing anterior-posterior deviation.