Standardized In-Bed Mobility Protocol to Increase Functional Outcomes in Pediatric Intensive Care Unit: A Pilot Randomized Controlled Trial

Abstract

The primary aim of this study is to determine whether a standardized in-bed mobility protocol involving an in-bed cycle ergometer in critically ill children increases functional outcomes as measured by the Functional Status Scale (FSS) and dynamometer measurements compared with patients participating in standard rehabilitation care. The secondary aim was to compare hospital length of stay (HLOS) between the two groups. This pilot randomized controlled trial (RCT) was conducted between April 2021 and December 2022. Eligible patients were randomized to the intervention group (up to 30 minutes of daily in-bed cycle ergometer use) or the control group (standardized rehabilitation care). During the study duration, 30 patients were randomized (13 in the control group and 17 in the intervention group). The difference in whole-body muscle strength measurements (enrollment vs. completion of study) was higher in the experimental group (3.68 lbs.) compared with the control group (1.5 lbs.). However, the difference between groups was not statistically significant (p = 0.18). Both the intervention group and the control group showed similar significant improvements in the FSS scores throughout the therapy, with no difference between the two groups. There was a significant positive correlation between exercise time and change in muscle strength (r = 0.75, p = 0.002). No difference in HLOS was detected in the study. Results from this pilot RCT suggest a trend toward benefits from using in-bed cycle ergometers. These devices may be an additional modality for preserving muscle function in critically ill children. Larger multicentric studies are needed for more conclusive evidence.

Keywords

intensive care unit - pediatric - early mobility - cycle ergometer - functional outcomes

Authors' Contributions

M.K. conceived and designed the project; she obtained regulatory approval and funding. M.K. also performed patient enrollment, randomization, and measurements. She assisted in drafting the protocol and final manuscript. J.G., S.M., J.P., K.B., L.H., C.L., and M.W. assisted in study design, patient recruitment, enrollment, and measurements. S.T. supervised the design and conduct of the study. He performed statistical analysis and interpretation and drafted the initial manuscript and all revisions. All authors have reviewed the final manuscript and approved it as submitted.

Publikationsverlauf

Eingereicht: 11. Januar 2024

Angenommen: 23. April 2024

Artikel online veröffentlicht:
30. Mai 2024

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