Short-term effect of active lower limb cycle ergometry on mobility and muscle strength in critically ill patients: a randomized blinded clinical trial

Abstract

Background: The effects of in-bed cycling on mobility and muscle strength is not well established, in parts due to the difficulty of measuring mobility. Objective: Investigate the effect of active lower limb cycle ergometry on mobility and muscle strength in critically ill patients evaluated by the Perme Intensive Care Unit Mobility Score and Medical Research Council, respectively. Methods: Critically ill patients dependent on mechanical ventilation were randomized, determining the control group and the experimental group. A intervention was applied for eight consecutive days and a blind physiotherapists assessed mobility before and after interventions. The experimental group (EG) was an active lower limb in-bed cycle ergometry by 15 minutes (once a day), associated with routine physiotherapy intervention (twice a day). The control group (CG) had routine physiotherapy intervention. The two-factor mixed ANOVA with Bonferroni correction tested the mobility status and muscle strength, evaluated by Perme Intensive Care Unit Mobility Score and Medical Research Council, respectively. Results: Thirty-seven patients were eligible, but 24 completed the study (12 each group). There was an interaction between interventions (before and after) and groups for mobility (F=59.513, p=0.006). But there was no interaction for muscle strength (F=4.097 p=0.055). The groups were similar before intervention for mobility [(p=0.343); confidence interval: (CG: 8.239 to 10.761) and (EG: 7.405 to 9.928)], but only the experimental group demonstrated improvement in mobility post-intervention [(p=0.017); confidence interval: (15.807 to 21.193)]. Conclusion: Compared to routine physiotherapy, in-bed cycling improved the mobility level, but not in muscle strength. Perme score was sensible to measure the mobility evolution in critical patients.