Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial. Fink, E. L; Beers, S. R; Houtrow, A. J; Richichi, R.; Burns, C.; Doughty, L.; Ortiz-Aguayo, R.; Madurski, C. A; Valenta, C.; Chrisman, M.; Golightly, L.; Kiger, M.; Patrick, C.; Treble-Barna, A.; Pollon, D.; Smith, C. M; Kochanek, P.; and PICU-Rehabilitation Study Group Pediatric Critical Care Medicine, January, 2019.
Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial. [link]Paper  doi  abstract   bibtex   
OBJECTIVES:Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. DESIGN:Randomized controlled trial. SETTING:Three tertiary care PICUs in the United States. PATIENTS:Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours. INTERVENTIONS:Early protocolized (consultation of physical therapy, occupational therapy, and speech and language therapy within 72 hr ICU admission, n = 26) or usual care (consultation per treating team, n = 32). MEASUREMENTS AND MAIN RESULTS:Primary outcomes were consultation timing, treatment type, and frequency of deferrals and safety events. Secondary outcomes included patient and family functional and quality of life outcomes at 6 months. Comparing early protocolized (n = 26) and usual care groups (n = 32), physical therapy was consulted during the hospital admission in 26 of 26 versus 28 of 32 subjects (p = 0.062) on day 2.4 ± 0.8 versus 7.7 ± 4.8 (p = 0.001); occupational therapy in 26 of 26 versus 23 of 32 (p = 0.003), on day 2.3 ± 0.6 versus 6.9 ± 4.8 (p = 0.001); and speech and language therapy in 26 of 26 versus 17 of 32 (p = 0.011) on day 2.3 ± 0.7 versus 13.0 ± 10.8 (p = 0.026). More children in the early protocolized group had consults and treatments occur in the ICU versus ward for all three services (all p \textless 0.001). Eleven sessions were discontinued early: nine during physical therapy and two during occupational therapy, none impacting patient outcome. There were no group differences in functional or quality of life outcomes. CONCLUSIONS:A protocol for early personalized rehabilitation by physical therapy, occupational therapy, and speech and language therapy in pediatric neurocritical care patients could be safely implemented and led to more ICU-based treatment sessions, accelerating the temporal profile and changing composition of interventions versus usual care, but not altering the total dose of rehabilitation.
@article{fink_early_2019,
	title = {Early {Protocolized} {Versus} {Usual} {Care} {Rehabilitation} for {Pediatric} {Neurocritical} {Care} {Patients}: {A} {Randomized} {Controlled} {Trial}.},
	url = {http://Insights.ovid.com/crossref?an=00130478-900000000-98302},
	doi = {10.1097/PCC.0000000000001881},
	abstract = {OBJECTIVES:Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients.

DESIGN:Randomized controlled trial.

SETTING:Three tertiary care PICUs in the United States.

PATIENTS:Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours.

INTERVENTIONS:Early protocolized (consultation of physical therapy, occupational therapy, and speech and language therapy within 72 hr ICU admission, n = 26) or usual care (consultation per treating team, n = 32).

MEASUREMENTS AND MAIN RESULTS:Primary outcomes were consultation timing, treatment type, and frequency of deferrals and safety events. Secondary outcomes included patient and family functional and quality of life outcomes at 6 months. Comparing early protocolized (n = 26) and usual care groups (n = 32), physical therapy was consulted during the hospital admission in 26 of 26 versus 28 of 32 subjects (p = 0.062) on day 2.4 ± 0.8 versus 7.7 ± 4.8 (p = 0.001); occupational therapy in 26 of 26 versus 23 of 32 (p = 0.003), on day 2.3 ± 0.6 versus 6.9 ± 4.8 (p = 0.001); and speech and language therapy in 26 of 26 versus 17 of 32 (p = 0.011) on day 2.3 ± 0.7 versus 13.0 ± 10.8 (p = 0.026). More children in the early protocolized group had consults and treatments occur in the ICU versus ward for all three services (all p {\textless} 0.001). Eleven sessions were discontinued early: nine during physical therapy and two during occupational therapy, none impacting patient outcome. There were no group differences in functional or quality of life outcomes.

CONCLUSIONS:A protocol for early personalized rehabilitation by physical therapy, occupational therapy, and speech and language therapy in pediatric neurocritical care patients could be safely implemented and led to more ICU-based treatment sessions, accelerating the temporal profile and changing composition of interventions versus usual care, but not altering the total dose of rehabilitation.},
	journal = {Pediatric Critical Care Medicine},
	author = {Fink, Ericka L and Beers, Sue R and Houtrow, Amy J and Richichi, Rudolph and Burns, Cheryl and Doughty, Lesley and Ortiz-Aguayo, Roberto and Madurski, Catherine A and Valenta, Cynthia and Chrisman, Maddie and Golightly, Lynn and Kiger, Michelle and Patrick, Cheryl and Treble-Barna, Amery and Pollon, Dorothy and Smith, Craig M and Kochanek, Patrick and {PICU-Rehabilitation Study Group}},
	month = jan,
	year = {2019},
	pages = {1},
}
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