Application of the Concept of Proprioceptive Neuromuscular Facilitation in Trunk Control in Patients Admitted to the ICU.

Official title

Effects of Applying the Concept of Proprioceptive Neuromuscular Facilitation in Trunk Control in Patients Admitted to the ICU: A Randomized Clinical Trial.

Overview

Muscle weakness acquired in the ICU (FAUTI) is related to the functional decline of patients admitted to an Intensive Care Unit (ICU). For better follow-up, scales such as (Chelsea Critical Care Physical Assessment) CPAx and (Medical Research Council) MRC help to identify early the muscle and functional impairment of these patients. Early mobilization aims to minimize these effects and therefore the search to reach the highest mobility milestone is constant bedside sitting (BSS) is an important milestone in recovery, associated with better functional results when there is good trunk control, as the coordinated activation of muscles in this region is essential for stabilization and reaching higher postures. The physiotherapeutic approach focused on the components of the activities and on the patient's participation is crucial, with the therapeutic option of Proprioceptive Neuromuscular Facilitation (PNF). To evaluate the effect of exercises based on the PNF concept through the Test Control Trunk (TCT) on the trunk balance of patients admitted to the ICU. This is a randomized, crossover clinical trial, carried out at the Pedro Ernesto University Hospital from June 2026 to June 2027. Adults hospitalized for more than 48 hours who meet the inclusion criteria will be screened. and clinical evaluation. The study consists of two blocks of pre- and post-crossover evaluations, conducted by the same blind evaluator. Patients will undergo assessments on the first day of BSS, including assessment of the trunk with TCT and assessment of diaphragm mobility and thickness by ultrasound, before and after intervention (PNF or conventional exercises). Between assessments, there will be a 3-hour rest period.

Detailed description

This is a randomized, crossover clinical trial to be conducted in the general ICU of the Pedro Ernesto University Hospital from December 2025 to December 2026. Patients from the general ICU will be recruited and included are those over 18 years of age, with an ICU stay greater than 48 hours, sitting at the bedside for the first time as indicated by the physiotherapy team, a RASS score greater than or equal to -2 and less than or equal to 1, a score less than or equal to 12 points on the "balance in sitting position" item in the TCT, and a score less than or equal to 2 on item 3 "sitting without support". Patients will be randomized for clinical evaluation followed by two evaluation blocks (pre- and post-washout). All evaluations will be performed by the same blinded evaluator. A screening evaluation will be performed to select individuals according to inclusion and exclusion criteria. Patients will undergo the following assessments on the first day of SBL: trunk assessment using the Trunk Test Control (TCT), assessment of diaphragmatic mobility and thickness via ultrasound, before and after the intervention (PNF or conventional). A 3-hour washout period will be considered, during which no motor interventions will be performed by the physiotherapy team on the patients, only care related to the medical and nursing teams. The first block with these three assessments will be performed in the morning by a blinded evaluator, followed by a three-hour washout period before repeating all assessments in the second block in the afternoon, but this time evaluating the effect of the other intervention (PNF or conventional). Participants will be randomly selected and assigned to one of the two groups through the random.org website by a professional independent of the evaluator. In addition, general information recorded in medical records will be collected, such as demographic data, general assessments, Sequential Organ Failure Assessment Score (SOFA), level of consciousness using the Richmond Agitation-Sedation Scale (RASS), Glasgow Coma Scale, Chelsea Critical Care Physical Assessment Tool (CPAx), and Medical Research Council (MRC) functional scale. All demographic, clinical, and ultrasound data will be incorporated into an attached assessment form.

Interventions

• Other Proprioceptive Neuromuscular Facilitation (PNF)
  From its beginnings, PNF has successfully integrated many of the concepts of contemporary neurorehabilitation interventions. The Philosophy and Basic Principles of PNF, together with the specific spiral and diagonal patterns, make up the cornerstone of PNF. PNF also includes motor learning and functional retention of newly learned activities with the repetition of a specific demand; the use of the developmental progression of motor behavior that enables patients to create and re-create strategie
• Other Standard physiotherapy
  This group will undergo conventional physiotherapy according to institutional protocol.

Primary outcome measures

• Trunk Control [Time frame: Day 1]

Secondary outcome measures (4)

• Functional Assesment [Time frame: 6 months]
• Diaphragmatic thickness [Time frame: Day 1]
• Diaphragmatic excursion [Time frame: Day 1]
• Length of stay in the ICU [Time frame: 28-day interval.]

Eligibility criteria

Inclusion criteria

• Over 18 years of age
• ICU stay greater than or equal 48 hours;
• RASS scale score greater than or equal to -2 and less than or equal to 1;
• TCT score less than or equal to 12 points on the "balance in sitting position" score less than or equal to 2 on item 3 "sitting without support".

Exclusion criteria

• Patients in a coma, with spinal cord instability, metastases, and bone lesions;
• Neuromuscular or neurological diseases
• Discharge from the general ICU before SBL
• Proportional care phase 3;
• Readmissions to the general ICU;

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Crossover

Masking

Double blind

Primary purpose

Treatment

Study locations

Brazil · 1 center

• Pedro Ernesto University Hospital — Rio de Janeiro

Identifiers

NCT: NCT07584564 · PNF 100685

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗