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Preliminary Communication
July 24/31, 2018

Effect of In-Bed Leg Cycling and Electrical Stimulation of the Quadriceps on Global Muscle Strength in Critically Ill AdultsA Randomized Clinical Trial

Author Affiliations
  • 1Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France
  • 2Service de Réanimation Chirurgicale, Centre Hospitalier Régional d’Orléans, Orléans, France
JAMA. 2018;320(4):368-378. doi:10.1001/jama.2018.9592
Key Points

Question  Can the combination of early in-bed leg cycling and electrical stimulation of the quadriceps muscles added to standardized early rehabilitation result in better muscle function in critically ill adult patients at discharge from the intensive care unit?

Findings  In this randomized clinical trial that included 314 patients, the addition of in-bed cycling and electrical stimulation of the quadriceps muscles to early rehabilitation compared with early rehabilitation alone did not result in a significant improvement in global muscle strength at discharge from the intensive care unit (48 vs 51 points, respectively, on the 60-point Medical Research Council grading system in which higher values represent better strength).

Meaning  Early in-bed cycling and electrical muscle stimulation as used in this study did not improve muscle strength in critically ill patients.

Abstract

Importance  Early in-bed cycling and electrical muscle stimulation may improve the benefits of rehabilitation in patients in the intensive care unit (ICU).

Objective  To investigate whether early in-bed leg cycling plus electrical stimulation of the quadriceps muscles added to standardized early rehabilitation would result in greater muscle strength at discharge from the ICU.

Design, Setting, and Participants  Single-center, randomized clinical trial enrolling critically ill adult patients at 1 ICU within an 1100-bed hospital in France. Enrollment lasted from July 2014 to June 2016 and there was a 6-month follow-up, which ended on November 24, 2016.

Interventions  Patients were randomized to early in-bed leg cycling plus electrical stimulation of the quadriceps muscles added to standardized early rehabilitation (n = 159) or standardized early rehabilitation alone (usual care) (n = 155).

Main Outcomes and Measures  The primary outcome was muscle strength at discharge from the ICU assessed by physiotherapists blinded to treatment group using the Medical Research Council grading system (score range, 0-60 points; a higher score reflects better muscle strength; minimal clinically important difference of 4 points). Secondary outcomes at ICU discharge included the number of ventilator-free days and ICU Mobility Scale score (range, 0-10; a higher score reflects better walking capability). Functional autonomy and health-related quality of life were assessed at 6 months.

Results  Among 314 randomized patients, 312 (mean age, 66 years; women, 36%; receiving mechanical ventilation at study inclusion, 78%) completed the study and were included in the analysis. The median global Medical Research Council score at ICU discharge was 48 (interquartile range [IQR], 29 to 58) in the intervention group and 51 (IQR, 37 to 58) in the usual care group (median difference, −3.0 [95% CI, −7.0 to 2.8]; P = .28). The ICU Mobility Scale score at ICU discharge was 6 (IQR, 3 to 9) in both groups (median difference, 0 [95% CI, −1 to 2]; P = .52). The median number of ventilator-free days at day 28 was 21 (IQR, 6 to 25) in the intervention group and 22 (IQR, 10 to 25) in the usual care group (median difference, 1 [95% CI, −2 to 3]; P = .24). Clinically significant events occurred during mobilization sessions in 7 patients (4.4%) in the intervention group and in 9 patients (5.8%) in the usual care group. There were no significant between-group differences in the outcomes assessed at 6 months.

Conclusions and Relevance  In this single-center randomized clinical trial involving patients admitted to the ICU, adding early in-bed leg cycling exercises and electrical stimulation of the quadriceps muscles to a standardized early rehabilitation program did not improve global muscle strength at discharge from the ICU.

Trial Registration  ClinicalTrials.gov Identifier: NCT02185989

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