Physiotherapy - Research Publications
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ItemCan an accelerometer-based monitor be used to accurately assess physical activity in a population of survivors of critical illness?(Canadian Center of Science and Education, 2012-04-28)PURPOSE: To investigate the validity and reliability of the Activity Monitoring Pod (AMP331) to record gait parameters in healthy young adults (YA) and intensive care unit inpatients (ICU). METHODS: Fifteen YA completed a series of over-ground walks. Another 15 YA completed a series of treadmill walks. The ICU group (N=20) completed a series of over-ground walks with repeat trials. Gait parameters were recorded simultaneously for each walk. RESULTS: For the YA over-ground condition, no significant differences were found between the measures recorded by the systems. For the YA treadmill condition, 43% of the measures differed (P < .05). For the ICU group, the AMP331 underestimated distance and speed by 3m and 25cm/s respectively. Reliability measures for distance (ICC 0.99, 95%CI 0.98 - 0.99) and step count (ICC 0.99, 95%CI 0.99 - 1.00) were excellent. CONCLUSIONS: The AMP 331 is a valid instrument for recording basic gait parameters for over-ground walking in healthy YA and ICU survivors.
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ItemNo Preview AvailableQuantifying Physical Activity Levels of Survivors of Intensive Care: A Prospective Observational Study(OXFORD UNIV PRESS INC, 2012-12)BACKGROUND: Promotion of increased physical activity is advocated for survivors of an intensive care unit (ICU) admission to improve physical function and health-related quality of life. OBJECTIVE: The primary aims of this study were: (1) to measure free-living physical activity levels and (2) to correlate the measurements with scores on a self-reported activity questionnaire. A secondary aim was to explore factors associated with physical activity levels. DESIGN: This was a prospective cohort study. METHODS: Nested within a larger randomized controlled trial, participants were block randomized to measure free-living physical activity levels. Included participants wore an accelerometer for 7 days during waking hours at 2 months after ICU discharge. At completion of the 7 days of monitoring, participants were interviewed using the Physical Activity Scale for the Elderly (PASE) questionnaire. Factors associated with physical activity were explored using regression analysis. RESULTS: The ICU survivors (median age=59 years, interquartile range=49-66; mean Acute Physiologic Chronic Health Evaluation [APACHE II] score=18, interquartile range=16-21) were inactive when quantitatively measured at 2 months after hospital discharge. Participants spent an average of 90% of the time inactive and only 3% of the time walking. Only 37% of the sample spent 30 minutes or more per day in the locomotion category (more than 20 steps in a row). Activity reported using the PASE questionnaire was lower than that reported in adults who were healthy. The PASE scores correlated only fairly with activity measured by steps per day. The presence of comorbidities explained one third of the variance in physical activity levels. LIMITATIONS: Accelerometer overreading, patient heterogeneity, selection bias, and sample size not reached were limitations of the study. CONCLUSIONS: Survivors of an ICU admission greater than 5 days demonstrated high levels of inactivity for prolonged periods at 2 months after ICU discharge, and the majority did not meet international recommendations regarding physical activity. Comorbidity appears to be a promising factor associated with activity levels.
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ItemExercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up(BMC, 2013)INTRODUCTION: The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors. METHODS: We conducted a single-center, assessor-blinded, randomized controlled trial. One hundred and fifty participants were stratified and randomized to receive usual care or intervention if they were in the ICU for 5 days or more and had no permanent neurological insult. The intervention group received intensive exercises in the ICU and the ward and as outpatients. Participants were assessed at recruitment, ICU admission, hospital discharge and at 3-, 6- and 12-month follow-up. Physical function was evaluated using the Six-Minute Walk Test (6MWT) (primary outcome), the Timed Up and Go Test and the Physical Function in ICU Test. Patient-reported outcomes were measured using the Short Form 36 Health Survey, version 2 (SF-36v2) and Assessment of Quality of Life (AQoL) Instrument. Data were analyzed using mixed models. RESULTS: The a priori enrollment goal was not reached. There were no between-group differences in demographic and hospital data, including acuity and length of acute hospital stay (LOS) (Acute Physiology and Chronic Health Evaluation II score: 21 vs 19; hospital LOS: 20 vs 24 days). No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12 months after ICU discharge. However, exploratory analyses showed the rate of change over time and mean between-group differences in 6MWT from first assessment were greater in the intervention group. CONCLUSIONS: Further research examining the trajectory of improvement with rehabilitation is warranted in this population. TRIAL REGISTRATION: The trial was registered with the Australian New Zealand Clinical Trials Registry ACTRN12605000776606.