title: Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: A randomized controlled trial.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  Enhanced rehabilitation combined with GEAA supplement may enhance physical recovery and reduce anxiety and depression.
authors.affiliation: Critical Care, Ward 4E, Whiston Hospital, Prescot, UK; Musculoskeletal Biology, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK. Electronic address: christinajonesc@aol.com.
authors.forename: C
authors.initials: C
authors.lastname: Jones
authors.affiliation: ICU, Manchester Royal Infirmary, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Eddleston
authors.affiliation: Critical Care, Ward 4E, Whiston Hospital, Prescot, UK.
authors.forename: A
authors.initials: A
authors.lastname: McCairn
authors.affiliation: Critical Care, Ward 4E, Whiston Hospital, Prescot, UK.
authors.forename: S
authors.initials: S
authors.lastname: Dowling
authors.affiliation: Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: D
authors.initials: D
authors.lastname: McWilliams
authors.affiliation: ICU, Manchester Royal Infirmary, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Coughlan
authors.affiliation: Musculoskeletal Biology, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK.
authors.forename: R D
authors.initials: RD
authors.lastname: Griffiths
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D000601:Amino Acids, Essential / Q000008:administration & dosage*; D000704:Analysis of Variance; D001007:Anxiety / Q000517:prevention & control; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000534:rehabilitation*; D003863:Depression / Q000517:prevention & control; D019587:Dietary Supplements; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005973:Glutamine / Q000008:administration & dosage; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016138:Walking / Q000502:physiology
chemical_list: D000601:Amino Acids, Essential; D005973:Glutamine
keywords: 6 minute walk test; Anxiety; Depression; Intervention; Physiotherapy; Supplement