Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: A randomized controlled trial

• Published in: Journal of critical care 2015-10, Vol.30 (5), p.901-907
• Main Authors: Jones, C., MPhil, PhD, Eddleston, J., FRCAnaes, McCairn, A., BSc, MSc, Dowling, S., BSc, McWilliams, D., BSc, Coughlan, E., RGN, Griffiths, R.D., BSc, MD, FRCP, FFICM, FHEA
• Format: Article
• Language: English
• Subjects: 6 minute walk test; Ambulatory Care - methods; Amino acids; Amino Acids, Essential - administration & dosage; Analysis of Variance; Anxiety; Anxiety - prevention & control; Critical Care; Critical Care - methods; Critical Illness - rehabilitation; Depression; Depression - prevention & control; Dietary Supplements; Double-Blind Method; Exercise Therapy - methods; Female; Glutamine - administration & dosage; Humans; Illnesses; Insulin; Intensive Care Units; Intervention; Male; Middle Aged; Musculoskeletal system; Nutrition; Palliative care; Physical fitness; Physical Therapy Modalities; Physiotherapy; Protein synthesis; Proteins; Quality of Life; Rehabilitation; Respiratory distress syndrome; Self help; Supplement; Walking - physiology
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.05.002

Abstract Purpose Patients recovering from critical illness may be left with significant muscle mass loss. This study aimed to evaluate whether a 6-week program of enhanced physiotherapy and structured exercise (PEPSE) and an essential amino acid supplement drink (glutamine and essential amino acid mixture [GEAA]) improves physical and psychological recovery. Materials and methods Intensive care patients aged 45 years or older, with a combined intensive care unit stay/pre–intensive care unit stay of 5 days or more were recruited to a randomized controlled trial examining the effect of PEPSE and GEAA on recovery. The 2 factors were tested in a 2 × 2 factorial design: (1) GEAA drink twice daily for 3 months and (2) 6-week PEPSE in first 3 months. Primary efficacy outcome was an improvement in the 6-minute walking test at 3 months. Results A total of 93 patients were randomized to the study. Patients receiving the PEPSE and GEA had the biggest gains in distance walked in 6-minute walking test ( P < .0001). There were also significant reductions in rates of anxiety in study groups control supplement/PEPSE ( P = .047) and GEAA supplement/PEPSE ( P = .036) and for GEAA supplement/PEPSE in depression ( P = .0009). Conclusion Enhanced rehabilitation combined with GEAA supplement may enhance physical recovery and reduce anxiety and depression.