What is the effect of passive movements on joint stiffness in intensive care unit patients?

INTERVENTION: For the purposes of this study, the intervention for the side of the body allocated to receive passive movements will involve the treating intensive care unit (ICU) physiotherapist moving the participant’s elbow and ankle joints through a full range of motion. These two joints were selected for the intervention based on previous research and our own anecdotal experience in ICU regarding which joints seem to get stiff most frequently, and the ease of measurement of range of motion. The intensity, frequency and duration of the intervention, as follows, is based on a treatment protocol used in a previous published study and survey responses reported previously. We elected to use a relatively intensive passive movement regimen as we want to maximise the likelihood of finding a treatment effect. Passive movements will be given to the elbow and ankle joints on the allocated side for 10 minutes each in the morning and afternoon, five days per week (weekdays). It is anticipated that participants will require the intervention for at least a two week period, though there is no mandatory minimum intervention duration. The intervention for the ankle joint will involve dorsiflexion (with knee in extension and flexion), plantarflexion, inversion and eversion through the available range of motion. For the elbow joint the intervention will involve flexion, extension, pronation and supination through the available range of motion. No force will be used at the end of joint range. As per usual clinical practice, no specific advice will be given to the treating physiotherapists regarding cadence of movements. Adherence with the provision of this intervention will be recorded on a purpose‐designed form. In keeping with usual clinical practice, the passive movements intervention (to CONDITION: Critical illness;Reduced range of joint movement; ; Critical illness ; Reduced range of joint movement Injuries and Accidents ‐ Other injuries and accidents Musculoskeletal ‐ Other muscular and skeletal disorders Neurological ‐ Other neurological disorders Respiratory ‐ Other respiratory disorders / diseases PRIMARY OUTCOME: Passive ankle dorsiflexion range of motion. Measured using a standard goniometer.[Baseline, at cessation of passive movements (if required) and 4 weeks after commencement of intervention. ] INCLUSION CRITERIA: • Admitted to the Royal Adelaide Hospital ICU. • Intubated and expected to remain invasively mechanically ventilated > 48 hours (total). • Anticipated ICU length of stay greater than or equal to 5 days. • Aged greater than or equal to 18 years. • Unable to move their limbs through full range of motion voluntarily (either unconscious/sedated patients and/or those who are not able to move their limbs due to their underlying medical condition). This is likely to include patients with medical illnesses (e.g. severe respiratory failure, sepsis) who are receiving sedative medications as part of their care and/or patients after spinal cord injury or traumatic brain injury. SECONDARY OUTCOME: Maximal mobility. Measured using the ICU Mobility Scale.[Baseline, at cessation of passive movements (if required) and 4 weeks after commencement of intervention. ] Participant feedback on study interventions. Measured using a purpose‐designed short questionnaire.[At cessation of passive movements or 4 weeks after commencement of intervention. ] Passive ankle plantarflexion. Measured with a standard goniometer.[Baseline, at cessation of passive movements (if required) and 4 weeks after commencement of intervention. ] Passive elbow extension. Measured with a standard goniometer.[Baseline, at cessation of passive movements (if required) and 4 weeks after commencement of intervention. ] Passive elbow flexion. Measured with a standard goniometer.[Baseline, at cessation of passive movements (if required) and 4 weeks after commencement of intervention. ] Self‐reported pain/stiffness in ankles/elbows. Measured with a verbal analogue scale (0‐10 where 0 = no pain/stiffness and 10 = worst pain/stiffness imaginable).[Baseline, at cessation of passive movements (if required) and 4 weeks after commencement of intervention. ]