Dr Kathy Stiller1, Simone Dafoe1, Christabel Jesudason1, Tony McDonald1, Rocky Callisto1
1Royal Adelaide Hospital, Central Adelaide Local Health Network, Australia
Biography:
Kathy Stiller obtained her PhD in 1995 and worked in ICU as the principal physiotherapist for approximately 20 years. She has worked part time as research coordinator for allied health at Central Adelaide Local Health Network for the last 10 years. Kathy has over 100 publications in peer-reviewed journals, covering a range of topics relevant to allied health.
Abstract:
Aims:
To investigate whether passive movements (PMs) prevent or reduce joint stiffness in ICU patients.
Methods:
A randomised, controlled, within-participant, assessor-blinded study was undertaken in an adult ICU. Intubated patients expected to be invasively mechanically ventilated > 48 hours with an ICU length of stay ≥ 5 days, and unable to voluntarily move their limbs through full range of motion (ROM) were eligible. The ankle and elbow on one side of each participant’s body received PMs (10 minutes/joint, morning and afternoon, 5 days/week). The other side was the control. The PMs intervention continued as clinically indicated to a maximum 4 weeks. The primary outcome was ankle dorsiflexion ROM at cessation-of-PMs. Plantarflexion, elbow flexion/extension ROM, and participant-reported joint pain and stiffness (verbal analogue scale [VAS]) were also measured. Outcomes were recorded at baseline and cessation-of-PMs. For participants whose PMs intervention ceased early due to recovery, additional post-early-cessation-of-PMs review measurements were undertaken as near as possible to 4 weeks.
Results:
Data from 25 participants with a median (IQR) ICU stay of 15.6 days (11.3-25.4) were analysed. Mean (95% CI) between-side difference for dorsiflexion ROM at cessation-of-PMs was 0.4º (-4.4, 5.2; P = 0.882), favouring the intervention side, indicating there was not a clinically meaningful effect (5º). No significant differences were found between intervention and control sides for any ROM or VAS data.
Conclusions:
In the first randomised controlled trial on this topic, PMs, as provided to this sample of medium- to long-stay ICU patients, did not prevent or reduce joint stiffness.