Efficacy of conventional rehabilitation, transcutaneous electrical nerve stimulation, or early mobilization to reverse acquired weakness in the intensive care unit. Randomized controlled pilot trial

Abstract

AbstractObjectiveTo compare the efficacy of conventional rehabilitation, transcutaneous electrical nerve stimulation, and early mobilization in reducing the time needed to reverse intensive care unit-acquired weakness (ICUAW), as assessed by the Medical Research Council muscle strength scale (MRC-MSS) score, in patients clinically diagnosed with ICUAW.SettingMedical-surgical ICU of a general acute care hospital with 26 beds.DesignPilot trial with random assignment and a control group.InterventionsGroup 1: standard or routine rehabilitation, Group 2: transcutaneous electrical nerve stimulation, and Group 3: early mobilization protocol.SubjectsIndividuals over 18 years old admitted to the ICU with invasive mechanical ventilation for more than 24 hours and diagnosed with ICUAW defined as Score MRC-MSS<48 measured over two consecutive days.Results18 subjects were included. One-way ANOVA showed differences in the treatment days needed to achieve an MRC-MSS ≥48 (p = 0.01), as well as in the number of sessions required to reverse ICUAW (p = 0.01) when comparing the different interventions. Through post hoc analysis, the group treated with transcutaneous electrical nerve stimulation was identified as requiring significantly more days and sessions to reverse ICUAW. Differences were observed in the Barthel index at the end and in the variation of the Barthel index as a result of functional capacity among the different treatments.ConclusionThe group treated with transcutaneous electrical nerve stimulation required a significantly greater number of days and sessions to achieve an MRC-SS ≥48. No differences in functional limitation were observed. These findings should be corroborated in similar studies. (Clinicaltrial.govNCT04613908)