EPICC
Trial question
What is the role of intensive physical rehabilitation therapy in critically ill patients?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 308
308 patients (128 female, 180 male).
Inclusion criteria: adult patients who had received at least 48 hours of either invasive or noninvasive ventilation.
Key exclusion criteria: end-of-life care; acute brain or spinal cord injury; multiple trauma if mobilization therapy was judged unlikely to be possible; burns; rapidly progressive neuromuscular disease.
Interventions
N=150 intensive therapy (a target of 90 minutes of physical rehabilitation daily for 5 days per week).
N=158 standard care (a target of 30 minutes of physical rehabilitation daily for 5 days per week).
Primary outcome
Physical Component Summary measure of 36-Item Short Form Survey Quality of Life questionnaire at 6 months
37 points
37 points
37.0 points
27.8 points
18.5 points
9.3 points
0.0 points
Intensive
therapy
Standard
care
No significant
difference ↔
No significant difference in Physical Component Summary measure of the 36-Item Short Form Survey QoL questionnaire at 6 months (37 points vs. 37 points; AD -1.1 points, 95% CI -7.5 to 5).
Secondary outcomes
No significant difference in Mental Component Summary measure of the 36-Item Short Form Survey QoL questionnaire at 6 months (47 points vs. 48 points; AD -0.4 points, 95% CI -6.5 to 5.7).
No significant difference in ICU length of stay in patients alive at discharge (13 days vs. 15 days; AD 0.3 days, 95% CI -4 to 4.8).
No significant difference in hospital length of stay in patients alive at hospital discharge (28 days vs. 28 days; AD 4.1 days, 95% CI -6.5 to 15.3).
Safety outcomes
No significant difference in adverse events or death.
Significant difference in Functional Independence Measure at 3 months (116 points vs. 111 points).
Conclusion
In adult patients who had received at least 48 hours of either invasive or noninvasive ventilation, intensive therapy was not superior to standard care with respect to Physical Component Summary measure of the 36-Item Short Form Survey QoL questionnaire at 6 months.
Reference
Stephen E Wright, Kirsty Thomas, Gillian Watson et al. Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax. 2018 Mar;73(3):213-221.
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