title: Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial.
abstract: OBJECTIVE
  Cognitive impairment after critical illness is common and debilitating. We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness.
  
  
  METHODS
  We randomized 87 medical and surgical ICU patients with respiratory failure and/or shock in a 1:1:2 manner to three groups: usual care, early once-daily physical therapy, or early once-daily physical therapy plus a novel, progressive, twice-daily cognitive therapy protocol. Cognitive therapy included orientation, memory, attention, and problem-solving exercises, and other activities. We assessed feasibility outcomes of the early cognitive plus physical therapy intervention. At 3 months, we also assessed cognitive, functional, and health-related quality of life outcomes. Data are presented as median (interquartile range) or frequency (%).
  
  
  RESULTS
  Early cognitive therapy was a delivered to 41/43 (95%) of cognitive plus physical therapy patients on 100% (92-100%) of study days beginning 1.0 (1.0-1.0) day following enrollment. Physical therapy was received by 17/22 (77%) of usual care patients, by 21/22 (95%) of physical therapy only patients, and 42/43 (98%) of cognitive plus physical therapy patients on 17% (10-26%), 67% (46-87%), and 75% (59-88%) of study days, respectively. Cognitive, functional, and health-related quality of life outcomes did not differ between groups at 3-month follow-up.
  
  
  CONCLUSIONS
  This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy. Future work to determine optimal patient selection, intensity of treatment, and benefits of cognitive therapy in the critically ill is needed.
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 350, Nashville, TN, 37203-1425, USA, nathan.brummel@vanderbilt.edu.
authors.forename: N E
authors.initials: NE
authors.lastname: Brummel
authors.forename: T D
authors.initials: TD
authors.lastname: Girard
authors.forename: E W
authors.initials: EW
authors.lastname: Ely
authors.forename: P P
authors.initials: PP
authors.lastname: Pandharipande
authors.forename: A
authors.initials: A
authors.lastname: Morandi
authors.forename: C G
authors.initials: CG
authors.lastname: Hughes
authors.forename: A J
authors.initials: AJ
authors.lastname: Graves
authors.forename: A
authors.initials: A
authors.lastname: Shintani
authors.forename: E
authors.initials: E
authors.lastname: Murphy
authors.forename: B
authors.initials: B
authors.lastname: Work
authors.forename: B T
authors.initials: BT
authors.lastname: Pun
authors.forename: L
authors.initials: L
authors.lastname: Boehm
authors.forename: T M
authors.initials: TM
authors.lastname: Gill
authors.forename: R S
authors.initials: RS
authors.lastname: Dittus
authors.forename: J C
authors.initials: JC
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D060825:Cognitive Dysfunction / Q000628:therapy*; D016638:Critical Illness / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods; D010865:Pilot Projects; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome